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Validation of the index for the core competence of nurses leading discharge planning for older patients in China†

Lu Lu
Lu Lu
, 
Ling Ding
Ling Ding
, 
Hong-Yan Lu
Hong-Yan Lu
, 
Xin-Ning Lei
Xin-Ning Lei
, 
Zhen-Zhen Wu
Zhen-Zhen Wu
 e 
Rui Zhang
Rui Zhang
   | 20 mar 2023
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Article Category: Original Article
Pubblicato online: 20 mar 2023
Pagine: 51 - 64
Ricevuto: 05 giu 2022
Accettato: 26 set 2022
DOI: https://doi.org/10.2478/fon-2023-0006
Parole chiave
© 2023 Lu Lu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

Research flow chart.
Research flow chart.

Figure 2.

Scree plot for the EFA. EFA, exploratory factor analysis.
Scree plot for the EFA. EFA, exploratory factor analysis.

Figure 3.

Second-order CFA structure model. Note: T1–T57 were the 57 observational internal variables, that is, the 57 three-level indicators of the indicator system; S1–S13 were the 13 potential internal factors (first-order factors), which were the secondary indicators of the index system; e1–e57 were the error variables of the 57 measurement indicators; e58–e57 were the error variables of the 13 first-order factors; and F1–F4 were the 4 primary indicators (second-order construct variables). CFA, confirmatory factor analysis.
Second-order CFA structure model. Note: T1–T57 were the 57 observational internal variables, that is, the 57 three-level indicators of the indicator system; S1–S13 were the 13 potential internal factors (first-order factors), which were the secondary indicators of the index system; e1–e57 were the error variables of the 57 measurement indicators; e58–e57 were the error variables of the 13 first-order factors; and F1–F4 were the 4 primary indicators (second-order construct variables). CFA, confirmatory factor analysis.

General characteristics of nurses, n (%).

Characteristics Database 1 (n1 = 510) Database 2 (n2 = 511) Total sample (n = 1021)
Sex
    Female 498 (97.65) 501 (98.04) 999 (97.85)
    Male     12 (2.35)     10 (1.96)     22 (2.15)
Nationality
    Han nationality 396 (77.65) 404 (79.06) 800 (78.35)
    Ethnic minority 114 (22.35) 107 (21.94) 221 (21.64)
Marital status
    Married 374 (73.33) 370 (72.42) 744 (72.87)
    Other 136 (26.67) 141 (27.58) 277 (27.13)
Education level
    Polytechnic school     24 (4.71)     19 (3.72)     43 (4.21)
    Junior college 260 (50.98) 255 (49.90) 515 (50.44)
    Undergraduate 226 (44.31) 237 (46.38) 463 (45.35)
Hospital level
    Grade III-A 172 (33.73) 184 (36.01) 356 (34.87)
    Grade III-B 102 (20.00)   85 (16.63) 187 (18.31)
    Grade II-A 218 (42.75) 224 (43.84) 442 (43.29)
    Grade II-B   18 (3.53)   18 (3.52)   36 (3.53)
Department
    Internal medicine 326 (63.92) 346 (67.71) 672 (65.82)
    Surgery 184 (36.08) 165 (32.29) 349 (34.18)
Technical title
    Nurse 232 (45.49) 236 (46.19) 468 (45.84)
    Primary nurse 193 (37.84) 174 (34.05) 367 (35.95)
    Nurse in charge   57 (11.18)   81 (15.85) 138 (13.52)
Post
    Deputy director nurse and above     28 (5.49)     20 (3.91)     48 (4.70)
    No job 403 (79.02) 404 (79.06) 807 (79.04)
    Head of responsible section   64 (12.55)   70 (13.70) 134 (13.12)
    Head nurse     43 (8.43)     37 (7.24)     80 (7.84)
Instructor for nursing students?
    Yes 258 (50.59) 252 (49.32) 510 (50.00)
    No 252 (49.41) 259 (50.68) 511 (50.00)

Reliability of the index system (n = 511).

