Predictors and Outcomes of Postpartum Mothers\u27 Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers\u27 perceptions of their readiness for hospital discharge. Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables. Setting: Midwestern tertiary perinatal center. Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants. Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data. Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services. Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers\u27 perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses\u27 skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services. Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth

Rankings Matter: Nurse Graduates from Higher-ranked Institutions Have Higher Productivity

Background Increasing demand for baccalaureate-prepared nurses has led to rapid growth in the number of baccalaureate-granting programs, and to concerns about educational quality and potential effects on productivity of the graduating nursing workforce. We examined the association of individual productivity of a baccalaureate-prepared nurse with the ranking of the degree-granting institution. Methods For a sample of 691 nurses from general medical-surgical units at a large magnet urban hospital between 6/1/2011–12/31/2011, we conducted multivariate regression analysis of nurse productivity on the ranking of the degree-granting institution, adjusted for age, hospital tenure, gender, and unit-specific effects. Nurse productivity was coded as “top”/“average”/“bottom” based on a computation of individual nurse value-added to patient outcomes. Ranking of the baccalaureate-granting institution was derived from the US News and World Report Best Colleges Rankings’ categorization of the nurse’s institution as the “first tier” or the “second tier”, with diploma or associate degree as the reference category. Results Relative to diploma or associate degree nurses, nurses who had attended first-tier universities had three-times the odds of being in the top productivity category (OR = 3.18, p \u3c 0.001), while second-tier education had a non-significant association with productivity (OR = 1.73, p = 0.11). Being in the bottom productivity category was not associated with having a baccalaureate degree or the quality tier. Conclusions The productivity boost from a nursing baccalaureate degree depends on the quality of the educational institution. Recognizing differences in educational outcomes, initiatives to build a baccalaureate-educated nursing workforce should be accompanied by improved access to high-quality educational institutions

Through the Eye of the Beholder: Multiple Perspectives on Quality in Women\u27s Health Care

Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs. This qualitative study using a semi-structured interview defined quality from the perspectives of patients, physicians, nurses, and payers associated with a hospital-based women\u27s service line, and how the attributes of quality varied among the multiple groups. The study also described how stakeholders become aware of quality and how they determined a hospital\u27s quality. From the findings of the study, a conceptual framework of quality in women\u27s health was developed

Development and Psychometric Analysis of The Patient Perceptions of Patient-Empowering Nurse Behaviours Scale (PPPNBS)

Aim To (1) develop and psychometrically test the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale, which measures patient perceptions of empowering nurse behaviours during hospitalization; and (2) refine to a shorter, more useful form, for measurement in clinical settings. Background Although patient empowerment has been promoted as a way to engage patients in chronic illness care, there is not a measure reported by patients as recipients of empowering nurse behaviours during hospitalization. Design Psychometric evaluation of construct and predictive validity, reliability and item reduction. Method Data gathered during hospitalization and six weeks postdischarge between April 2012 - August 2014 were used to determine the validity and reliability of the long and short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale in a sample of 395 chronically ill medical and surgical adult patients. Results The long and short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale demonstrated strong reliability and convergent validity with pre-discharge 13-item Patient Activation Measure scores. Both forms of the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale predicted postdischarge 13-item Patient Activation Measure scores and the long-form predicted physical health status. Confirmatory factor analysis demonstrated improved model fit for the short-form instrument when compared with the long-form fit. The short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale explained 98% of the variance of the long-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale. Conclusion The results provide evidence supporting reliability and validity of both forms. While the scales measure patient reports and not direct observation of empowering nurse behaviours, incorporating patients\u27 experiences as recipients of care is necessary to validate the contribution of nursing care to patients\u27 engagement in chronic illness management

A Substruction Approach to Assessing the Theoretical Validity of Measures

Background Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures. Purpose To describe substruction as a method for assessing the toretical validity of research measures. Methods Using Fawcett\u27s Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures. Results Substruction tables display evidence supporting theoretical validity of the instruments used in the study. Conclusion A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects

Integrating Research and Quality Improvement Using TeamSTEPPS: A Health Team Communication Project to Improve Hospital Discharge

