Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke
PDF

Keywords

stroke
readiness for hospital discharge
patient readmission
nursing
Thailand

How to Cite

Posri, N., Srisatidnarakul, B., & Hickman, R. L. (2022). Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. Belitung Nursing Journal, 8(1), 75–83. https://doi.org/10.33546/bnj.1968
Share |

Abstract

Background: The transition from hospital to home among patients with stroke is quite challenging. If the patients are not ready for hospital discharge, their condition may worsen, which also causes a high rate of readmission. Although instruments to measure readiness for hospital discharge exist, none of them fit with the Thailand context.

Objective: This study aimed to develop a Readiness for Hospital Discharge assessment tool in Thai patients with stroke.

Methods: The study was conducted from February to September 2020, which consisted of several steps: 1) conducting an extensive literature review, 2) content validity with five experts, 3) pilot testing with 30 samples, and 4) field testing with 348 participants. Content validity index (CVI) was used to measure the content validity, Cronbach’s alpha and inter-item correlation to evaluate reliability, and multiple logistic regression analysis to measure the construct validity.

Results: The findings showed good validity and reliability, with I-CVI of 0.85, Cronbach’s alpha of 0.94, and corrected item-total correlation ranging from 0.43 to 0.86. The construct validity was demonstrated through the results of regression analysis showing that the nine variables include level of consciousness (OR = 0.544; CI 95% = 0.311 - 0.951), verbal response (OR = 0.445; 95% CI 0.272- 0.729), motor power right leg (OR = 0.165; 95% CI 0.56- 0.485), visual field (OR = 0.188; 95% CI 0.60-0.587), dysphagia (OR = 0.618; 95% CI 0.410-0.932), mobility (OR = 0.376; 95% CI 0.190 - 0.741), self-feeding (OR = 0.098; 95% CI 0.036 -0.265), bathing (OR = 0.099; 95% CI 0.026-0.378), and bladder control (OR = 0.589; 95% CI 0.355-0.977) that significantly influenced the hospital readmission within 30 days in patients with stroke.

Conclusion: The Readiness for Hospital Discharge assessment tool is valid and reliable. Healthcare providers, especially nurses, can use this tool to assess discharge conditions for patients with stroke with greater accuracy in predicting hospital readmission.

https://doi.org/10.33546/bnj.1968
PDF

Copyright

Copyright (c) 2022 Nuengruethai Posri, Boonjai Srisatidnarakul, Ronald L Hickman

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Abstract views: 461 | PDF views: 360

Downloads

Download data is not yet available.

PlumX Metrics

Declaration of Conflicting Interest

None to declare.

Acknowledgment

The authors would like to express sincere thanks to all participants for all the useful information provided in this study.

Authors’ Contributions

Conceptualization, BS and RLH; Data curation, NP; Formal analysis, NP, BS; Investigation, BS, RLH; Methodology, NP, BS; Project administration, NP; Supervision, BS, RLH; Writing-original draft, NP; Writing-review & editing, BS, RLH. All authors read and approved the final version of the work to be published.

Data Availability

All data generated or analyzed during this study are included in this publish article. The data sets are not publicly available due to the information that could compromise research participants’ privacy.


References

Ayerbe, L., Ayis, S. A., Crichton, S., Wolfe, C. D. A., & Rudd, A. G. (2014). Natural history, predictors and associated outcomes of anxiety up to 10 years after stroke: The South London Stroke Register. Age and Ageing, 43(4), 542-547. https://doi.org/10.1093/ageing/aft208

Bastami, M., & Azadi, A. (2020). Effects of a multicomponent program on fall incidence, fear of falling, and quality of life among older adult nursing home residents. Annals of Geriatric Medicine and Research, 24(4), 252-258. https://doi.org/10.4235/agmr.20.0044

Béjot, Y., Delpont, B., & Giroud, M. (2016). Rising stroke incidence in young adults: More epidemiological evidence, more questions to be answered. Journal of the American Heart Association, 5(5), e003661. https://doi.org/10.1161/JAHA.116.003661

Bobay, K. L., Weiss, M. E., Oswald, D., & Yakusheva, O. (2018). Validation of the registered nurse assessment of readiness for hospital discharge scale. Nursing Research, 67(4), 305-313. https://doi.org/10.1097/NNR.0000000000000293

Burns, N., & Grove, S. K. (2005). The practice of nursing research: Conduct, critique and utilization. St. Louis, Missouri: Elsevier Saunders.

Chen, Y., & Bai, J. (2017). Reliability and validity of the Chinese version of the Readiness for Hospital Discharge Scale–Parent Form in parents of preterm infants. International Journal of Nursing Sciences, 4(2), 88-93. https://doi.org/10.1016/j.ijnss.2017.01.009

Chick, N., & Meleis, A. I. (1986). Transitions: A nursing concern. Rockville, MD: Aspen Publications.

Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127-137.

Cimilli Ozturk, T., Ak, R., Unal Akoglu, E., Onur, O., Eroglu, S., & Saritemur, M. (2017). Factors associated with multiple falls among elderly patients admitted to emergency department. International Journal of Gerontology, 11(2), 85-89. https://doi.org/10.1016/j.ijge.2016.05.009

Dasenbrock, H. H., Angriman, F., Smith, T. R., Gormley, W. B., Frerichs, K. U., Aziz-Sultan, M. A., & Du, R. (2017). Readmission after aneurysmal subarachnoid hemorrhage. Stroke, 48(9), 2383-2390. https://doi.org/10.1161/STROKEAHA.117.016702

Fleiss, J. (2013). Statistical methods for rate and proportions (2 ed.). New York: Wiley.

Flink, M., & Ekstedt, M. (2017). Planning for the discharge, not for patient self-management at home–an observational and interview study of hospital discharge. International Journal of Integrated Care, 17(6). https://dx.doi.org/10.5334%2Fijic.3003

Galvin, E. C., Wills, T., & Coffey, A. (2017). Readiness for hospital discharge: A concept analysis. Journal of Advanced Nursing, 73(11), 2547-2557. https://doi.org/10.1111/jan.13324

Gunawan, J., Marzilli, C., & Aungsuroch, Y. (2021). Establishing appropriate sample size for developing and validating a questionnaire in nursing research. Belitung Nursing Journal, 7(5), 356-360. https://doi.org/10.33546/bnj.1927

Hansen, L. O., Young, R. S., Hinami, K., Leung, A., & Williams, M. V. (2011). Interventions to reduce 30-day rehospitalization: A systematic review. Annals of Internal Medicine, 155(8), 520-528. https://doi.org/10.7326/0003-4819-155-8-201110180-00008

Hickman, R. L., Jr, & Douglas, S. L. (2010). Impact of chronic critical illness on the psychological outcomes of family members. AACN Advanced Critical Care, 21(1), 80-91. https://doi.org/10.4037/15597768-2010-1010

Karapinar, M., Baskurt, F., Baskurt, Z., Gunal, A., & Kockar, M. C. (2020). Reliability and validity of the Turkish version of the oxford participation and activities questionnaire in older people. Annals of Geriatric Medicine and Research, 24(4), 282-289. https://doi.org/10.4235/agmr.20.0074

Kaya, S., Sain Guven, G., Aydan, S., Kar, A., Teleş, M., Yıldız, A., Koca, G. Ş., Kartal, N., Korku, C., & Ürek, D. (2018). Patients’ readiness for discharge: Predictors and effects on unplanned readmissions, emergency department visits and death. Journal of Nursing Management, 26(6), 707-716. https://doi.org/10.1111/jonm.12605

Kilkenny, M. F., Dalli, L. L., Kim, J., Sundararajan, V., Andrew, N. E., Dewey, H. M., …, & null, n. (2020). Factors associated with 90-day readmission after stroke or transient ischemic attack. Stroke, 51(2), 571-578. https://doi.org/10.1161/STROKEAHA.119.026133

Kumar, A., Resnik, L., Karmarkar, A., Freburger, J., Adhikari, D., Mor, V., & Gozalo, P. (2019). Use of hospital-based rehabilitation services and hospital readmission following ischemic stroke in the United States. Archives of Physical Medicine and Rehabilitation, 100(7), 1218-1225. https://doi.org/10.1016/j.apmr.2018.12.028

Lau, D., Padwal, R. S., Majumdar, S. R., Pederson, J. L., Belga, S., Kahlon, S., Fradette, M., Boyko, D., & McAlister, F. A. (2016). Patient-reported discharge readiness and 30-day risk of readmission or death: A prospective cohort study. The American Journal of Medicine, 129(1), 89-95. https://doi.org/10.1016/j.amjmed.2015.08.018

Lieber, A. C., Hong, E., Putrino, D., Nistal, D. A., Pan, J. S., & Kellner, C. P. (2018). Nutrition, energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: A review of the literature. Brain Sciences, 8(12). https://doi.org/10.3390/brainsci8120218

Mabire, C., Coffey, A., & Weiss, M. (2015). Readiness for Hospital Discharge Scale for older people: Psychometric testing and short form development with a three country sample. Journal of Advanced Nursing, 71(11), 2686-2696. https://doi.org/10.1111/jan.12731

Nguyen, T. V., Dang, H. T., Burns, M. J., Dao, H. H. H., & Nguyen, T. N. (2021). Impairment in activities of daily living and readmission in older patients with heart failure: A cohort study. BMJ Open, 11(2), e044416. https://doi.org/10.1136/bmjopen-2020-044416

Nkemdirim Okere, A., Sanogo, V., Balkrishnan, R., & Diaby, V. (2020). A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases, 29(9), 105053. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105053

Nunnally, J. C. (1978). Psychometric Theory (2 ed.). New York: McGraw-Hill.

Oza, R., Rundell, K., & Garcellano, M. (2017). Recurrent ischemic stroke: Strategies for prevention. American Family Physician, 96(7), 436-440.

Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459-467. https://doi.org/10.1002/nur.20199

Posri, N., Srisatidnarakul, B., & Hickman, R. (2021). Development of a readiness for hospital discharge assessment tool for stroke patients’ accuracy in predicting hospital readmission: A prospective cohort study [PhD Dissertation]. Thammasat University, Pathum Thani, Thailand.

Rowe, F. J., Hepworth, L. R., Howard, C., Hanna, K. L., Cheyne, C. P., & Currie, J. (2019). High incidence and prevalence of visual problems after acute stroke: An epidemiology study with implications for service delivery. PloS One, 14(3), e0213035. https://doi.org/10.1371/journal.pone.0213035

Sribundit, N., Riewpaiboon, A., Stewart, J. F., Tantirittisak, T., & Hanchaipiboolkul, S. (2017). Cost of acute care for ischemic stroke in Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 48(3), 628-640.

Srisatidnarakul, B. (2012). Development and validation of research instruments: Psychometric properties. Bangkok: Chulalongkorn University Press.

Srisatidnarakul, B. (2020). Effect size, power analysis, optimal sample size calculations, using G* power software. Bangkok: Chulalongkorn University Press.

Suksatan, W., Collins, C. J., Koontalay, A., & Posai, V. (2021). Burdens among familial caregivers of stroke survivors: A literature review. Working with Older People. https://doi.org/10.1108/WWOP-02-2021-0007

Suksatan, W., & Posai, V. (2020). An integrative review of discharge planning interventions with Thai stroke patients. Systematic Reviews in Pharmacy, 11(11), 1692-1700.

Suwanwela, N. C. (2014). Stroke epidemiology in Thailand. Journal of Stroke, 16(1), 1-7. https://doi.org/10.5853/jos.2014.16.1.1

Thomas, L. H., Coupe, J., Cross, L. D., Tan, A. L., & Watkins, C. L. (2019). Interventions for treating urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews(2). https://doi.org/10.1002/14651858.CD004462.pub4

Vluggen, T. P. M. M., van Haastregt, J. C. M., Tan, F. E. S., Kempen, G. I. J. M., Schols, J. M. G. A., & Verbunt, J. A. (2020). Factors associated with successful home discharge after inpatient rehabilitation in frail older stroke patients. BMC Geriatrics, 20(1), 25. https://doi.org/10.1186/s12877-020-1422-6

Wallace, A. S., Perkhounkova, Y., Bohr, N. L., & Chung, S. J. (2016). Readiness for hospital discharge, health literacy, and social living status. Clinical Nursing Research, 25(5), 494-511. https://doi.org/10.1177%2F1054773815624380

Wang, J.-P., Su, Y.-Y., Liu, Y.-F., Liu, G., Fan, L.-L., & Gao, D.-Q. (2018). Study of Simplified Coma Scales: Acute stroke patients with tracheal intubation. Chinese Medical Journal, 131(18), 2152-2157. https://doi.org/10.4103/0366-6999.240813

Wang, Y., Shen, Z., Lu, X., Zhen, Y., & Li, H. (2018). Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: A systematic review and meta-analysis. Medical Ultrasonography, 20(1), 32-36. https://doi.org/10.11152/mu-1223

Weiss, M. E., Piacentine, L. B., Lokken, L., Ancona, J., Archer, J., Gresser, S., Holmes, S. B., Toman, S., Toy, A., & Vega-Stromberg, T. (2007). Perceived readiness for hospital discharge in adult medical-surgical patients. Clinical Nurse Specialist, 21(1), 31-42.

Wongsilarat, T. (2016). Effects of using the stroke fast tract program on ability to screening and referral patient, and satisfaction among nurses in emergency department, Muang Songkhla hospital. The Southern College Network Journal of Nursing and Public Health 3(2), 149-164.

World Health Organization. (2020). The top 10 causes of death. Retrieved October 4, 2021 from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

Zijlmans, E. A. O., Tijmstra, J., van der Ark, L. A., & Sijtsma, K. (2017). Item-score reliability in empirical-data sets and its relationship with other item indices. Educational and Psychological Measurement, 78(6), 998-1020. https://doi.org/10.1177/0013164417728358