影響內科病人主觀出院準備度之相關因素

Factors Associated With Readiness for Discharge Among Medical Inpatients

10.6142/VGHN.202112_38(4).0004

陳嬿今(Yen-Chin Chen)；洪筱瑩(Hsiao-Ying Hung)；梁詩欣(Shih-Hsin Liang)；楊淑齡(Shu-Ling Yang)；柯乃熒(Nai-Ying Ko)；張瑩如(Ying-Ju Chang)

準備度 ； 出院 ； 內科住院病人 ； 中文版出院準備度量表 ； readiness ； hospital discharge ； medical inpatients ； Chinese version of the Readiness for Hospital Discharge Scale

榮總護理

38卷4期（2021 / 12 / 01）

360 - 371

繁體中文

背景：出院準備服務可提早協助病人或家屬面對出院後照顧問題，亦可降低再入院率。然而，鮮少研究針對住院病人出院前主觀準備度之狀態及其出院準備度之相關因素進行探討。目的：探討住院病人之出院準備度及其影響因子。方法：採橫斷性研究設計，以方便取樣方式，招募於4小時內準備出院之內科病人，使用中文版短版12題出院準備度量表（Chinese version of readiness for hospital discharge scale, CRHDS），測量病人個人狀態、因應能力以及預期性支持等層面主觀出院準備度感受，以邏輯式迴歸分析影響病人出院準備度之相關因素。結果：共招募354位病人，其中有78.2%主觀認為其出院準備度佳（CRHDS＞7分），在出院準備度次變項中以預期性支持平均得分為最高，出院準備度佳者整體住院天數顯著短少8天。邏輯式迴歸分析結果指出平均住院天數越短［adjusted odds ratio（AOR）=0.96, p=.039］、意識清楚（AOR=2.66, p=.045）、日常生活自理（AOR=1.89, p=.024）及出院後返家者（AOR=3.41, p=.013）與出院準備度有顯著正相關。結論／實務應用：建議應注意出院病人的出院準備度，尤其是住院天數長、意識不清、日常生活無法自理以及出院返回機構的病人，以利協助病人以及家屬順利度過急性疾病治療後出院的過渡期。

Background: Readiness for hospital discharge has been identified as a crucial part of continuous care and may be related to a reduced risk of readmission. However, research on inpatients self-reporting their readiness for hospital discharge medical inpatients is lacking. Purpose: This study investigated factors related to readiness for discharge among medical inpatients. Methods: This cross-sectional study recruited medical inpatients older than 20 years between February and June 2019. The study employed a 12-item Chinese version of the Readiness for Hospital Discharge Scale (CRHDS), consisting of three dimensions: personal status, coping ability, and expected support. Logistic regression was used to examine the factors associated with the medical inpatients' readiness for discharge. Results: A total of 65.7% (354/539) of the inpatients responded to the CRHDS questionnaire. Of these, 78.2% self-reported a high level of readiness (CRHDS score ＞7). The expected support subscale received the highest score of the three subscales. Inpatients with a high level of readiness had a significantly shorter (8 days) duration of hospitalization than did those with a low level of readiness (p ＜ .001). Shorter hospitalization [adjusted odds ratio (AOR) = 0.96, p = .039], full consciousness (AOR = 2.66, p = .045), living more independently (AOR = 1.89, p = .024), and discharge to home (AOR = 3.41, p = .013) were significantly associated with a high level of readiness for hospital discharge. Conclusions/Implications for Practice: These results suggest that health-care providers should strengthen their assessments of readiness for hospital discharge, especially for those with longer hospital stays or without full consciousness or for those being discharged to home to support patients and their families in the difficult transition from hospital to home.