Purpose/Objectives: The purpose of this article is to describe an innovative approach to the integration of quality improvement and research processes. A project with the objective of improving health team communication about hospital discharge provides an exemplar case. Description of the Project/Program: The TeamSTEPPS 10-step action planning guide provided the structure for planning, developing, and evaluating a redesign of interprofessional health team communication to improve hospital discharge led by 2 clinical nurse specialists. The redesign involved development of processes for team bedside rounding, registered nurse bedside shift reports, and briefing tools to support the rounding processes. Outcome: Using the TeamSTEPPS process, a 4-phase combined quality improvement and research project was designed and implemented. Implementation is ongoing, supported by process evaluation for continuing process improvement. Longitudinal analysis of research outcomes will follow in the future. Conclusions: Led by unit-based clinical nurse specialists, use of an integrated process of quality improvement and research creates evidence-based innovation to solve interprofessional practice problems. Incorporating research within the project design allows for data-based decisions to inform the clinical process improvement, as well as documentation of both the processes and outcomes of the local improvements that can inform replications in other sites

Predictors of Engagement in Postpartum Weight Self-management Behaviours in the First 12 Weeks After Birth

Aim To explore factors that influence postpartum weight self-management behaviours. Transitions Theory and the Integrated Theory of Health Behaviour Change guided selection of variables. Transition conditions, level of patient activation and social facilitation were examined for association with postpartum weight self-management behaviours. Background Retention of pregnancy weight increases risk of overweight and obesity later in life. Little is known about what women do to self-manage return to pre-pregnant weight and how providers can influence their behaviours. Design Prospective, longitudinal, correlational. Methods Data collection occurred from March through October, 2013. One hundred and twenty-four women completed surveys during postpartum hospitalization; telephone interviews were completed by 91 women at 6 weeks and 66 women at 12 weeks. Standard and hierarchical multiple regression methods were used for analyses. Results Transition difficulty was negatively associated with patient activation and immediate postbirth patient activation was positively associated with eating behaviours at 6 weeks, eating behaviours at 12 weeks and physical activity at 12 weeks. Social support and social influence were not significant predictors in the regression models. Conclusion Patients experiencing a difficult postpartum transition have lower activation levels; those less activated are less probably to engage in weight self-management behaviours in the 12 weeks following their baby\u27s birth. Patient activation level should be considered in tailoring promotion of healthy postpartum weight management

Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample

Aim To develop and psychometrically test Readiness for Hospital Discharge Scale for older people and to reduce the scale to a more practical short form. Background The Readiness for Hospital Discharge Scale is the only available and validated scale measuring patients\u27 perceived readiness just prior to discharge. Design Secondary analysis of hospital studies data from three countries. Method Data were collected between 2008–2012. The study sample comprised 998 medical-surgical older patients. Factor analysis was undertaken to identify the factor structure of the Readiness for Hospital Discharge Scale. Group comparisons for construct validity and predictive validity for readmission were also conducted. Results The Readiness for Hospital Discharge Scale original four factor solution does not appear to be consistent with the observed data of older people in the three countries. Confirmatory factor analysis revealed that a 17-item scale with three factors produced the best model fit. Nine items, three from each factor, loaded consistently on their respective factors in each country sample. Confirmatory factor analysis of this short form model indicated that the model adequately fit the data. Patients who lived alone, were older, or who indicated ‘not ready’ for discharge had lower Readiness for Hospital Discharge Scale for Older People scores, which were also associated with readmission risk. Conclusion The revised three factor structure of the Readiness for Hospital Discharge Scale for Older People in long and short forms more adequately assesses core components of discharge readiness in the older adult population than the original adult form

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization

Objectives. To determine the impact of unit-level nurse staffing on quality of discharge teaching, patient perception of discharge readiness, and postdischarge readmission and emergency department (ED) visits, and cost-benefit of adjustments to unit nurse staffing. Data Sources. Patient questionnaires, electronic medical records, and administrative data for 1,892 medical–surgical patients from 16 nursing units within four acute care hospitals between January and July 2008. Design. Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables. Data Collection/Extraction. Registered nurse (RN) staffing was recorded monthly in hours-per-patient-day. Patient questionnaires were completed before discharge. Thirty-day readmission and ED use with reimbursement data were obtained by cross-hospital electronic searches. Principal Findings. Higher RN nonovertime staffing decreased odds of readmission (OR=0.56); higher RN overtime staffing increased odds of ED visit (OR=1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1 SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.$11.64 million and U.S.$544,000 annually for the 16 study units. Conclusions. Postdischarge utilization costs could potentially be reduced by investment in nursing care hours to better prepare patients before hospital discharge