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Lippincott Williams & Wilkins, Inc.
Clinical Nurse Specialist
Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients' perceptions of their readiness for hospital discharge.
Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables.
Setting: Midwestern tertiary medical center.
Sample: 147 adult medical-surgical patients.
Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services.
Findings: Living alone, discharge teaching (amount of content received and nurses' skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions.
Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis' transitions theory as a useful model for conceptualizing and investigating the discharge transition.
Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes.