Mary K. Anthony, PhD,RN 1,2 Kathleen Vidal, MSN,RN 2 Pimpanitta Jittapiriom , PhD (candidate) 1

1. RELATIONAL NURSING CARE: A Strategic Model Of Care To Improve Discharge Readiness and Safe Transitions Mary K. Anthony, PhD,RN1,2 Kathleen Vidal, MSN,RN2 PimpanittaJittapiriom, PhD (candidate)1 Carolyn Kleman, MSN, RN1 Amany Farag, PhD,RN3 Supported by Kent State University University Hospitals Case Medical Center 1Kent State University,2University Hospitals Case Medical Center,3University of Iowa

2. BACKGROUND • Discharge represents a time that bridges the transition from hospital to home. • Profile • Nearly 40 million discharges per year • Approximately 20% are readmitted within 30 days • Up to one third of these readmissions are preventable • 19% have an adverse event post discharge Kent State University University Hospitals Case Medical Center

3. BACKGROUND • Many interdisciplinary and interdisciplinary models have been designed and implemented to address the challenges of discharge. • Models address structure of discharge, processes of discharge and standardization of both structure and processes. • Failure of existing systems. Models of care built around relational capital may offer promise as a strategic driver in accomplishing safe discharge. Kent State University University Hospitals Case Medical Center

4. BACKGROUND Is discharge the most important conversation in a hospitalization? Characteristics of Discharge Communication Complex Uncertain Unfamiliar Rushed Kent State University University Hospitals Case Medical Center

5. PURPOSE To assess the extent that core processes in a model of nursing care delivery explain nurse and patient perception of discharge readiness. The underpinnings of the model: To build relationships and promote information sharing. Kent State University University Hospitals Case Medical Center

6. METHOD Design: Cross-sectional correlational Sample: Convenience Setting: Kent State University University Hospitals Case Medical Center

7. METHOD Kent State University University Hospitals Case Medical Center

8. RN DATA COLLECTION • Hospital Liaison for each hospital • Unit meeting to explain the study • Survey placed in unit mailboxes • Reminder Flyers posted on units at specified intervals: • The same day of survey distribution • One week after survey distribution • Two weeks after survey distribution • Three weeks after survey distribution Kent State University University Hospitals Case Medical Center

9. PATIENT DATA COLLECTION • Data collected from patients during the same time month of RN data collection. • Recruited patients who met following criteria: • Discharge within 4-6 hours • Discharged home • Consent obtained • Survey was given to patient along with a envelope to place questionnaire and return to drop box on unit. Kent State University University Hospitals Case Medical Center

10. METHOD Kent State University University Hospitals Case Medical Center

11. RN DEMOGRAPHICS Kent State University University Hospitals Case Medical Center

12. PATIENT DEMOGRAPHICS Kent State University University Hospitals Case Medical Center

13. INSTRUMENTS:Relationship Based Care(Anthony et al., 2009) 1. “Think back over the last week (7 days). In your day to day interactions, on days you worked, how often did you conduct the following activities with your assigned patients” • Admission Interview • Sit down Daily Rounds • Discharge Interview • Follow-up phone call Not at all (1) to All the time (4) 2. Nurses were asked to rank order a series of activities related to providing care. Kent State University University Hospitals Case Medical Center

14. INSTRUMENTSPerception Of Readiness For Discharge Nurse Perception of Readiness Nurse Perception of Quality Care (Aiken, 2002) • Nurses rated confidence in patients ability to manage care at time of discharge Confident (1) to Not Confident at All (4) (reverse scored) Patient Perception of Readiness Patient Readiness for Discharge (Weiss, 2006) • 7-item instrument • Responses on the RHDS are on an 11-point summated numeric rating scale Not at All (0) to Totally (10) Kent State University University Hospitals Case Medical Center

15. RELATIONSHIP BASED CARE Kent State University University Hospitals Case Medical Center

16. RANK ORDER OF NURSING CARE ACTIVITIES Kent State University University Hospitals Case Medical Center

17. READINESS FOR DISCHARGE Kent State University University Hospitals Case Medical Center

18. RESEARCH QUESTIONS • What are the relationships among: • RN perception of readiness and patient perception of readiness for discharge? • Readiness for discharge (patient and nurse) with core processes of relationship based care and their relative importance? • Based on univariate analysis, what is the explanatory power of a relationship based model of care on nurse and patient readiness for discharge? Kent State University University Hospitals Case Medical Center

19. Relationship of Discharge Readiness Kent State University-University Hospitals Case Medical Center

20. Correlation Kent State University-University Hospitals Case Medical Center

21. Correlation Kent State University-University Hospitals Case Medical Center

22. RN PERCEPTION OF PATIENT READINESS FOR DISCHARGE(N = 23) Beta t p Admission Interview - .10 - .55 .58 Sit down rounds .55 2.30 .03 Discharge Interview - .07 - .31 .76 Importance of Discharge Planning - .28 -1.46 .16 Model R2=.38, F 4, 18= 2.80 p = .057 *p< .05,* * p < .01 ***p < .001 Kent State University University Hospitals Case Medical Center

23. PATIENT PERCEPTION OF PATIENT READINESS FOR DISCHARGE(N = 23) Beta t p Admission Interview .29 1.38 .18 Sit down rounds .12 0.46 .65 Discharge Interview .15 0.55 .58 Importance of Discharge Planning -.34 - 1.56 .13 Model R2=.23, F 4, 18= 1.36 p = .28 *p< .05,* * p < .01 ***p < .001 Kent State University University Hospitals Case Medical Center

24. CONCLUSIONS • RN sample, the sit down rounds and relative ranking of discharge planning were important to their perception that patients were ready for discharge. • Patient sample, the admission interview and relative ranking of discharge planning were to their perception of being ready for discharge. • What is in common is that both the admission interview and sit down rounds involve focused conversations. • The small sample likely accounted for moderate effects to be nonsignificant. Kent State University University Hospitals Case Medical Center

25. IMPLICATIONS Discharge Information What helps patients manage this complex information? What helps patients make sense of complex information? What helps them differentiate information? What is the discussion around structured conversation with relational conversation in managing discharge? Complex Uncertain Unfamiliar Rushed Kent State University University Hospitals Case Medical Center