Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Readiness for Hospital Discharge Scale

Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Readiness for Hospital Discharge Scale

Article excerpt

The purpose of the study was to assess the psychometrics properties of the Readiness for Hospital Discharge Scale (RHDS), a 23-item instrument that measures patients' perception of readiness for discharge. Data were obtained from 356 respondents from two urban tertiary medical centers (adult and children's) in the midwestern United States who were participants in a larger study of predictors and outcomes of readiness for hospital discharge. Confirmatory factor analysis, contrasted group comparisons, and predictive validity testing supported the 4-factor structure and construct validity of the instrument. Following deletion of two poorly performing items, Cronbach's alpha for the revised 21- item scale was 0.90. The RHDS can be a useful tool for measurement of readiness for discharge for clinical and research purposes.

Keywords: readiness for discharge; postpartum; medical-surgical; parents; validity; reliability

Patients are discharged from hospitals in an intermediate stage of recovery (Korttila, 1991) and continue their recovery at home or in an intermediate care facility. The need to assess readiness for hospital discharge and transition to another location and level of care has become increasingly important to patient safety, satisfaction, and outcomes. The purpose of this study was to evaluate the psychometric properties of the Readiness for Hospital Discharge Scale (RHDS), an instrument developed to measure patients' perception of their readiness for hospital discharge.

BACKGROUND

The multidimensional construct readiness for discharge represents an estimate of patients' and family members' ability to leave an acute care facility (Titler & Pettit, 1995). It is a perception or judgment of being prepared or not prepared for hospital discharge (Congdon, 1994; Fenwick, 1979). Home readiness, a term used in the anesthesia and ambulatory surgery literature, describes patients at a stage of sufficient recovery to safely discharge (Korttila, 1991).

Readiness for Discharge Attributes and Associated Factors

A number of attributes of readiness for discharge are evident in clinical papers and research reports describing preparation for discharge, protocols for clinical assessment of discharge readiness, and postdischarge transition. Physical stability is a commonly described dimension that includes elements such as vital signs, intake and output, elimination, ambulation, minimal bleeding, pain control, and absence of nausea or vomiting (Bernstein et al., 2002; Clark, Steinberg, & Bischoff, 1997; Fenwick, 1979; Korttila, 1991; Stephenson, 1990; Titler & Pettit, 1995; Wong & Wong, 1999). Other dimensions of readiness for hospital discharge include functional ability and preparedness or competence to manage self-care at home (Artinian, 1993; Fenwick, 1979; Schaefer, Anderson, & Simms, 1990; Titler & Pettit, 1995), availability of social support (Artinian, 1993; Stephenson, 1990; Titler & Pettit, 1995; Wong & Wong, 1999), access to health care system and community resources (Bernstein et al., 2002; Titler & Pettit, 1995), psychosocial factors including coping skills (Bernstein et al., 2002; Fenwick, 1979; Schaefer et al., 1990; Wong & Wong, 1999), and adequate education and information about what to expect (Artinian, 1993; Bernstein et al., 2002). Patient populations included in these studies and reports related to readiness for discharge have included postanesthesia, ambulatory surgery, cardiac, surgical, elderly, rehabilitation, and mothers and their newborns.

A patient's readiness for discharge can be assessed from the perspectives of the provider, patient, and family. Criterion-based assessment by the provider is the most commonly reported method. Situation-specific criteria are used as clinical decision guides for determining readiness for discharge (Stephenson, 1990). For example, Chung (1995a) has developed a tool called the Post-Anesthesia Discharge Scoring System for use in discharge decision-making for ambulatory surgery. …

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