1. Anthony, M. K.,Hudson-Barr, D.(2004).A patient-centered model of care for hospital discharge.Clinical Nurse Research,13(2),117-136.
2. Beattie, M.,Murphy, D. J.,Atherton, I.,Lauder, W.(2015).Instruments to measure patient experience of healthcare quality in hospitals: A systematic review.Systematic Reviews,4,97.
3. Berard, D. M.,Vandenkerkhof, E. G.,Harrison, M.,Tranmer, J. E.(2012).Gender differences in the influence of social support on one-year changes in functional status in older patients with heart failure.Cardiology Research and Practice,2012,616372.
4. Bobay, K. L.,Jerofke, T. A.,Weiss, M. E.,Yakusheva, O.(2010).Age-related differences in perception of quality of discharge teaching and readiness for hospital discharge.Geriatric Nursing,31(3),178-187.
5. Coffey, A.,McCarthy, G. M.(2013).Older people's perception of their readiness for discharge and post discharge use of community support and services.International Journal of Older People Nursing,8(2),104-115.
6. Fenwick, A. M.(1979).An interdisciplinary tool for assessing patients' readiness for discharge in the rehabilitation setting.Journal of Advanced Nursing,4(1),9-21.
7. Galvin, E. C.,Wills, T.,Coffey, A.(2017).Readiness for hospital discharge: A concept analysis.Journal of Advanced Nursing,73(11),2547-2557.
8. Gonçalves-Bradley, D. C.,Lannin, N. A.,Clemson, L. M.,Cameron, I. D.,Shepperd, S.(2016).Discharge planning from hospital.The Cochrane Database of Systematic Reviews,1,Cd000313.
9. Korttila, K.(1991).Anaesthesia for ambulatory surgery: Firm definitions of "home readiness" needed.Annals of Medicine,23(6),635-636.
10. Mabire, C.,Bachnick, S.,Ausserhofer, D.,Simon, M.(2019).Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: A cross - sectional study.International Journal of Nursing Studies,90,13-20.
11. Meleis, A. I.,Sawyer, L. M.,Im, E. O.,Hilfinger Messias, D. K.,Schumacher, K.(2000).Experiencing transitions: An emerging middle-range theory.Advances in Nursing Science,23(1),12-28.
12. Rodríguez-Madrid, M. N.,Del Río-Lozano, M.,Fernandez-Peña, R.,Jiménez-Pernett, J.,García-Mochón, L.,Lupiañez-Castillo, A.,García-Calvente, M. D. M.(2019).Gender differences in social support received by informal caregivers: A personal network analysis approach.International Journal of Environmental Research and Public Health,16(1),91.
13. Steele, N. F.,Sterling, Y. M.(1992).Application of the case study design: nursing interventions for discharge readiness.Clinical Nurse Specialist,6(2),79-84.
14. Tasheva, P.,Vollenweider, P.,Kraege, V.,Roulet, G.,Lamy, O.,Marques-Vidal, P.,Méan, M.(2020).Association between physical activity levels in the hospital setting and hospital-acquired functional decline in elderly patients.JAMA Network Open,3(1),e1920185-e1920185.
15. Weiss, M. E.,Costa, L. L.,Yakusheva, O.,Bobay, K. L.(2014).Validation of patient and nurse short forms of the readiness for hospital discharge scale and their relationship to return to the hospital.Health Service Research,49(1),304-317.
16. Weiss, M. E.,Piacentine, L. B.(2006).Psychometric properties of the readiness for hospital discharge scale.Journal of Nursing Measurement,14(3),163-180.
17. 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.
18. Weiss, M. E.,Yakusheva, O.,Bobay, K. L.(2011).Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization.Health Service Research,46(5),1473-1494.
19. Weiss, M. E.,Yakusheva, O.,Bobay, K. L.,Costa, L.,Hughes, R. G.,Nuccio, S.,Hamilton, M.,Bahr, S.,Siclovan, D.,Bang, J.,READI Site Investigators(2019).Effect of implementing discharge readiness assessment in adult medical-surgical units on 30-day return to hospital: The READI randomized clinical trial.JAMA Network Open,2(1),e187387-e187387.
20. 林佑樺,高家常,黃阿美,紀媚慈,周汎澔(2014)。中文版醫院出院準備度量表之信效度檢定。護理雜誌，61(4)，56-65。
21. 國家發展委員會 (2018，8 月 30 日 )．國發會「人口推估報告 (2018 至 2065 年 )」新聞稿。https://www.ndc.gov.tw/nc_27_30091
22. 許瀞文,李璧伊,湯振青,陳思豪(2018)。談出院準備服務。家庭醫學與基層醫療，33(10)，285-289。
23. 衛生福利部 (2018 年，7 月 24 日 )．長照十年計畫 2.0 新聞稿．衛生福利部。https://www.mohw.gov.tw/cp-3796-42872-1.html
24. 謝生蘭,李金德,江秀珠,劉芹芳(2013)。經出院準備服務病人於 14 天非計畫性再住院之相關因素。醫院雙月刊，46(2)，34-44。