| Summary: | 碩士 === 台北醫學院 === 護理學研究所 === 88 === Discharge planning can shorten the length of hospital stay, facilitate patient self-care, promote patient satisfaction, and prevent readmissions. COPD evolves from a long period of lung destruction, which results in dyspnea. Dyspnea can limit patients'' activities, which leads to great effects on their quality of life. Providing integrative discharge planning should be able to build-up patient coping skills, to lessen the severity of the disease, and to improve quality of life.
A quasi-experimental study was conducted. Four internal medicine units where the background of nursing staff and the COPD caseload are selected and compared. By randomization, two units were assigned as the intervention group and the other two as the control group. Patients of the intervention group had been treated with integrative discharge planning while the control group received traditional discharge service.
Patients who met the inclusion criteria were recruited. The effects of discharge planning on the following outcomes were to be examined: length of stay, unexpected medical visits four weeks after discharged, knowledge and skills of self-care, health related quality of life, and hospital expenses.
All eligible patients had to complete "The Knowledge of Patient Self-Care Questionnaire (KPSCQ)", "The Skill of Patient Self-Care Scale (SPSCS)", and "The Seattle Obstructive Lung Disease Questionnaire (SOLQ)" by the time of admission, discharged and four weeks after discharged. Expert validity was conducted for the KPSCQ and SOLQ. Internal reliability of KPSCQ was 0.83 (Cronbach''s ). Reliability of physical function, emotional function, coping skills and treat satisfaction of the SOLQ was 0.92, 0.77, 0.79, and 0.96, respectively. Inter-rater reliability was 0.77 -0.84 (Kappa). Nonparametric statistical test were exercised temporarily because of insufficient case number.
The results demonstrate that implementing the discharge planning can significantly facilitate COPD patients to gain knowledge of self-care, to improve skill of self-care, coping skills, and to lessen emotional burdens. The length of stay and the average hospital expenses did not significantly reduce because of the study flaws. However, according to the experiment, the length of stay for the intervention group was found significantly shorter than the COPD patients at the same period last year. Moreover, the hospital expenses of the intervention group did not significantly increase even though the insurance payment had been increased by the Bureau of National Health Insurance. No significant difference was found between the intervention group and the control group of unexpected medical visits.
Due to the insufficient number of case study, the inference and explanation of this experiment are limited. The effects of the discharge planning on COPD patient outcomes are yet to be determined as more cases are collected and studied.
|
|---|
