Chihiro Kimura, K A T M Ehsanul Huq, Yuko Tsumoto, Michiko Moriyama
This long-term follow-up study revealed several challenges to the implementation of palliative care and underscored the demanding work of managers. Staff shortage, limited budget and support led to work-related instability. Closer interprofessional collaboration and a broader approach to palliative care as a process from early signs to the end of life need to continue and deepen to be knowledge-based nursing care. From a leadership perspective, a successful implementation requires a long-term commitment, financial resources, a supportive organisation, and manager competence.
BACKGROUND: Care transitions refer to the movement of patients between healthcare providers and/or care settings, such as from hospital to home. Continuous interventions, responses to unexpected changes during care transitions, and discharge support programs have been implemented to improve care transitions. However, a scale to measure information-sharing practices that address uncertainty in care transitions and differences in stakeholder perspectives has yet to be developed. Therefore, this study aimed to develop and evaluate the validity and reliability of an instrument to assess information-sharing practices among nurses during care transitions from hospital to home, with a focus on the discharge of older adults with high healthcare needs.
METHODS: The study involved several stages to develop the Care Transition Information Sharing Practice Scale (CT-ISPS). At first, the scale construct was defined based on the literature reviews and reviewed by experts, 36 preliminary items were generated. A cross-sectional survey was conducted to assess the scale's validity and reliability. Nurses with ≥5 years of clinical experience in discharge support working at randomly selected hospitals were enrolled. The questionnaire included the newly developed CT-ISPS, the Interprofessional Collaboration Behavior Scale (ICBS) to assess convergent validity, and nurses' demographic characteristics.
RESULTS: A total of 353 valid responses were obtained from the nationwide survey. Item analysis and exploratory factor analysis resulted in a 23-item scale comprising 3 factors: (1) knowledge sharing to support adaptation, (2) sharing patients' holistic status to set direction, and (3) sharing external factors for anticipation. Confirmatory factor analysis demonstrated a mixed-model fit (CFI = 0.91, RMSEA = 0.093). Cronbach's alpha coefficients for the factors ranged from 0.83 to 0.95, indicating adequate internal consistency. The correlation coefficient supported convergent validity between CT-ISPS and ICBS.
CONCLUSION: The scale demonstrated preliminary evidence of structural validity, construct validity, and internal consistency in assessing information-sharing practices during care transition at discharge among hospital nurses. Future research should further examine its validity among home-care providers and other stakeholders involved in care transitions.