First-level indicator Second-level indicator Number of items Cronbach’s α Retest reliability
Assessment of discharge planning 14 0.96 0.84
Collection of general information   3 0.84 0.79
Assessment of medical care issues   5 0.93 0.79
Judgment of the necessity of discharge planning   2 0.88 0.74
Assessment of discharge needs   4 0.91 0.83
Formulation of discharge planning 14 0.97 0.85
Establishment of individualized discharge planning   3 0.90 0.75
Predischarge preparation   4 0.88 0.78
Rational utilization of social resources   4 0.89 0.72
Explanation and adjustment of discharge planning   3 0.89 0.73
Implementation of discharge planning 14 0.97 0.85
Multidisciplinary teamwork   6 0.93 0.78
Health education before discharge   8 0.96 0.76
Follow-up and effectiveness evaluation 15 0.97 0.81
Coordination of health services   5 0.93 0.81
Out-of-hospital follow-up   6 0.95 0.79
Effectiveness evaluation   4 0.94 0.77
The total index system 57 0.98 0.86

Eigenvalue and variance contribution rate of each component of the index.

Component Eigenvalue Variance (%) Cumulative variance (%)
Factor 1(Follow-up and effectiveness evaluation) 34.89 23.59 23.59
Factor 2(Assessment of discharge planning)   3.40 18.18 41.77
Factor 3(Implementation of discharge planning)   1.65 18.16 59.93
Factor 4(Formulation of discharge planning)   1.55 12.87 72.79

Factor loadings after varimax rotation based on the EFA (n = 510).

