Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Abstract

Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers'perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems.As hospital length of stay has decreased, the need to assess readiness for discharge and transition to home following hospitalization has become increasingly important to patient safety, satisfaction, physical, emotional, psychological, and social outcomes. Length of stay for childbirth has been an emotionally and politically charged issue. Public and political reaction to the perception that mothers and babies were being sent home too early and before they were ready resulted in legislation that mandated payment for a 48-hour postpartum stay for vaginal birth mothers and 96 hours for cesarean mothers (Newborn and Mothers Health Protection Act, 1996; effective January 1, 1998). However, the legislation left the decision about discharge timing to the mother and her health care provider. clinician's assessment of a new mother's readiness for discharge may be different from the new mother's perception. Shorter length of stay has been associated with lower perceived readiness for discharge (Weiss, Ryan, Lokken, & Nelson, 2004), suggesting that the mothers' perceptions of readiness may not be taken into account in discharge timing decisions. Instruments to measure the new mother's perception of her readiness for discharge after birth have not been available for clinical assessment or research purposes. The purpose of this study was to assess the validity and reliability of a new scale to measure perceived readiness for discharge after birth. BackgroundReadiness for discharge has been described as a multifaceted concept that provides an estimate of patients' and family members' ability to leave an acute care facility (Steele & Sterling, 1992). It is a perception 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 in intermediate rather than later stages of recovery and indicates a sufficient level of recovery to permit safe discharge (Korttila, 1991). Concerns about adequacy of maternal preparation and safety of early neonatal discharge (Braveman, Egerter, Pearl, Marchi, & Miller, 1995;Brown, Small, Faber, Krastev, & Davis, 2002;Eaton, 2001;Grullon & Grimes, 1997) have been prominently reported in the professional and lay literature.Readiness for discharge can be assessed from the perspectives of the providers, patients, and family members. Criterion-based assessment by the provider is the most commonly reported method of determining discharge readiness, and discharge criteria have been reported for many clinical populations (Barnes, 2000;Chung, 1995;Fenwick, 1979;Korttila, 1991;Merritt & Raddish, 1998;Stephenson, 1990;Titler & Pettit, 1995;Wong & Wong, 1999).Criteria that have been included in discharge readiness assessments are ...

Are families prepared for discharge from the NICU?

“…Other studies have prospectively examined discharge preparedness on discharge day in term infants. 2,3 However, for preterm infants, this issue has only been addressed retrospectively 4-6 weeks after discharge. 7 This study adds to the literature because we combine the concepts of discharge day preparedness for families with preterm infants.…”

“…24 Another limitation is that we did not assess educational attainment or couple status, which have been shown in other studies to be related to perceived discharge readiness. 3 These factors likely have a limited impact in our population because the majority is part of a couple and has some college education or more. Unlike the pilot study, we did not collect data on the families and nurses not included in this study.…”

“…1 Interventions to teach parents about the skills needed should result in parents being discharge prepared. 1,3,7,10,11 However, discharge readiness is decided by both the parents and the clinical staff. 2 Full-term infant studies indicate that, despite discharge teaching, some parents do not feel adequately prepared.…”

“…1 Even for families with healthy term infants, poor discharge preparation has been linked to problems at home and increased unscheduled health care use. 2,3 Poor discharge planning has the potential for even worse outcomes for preterm infants because of their poor cues to needs and ongoing medical problems after hospital discharge, in particular, those with lung disease and others at the highest risk for rehospitalization. [4][5][6][7][8] Rehospitalization and other post-discharge health care use constitute a significant proportion of the preterm infants care costs.…”

“…2 Full-term infant studies indicate that, despite discharge teaching, some parents do not feel adequately prepared. 2,3 Among preterm infants, this is a crucial aspect of neonatal care that has had only limited research. We are only aware of one group exploring this issue for the NICU patients for whom the skill level needed by parents is generally higher.…”