Antepartum, Intrapartum, Postpartum Predictors

and Outcomes of Discharge Readiness

Gabriella Malagon-Maldonado, PhD, DNP, APRN, CNS, NEA-BC

Background Adaptation to Transitions Conceptual Framework Methods

Patient Outcomes •Research Design: Descriptive correlational
• Discharge before a mother is physically and/or repeated measures design
psychologically ready, places the mother and
Antepartum Intrapartum Postpartum
infant at a greater risk of detrimental maternal and •Setting: 72-bed postpartum unit with mother-baby
infant outcomes Nature of Transition Patterns of couplet care in a non-profit women’s specialty
Transition and Conditions Response hospital
Education and Policy
Environmental and Coping and
• Newborns’ and Mothers’ Health Protection Act Adaptation •Sample: 185 postpartum mothers, 18 years of
shortened the length of hospital stay Stimuli Processes age, uneventful post-birth experience, mothers with
• Physical, psychological, and social well-being
Modes infants who were not transferred to the NICU,
needs of mother and infant must be addressed sufficient English or Spanish language skills
prior to discharge
•Twenty-four hours prior to discharge:
Transitions of Care and Financial Implications -Demographic Questionnaire
• Limited improvements in care transitions are Nursing -Readiness for Hospital Discharge Scale
related to understanding the maternal and infant Therapuetics/ -Quality of Discharge Teaching Scale
factors contributing to poor outcomes Interventions
• Reimbursement payments are associated with •Four weeks post-discharge:
nurses’ communication with patients and families -Post-Discharge Coping Difficult Scale
and discharge information -Quality of Discharge Teaching Scale
Purpose Results Implications
 Demographics: Participants’ mean age was 30.8,  Q2. Predictors of Coping Difficulty: •The quality of discharge teaching as a predictor
majority were Caucasian (41.6%), married & living
The purpose of this study was to explore the
Variable Statistics of readiness for hospital discharge, post-
with the father of the infant (74.6%), & had a
antepartum, intrapartum, and postpartum factors, bachelor’s degree (31.4%). Majority planned on Predictor Variables Model B SE B Standardized t P
discharge coping, and health care utilization,
including nursing practices, associated with returning to work full-time (43.8%), had an average of provides evidence of the importance of patient
Statistics β
readiness for hospital discharge and the two children, delivered vaginally (61.6%) with an Antepartum Characteristics F(6,60)=5.1 -1.8 0.86 -0.24 -2.1 0.04
and family education
average length of stay 2.9 days, and were P=<0.001
subsequent outcomes after hospitalization. (a) Less than High School R2=0.33
breastfeeding upon discharge (70.8%). Infants’ Education Adjusted •Discharge teaching requires attention to
R2=0.28 -0.2 0.09 -0.27 -2.2 0.03
gestational mean age was 38.9 weeks & length of stay Nursing Interventions
adequacy of content and delivery of information
on average was 2.7 days. influencing a patients’ readiness of hospital
(b) Content difference subscale
Research Questions Variable Statistics  Q2. Predictors of Service Utilization:
discharge
Predictor Variables Model B SE B Standardized t P
 Q1. Predictors of Readiness: Logistic Regression Statistics
•Conceptualizing and investigating the transition
Outcome Variables Significant B SE B χ2 Odds 95% CI P
1. What antepartum, intrapartum, and postpartum Statistics β
Predictor Ratio home after hospital is essential to improve
factors ,including nursing practices, are Postpartum characteristics F(8,176)=17.5
Variables
organizational structures and processes to
Calls to healthcare PDCDS 0.54 0.22 5.79 1.71 (1.11-2.64) 0.02
predictive of postpartum mothers’ perceptions (a) Infant LOS P=<0.001 -0.21 0.1 -0.2 2.05 0.04
providers facilitate optimal patient outcomes
Calls to hospital Content -1.18 0.44 7.19 0.31 (0.13-0.73) 0.01
of readiness for hospital discharge? Received
Nursing Interventions R2=0.44
Delivery 1.41 0.64 4.78 4.08 (1.16-14.3) 0.03 References/Acknowledgments
(b) Delivery subscale Adjusted 0.45 0.06 0.51 7.06 <0.001 Office/Clinic visits Delivery 1.43 0.5 8.22 4.18 (1.57-11.1) 0.004
PDCDS 0.74 0.34 4.84 2.09 (1.08-4.03) 0.03 References available on handout.
2. What are the factors associated with post- (c) Content difference subscale R2=0.42 0.15 0.04 0.22 3.55 <0.001
Content -0.65 0.31 4.38 0.52 (0.28-0.96) 0.04 Acknowledgements: Drs. Cynthia Connelly, Ruth
discharge coping difficulty and utilization of Received
support and health services? • Qualitative Results: Bush, Jane Georges; Bob and Betty Beyster, USD
• Resources, staff, and delivery of specific • Qualitative Results: School of Nursing and Health Science, and Sharp
information • Health, infant, family needs HealthCare’s Center of Nursing Excellence