Three-level indicator Factor 1 Factor 2 Factor 3 Factor 4
4.1.2 Assesses the rehabilitation of older patients at each home visit. 0.808 0.228 0.142 0.296
3.3.4 Coordinates beds and other resources for older patients when referring to lower medical institutions. 0.772 0.225 0.184 0.264
4.1.6 Judges whether to end the discharge planning according to the results of family visits. 0.769 0.242 0.188 0.279
4.2.1 Tracks and evaluates the rehabilitation and living conditions of older patients after discharge from hospital. 0.767 0.225 0.217 0.308
4.2.4 Evaluates and analyzes the whole process after the discharge planning is completed. 0.760 0.273 0.307 0.178
3.3.5 Provides technical guidance and training for lower medical service centers. 0.758 0.309 0.207 0.140
4.1.1 Provides multiple forms of follow-up for older patients. 0.749 0.251 0.275 0.212
4.1.5 Records the follow-up progress of older patients in a timely and accurate manner. 0.749 0.221 0.339 0.228
3.3.3 Coordinates nursing clinics to provide follow-up services and nursing specialist guidance for older patients. 0.745 0.183 0.268 0.262
4.2.2 Assesses the psychological status of older patients before and after discharge. 0.728 0.286 0.364 0.119
4.2.3 Investigates older patients’ satisfaction with discharge planning and analyze results. 0.722 0.278 0.343 0.146
4.1.4 Coordinates or resolve issues raised by older patients and their families at the time of follow-up. 0.685 0.309 0.445 0.089
4.1.3 Adjusts the discharge planning in a timely manner based on the rehabilitation of older patients. 0.656 0.364 0.368 0.197
3.3.2 Coordinates the implementation of discharge planning between community health service centers and other medical institutions. 0.648 0.208 0.165 0.495
3.3.1 collaborates with community health service centers and other medical institutions to ensure the smooth referral of older patients. 0.647 0.254 0.211 0.446
3.1.6 Works with community health care professionals to ensure the smooth discharge of older patients. 0.603 0.138 0.250 0.530
3.1.2 Assists rehabilitation teachers in providing rehabilitation guidance to older patients with low self-esteem and their families. 0.562 0.218 0.366 0.439
3.1.4 Assists nutritionists to implement individualized dietary guidance according to the nutritional status of older patients. 0.524 0.230 0.292 0.493
1.3.1 Makes a preliminary judgment on whether older patients need discharge planning services. 0.202 0.750 0.330 0.220
1.4.1 Understands and records the concerns and expectations of older patients and their families about disease treatment and out-of-hospital life. 0.307 0.715 0.253 0.277
1.3.2 Discusses with the attending physician the necessity of improving discharge planning for older patients. 0.325 0.704 0.284 0.271
1.4.2 Understands and documents the thoughts of older patients and their families about dying problems and home care. 0.401 0.691 0.182 0.330
1.2.5 Assesses the self-care ability of older patients and the care capacity of primary caregivers. 0.190 0.688 0.476 0.148
1.2.2 Assesses the physical function, cognition, and mental psychology of older patients. 0.241 0.680 0.426 0.142
1.2.4 Assesses the understanding of disease treatment and knowledge of disease in older patients. 0.209 0.677 0.474 0.140
1.2.1 Assesses disease status, progression and prognosis in older patients. 0.291 0.662 0.440 0.175
1.2.3 Assesses the nursing problems of older patients, such as falls, falling into bed, skin integrity, etc. 0.126 0.655 0.556 0.037
1.1.2 Collects family composition of older patients and relevant information of primary caregivers such as relationship with patients, contact information, etc. 0.314 0.627 0.188 0.302
1.1.3 Assesses the safety of older patients’ living environment, including indoor lighting, toilet layout, skid-proof facilities, etc. 0.282 0.612 0.436 0.182
1.1.1 Collects sociodemographic data of older patients. 0.348 0.574 −0.023 0.390
2.1.1 Maximizes the self-care ability of older patients as the goal of the discharge planning. 0.310 0.536 0.357 0.439
1.4.4 Uses linguistic and nonverbal communication strategies in the assessment process to address potential sensory and cognitive impairments in older patients. 0.348 0.524 0.352 0.452
1.4.3 Uses interviews to assess the discharge needs of older patients and their families. 0.407 0.500 0.305 0.412
2.2.1 Coordinates or resolve issues of concern to older patients and their families. 0.362 0.488 0.403 0.425
2.1.2 Develops a discharge planning centered on the needs of older patients and their families. 0.360 0.485 0.326 0.483
2.2.2 Discusses emergency plans for developing aggravated or critical moments in older patients. 0.366 0.451 0.425 0.440
3.2.7 Provides guidance on care methods for older patients at risk of falls, pipe falls and pressure sores. 0.286 0.375 0.741 0.032
3.2.8 Provides psychologically care for older patients and their families to alleviate their anxiety and anxiety about off-campus life. 0.384 0.351 0.666 0.136
3.2.5 Provides guidance to older patients and their families on the use of relevant medical devices and articles. 0.374 0.258 0.661 0.321
3.2.2 Provides individualized health education according to the understanding of older patients. 0.373 0.380 0.659 0.199
3.2.1 Arranges health education in accordance with the priority of older people’s health knowledge needs. 0.371 0.379 0.645 0.306
3.2.4 Guides the older patients and their families on disease management methods and matters needing attention in daily life. 0.411 0.362 0.636 0.244
2.4.2 Introduces to the older patients and their families what services the hospital can provide after discharge. 0.332 0.284 0.633 0.398
3.2.6 Guides the older patients and their families to identify critical symptoms and signs and emergency measures. 0.376 0.294 0.632 0.306
2.3.3 Introduces reimbursement methods and proportions of medical insurance to older patients and their families. 0.194 0.265 0.610 0.441
2.4.1 Introduces and confirm the contents of the discharge planning to older patients and their families. 0.240 0.263 0.587 0.517
3.1.5 Assists the doctor in determining the patient’s discharge date and return date. 0.418 0.399 0.586 0.234
2.4.3 Maintains the rights of older patients and their families in medical decision-making, such as the informed consent form for signing the discharge planning. 0.283 0.316 0.577 0.417
2.2.4 Discussions can be used to determine the mode of delivery of older patients at discharge. 0.183 0.447 0.573 0.290
3.2.3 Gives full play to the subjective initiative of older patients and help develop programs that change their poor health behaviors. 0.423 0.385 0.544 0.312
2.3.4 Introduces relevant healthcare policies and care resources to older patients and their families. 0.292 0.259 0.494 0.490
3.1.3 Cooperates with physicians and pharmacists to guide drug management for older patients and their families. 0.460 0.222 0.492 0.448
2.3.1 Familiarizes with the social resources available near the home of older patients, such as the location, contacts, services provided by the nearby community health service institutions, etc. 0.323 0.293 0.204 0.687
2.3.2 Fully considers the social resources available in the vicinity of older patients’ housing when formulating the discharge planning, and provide them to older patients and their families in time. 0.429 0.366 0.204 0.628
2.2.3 Judges the need for the use of home medical devices and items and to provide access to them. 0.375 0.329 0.365 0.588
2.1.3 Makes individualized follow-up plan (method, content, time, etc.) according to the disease status of older patients. 0.378 0.409 0.311 0.554
3.1.1 Coordinates multidisciplinary team members to complete preparations for older patients before discharge. 0.480 0.223 0.365 0.541

Second-order CFA structural model fitting index.

Index system Absolute fitness index Value-added fitness index Simplified fitness index
RMR RMSEA AGFI NNFI CFI NFI χ2/df PNFI PGFI
Second-order model 0.047 0.07 0.671 0.879 0.885 0.846 3.481 0.806 0.642
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