Li Shuang, Chen Ran, Zhang Lihong, Li Hui, Gong Yiqiu, Hang Yanfeng, Cao Jie, Zhang Hong
Department of Neurology, Taicang First People's Hospital, Suzhou, China.
Department of Nursing, Taicang First People's Hospital, Suzhou, China.
J Clin Nurs. 2024 Oct 9. doi: 10.1111/jocn.17481.
The study investigated the influence of quality of discharge teaching (QDT) on readiness for hospital discharge (RHD) and pathways involved in patients with first-episode stroke, aiming to provide a theoretical framework for enhancing RHD levels and reducing readmission rates.
Cross-sectional study.
A total of 372 inpatients completed the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Chronic Disease Self-efficacy Scale and Southampton Stroke Self-Management Questionnaire. Structural equation modelling and Pearson's correlation analysis were utilised to elucidate relationships and action pathways among these variables.
The correlation analysis demonstrated significant positive pairwise correlations between QDT, RHD, self-efficacy and self-management (r = 0.376-0.678, p < 0.01). The final model exhibited a good fit with the following indices: χ/df = 3.286, RMSEA = 0.078, SRMR = 0.0303, GFI = 0.984, AGFI = 0.926, CFI = 0.991 and TLI = 0.970. The impact of QDT on RHD in patients with first-episode stroke was observed through one direct and three indirect pathways: (1) QDT exerted a direct influence on RHD (p < 0.001); (2) QDT indirectly influenced RHD via self-efficacy (p < 0.001); (3) QDT indirectly affected RHD through self-management (p < 0.001); and (4) QDT had an indirect effect on RHD via both self-efficacy and self-management (p < 0.05).
QDT was found to directly influence RHD in patients with first-episode stroke and also exerted indirect effects through self-efficacy and self-management, either independently or in combination. Early screening of RHD levels in patients before discharge is recommended, along with the enhancement of QDT through the development of tailored guidance plans according to different disease stages, ultimately improving RHD levels and facilitating a safer transition from hospital to home or community.
Healthcare professionals should assess both QDT and RHD levels to provide targeted interventions. The establishment of transitional care teams and implementation of long-term poststroke management are essential for reducing stroke recurrence and mortality rates.
本研究调查了出院指导质量（QDT）对首次发作卒中患者出院准备度（RHD）的影响及相关途径，旨在为提高RHD水平和降低再入院率提供理论框架。
横断面研究。
共有372名住院患者完成了出院指导质量量表、出院准备度量表、慢性病自我效能量表和南安普顿卒中自我管理问卷。采用结构方程模型和Pearson相关分析来阐明这些变量之间的关系和作用途径。
相关分析表明，QDT、RHD、自我效能感和自我管理之间存在显著的正相关关系（r = 0.376 - 0.678，p < 0.01）。最终模型拟合良好，指标如下：χ/df = 3.286，RMSEA = 0.078，SRMR = 0.0303，GFI = 0.984，AGFI = 0.926，CFI = 0.991，TLI = 0.970。观察到QDT对首次发作卒中患者RHD的影响通过一条直接途径和三条间接途径：（1）QDT对RHD有直接影响（p < 0.001）；（2）QDT通过自我效能感间接影响RHD（p < 0.001）；（3）QDT通过自我管理间接影响RHD（p < 0.001）；（4）QDT通过自我效能感和自我管理对RHD产生间接影响（p < 0.05）。
发现QDT直接影响首次发作卒中患者的RHD，还通过自我效能感和自我管理单独或联合发挥间接作用。建议在出院前对患者的RHD水平进行早期筛查，并根据不同疾病阶段制定个性化指导计划来提高QDT，最终提高RHD水平，促进从医院到家庭或社区的更安全过渡。
医疗保健专业人员应评估QDT和RHD水平以提供针对性干预。建立过渡性护理团队和实施长期卒中后管理对于降低卒中复发率和死亡率至关重要。
