Antepartum, Intrapartum, Postpartum Predictors and Outcomes of Readiness for Hospital Discharge

Purpose: The antepartum, intrapartum, and postpartum periods are considered to be a time of critical adjustment in physical, psychological, and social well-being with considerable adjustments that occur at each phase in transitioning to new family dynamics. According to the World Health Organization, preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. Of concern was the insufficient discharge preparation time to address the mother's learning needs regarding self-care and infant-care influencing the readiness for hospital discharge. Although a mother's perceived readiness for hospital discharge may be influenced by many factors, research suggests the quality of discharge teaching may be a predictor of readiness for hospital discharge. Additional research is needed to identify the predictors of readiness for hospital discharge and post-discharge outcomes taking into consideration transition factors that may influence a mother's ability to apply discharge information. Therefore, the purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of readiness for hospital discharge and post-discharge outcomes.  The Adaptation to Transitions conceptual framework composed of conceptually-related variables was used to study factors associated with transition processes that influence discharge readiness in the antepartum, intrapartum, and postpartum periods and the impact of nursing interventions.

Methods: This is a descriptive correlational repeated measure design study. A purposive sample of English and Spanish-speaking postpartum mothers who experienced a vaginal or cesarean birth of a healthy infant (N = 185) completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. Items were related to the nature of transition and transition conditions effecting patterns of response during labor and postpartum as described in the conceptual framework. Discharge teaching was the nursing therapeutic process under investigation during hospital transitions to home. Four weeks post-discharge, participants completed a coping difficulty questionnaire consistent with postpartum patterns of responses and modes of adaptation, and the quality of discharge teaching questionnaire, to compare pre- and post- hospital discharge perceptions of teaching.

Results: A final model was computed with all significant predictors for readiness for hospital discharge and post-discharge coping difficulty. The delivery of education was the only significant independent predictor, accounting for 33% of the variance in readiness for hospital discharge (R² =0.33, R²_adj =0.32, F (8,185) =88.08, p=0.01). Mother's perceived readiness of hospital discharge was the only significant independent predictor accounting for 27% of the variance in post-discharge coping difficulty (R² =0.27, R²_adj =0.26, F (5, 67) =62.89, p=0.01). A statistically significant difference in the quality of discharge teaching between pre- and post- hospital discharge was noted (t (66) = 2.60, p=0.01) where the quality of discharge teaching mean score decreased from pre-hospital discharge to post-hospital discharge (mean change = -0.485, 95% CI=0.857-0.113).

Conclusion: The relationship between quality of discharge teaching and the antepartum, intrapartum, postpartum factors, readiness for discharge, and post-discharge coping, provides evidence of nurses’ critical role in educating patients in caring for themselves and their baby. Patient perception of discharge readiness may be both a process measure, to identify patients in need of additional interventions before and after discharge, and a nurse-sensitive outcome measure of the postpartum hospitalization experience. Building systems of care that routinely assess quality of discharge teaching and discharge readiness will promote optimal outcomes of the post-childbirth experience.