The Association Between Self-Care Agency and Readiness for Hospital Discharge in Postoperative Patients with Diabetic Foot: The Chain Mediating Roles of Perceived Social Support and Quality of Discharge Teaching.

OBJECTIVE: This study aims to explore the chain mediating role of perceived social support and quality of discharge teaching in the association between self-care agency and readiness for hospital discharge. METHODS: Convenience sampling was used to recruit 257 postoperative patients with diabetic foot who were admitted to four tertiary grade A hospitals in Hunan Province from March to December 2024.Data were collected using a self-designed General Information Questionnaire for postoperative patients with diabetic foot, the Readiness for Hospital Discharge Scale (RHDS),the Perceived Social Support Scale (PSSS),the Exercise of Self-Care Agency Scale (ESCA),and the Quality of Discharge Teaching Scale (QDTS). RESULTS: The total scores for readiness for hospital discharge, perceived social support, self-care agency, and quality of discharge teaching among postoperative patients with diabetic foot were 89.18 ± 17.62,61.67 ± 12.37,104.61 ± 29.44,and 141.78 ± 27.66 points, respectively. The quality of discharge teaching (β = 0.336), self-care agency (β = 0.256), and perceived social support (β = 0.303) were all positively associated with readiness for hospital discharge in postoperative patients with diabetic foot. Perceived social support and quality of discharge teaching mediated the association between self-care agency and readiness for hospital discharge (β = 0.430,95% CI [0.260,0.638], 62.7% of total effect). The three indirect pathways were self-care agency → perceived social support → readiness for hospital discharge (β = 0.209,95% CI [0.018,0.539], 30.4%); self-care agency → quality of discharge teaching → readiness for hospital discharge (β = 0.090, 95% CI [0.005,0.230],13.1%); self-care agency → perceived social support → quality of discharge teaching → readiness for hospital discharge (β = 0.132,95% CI [0.043,0.304],19.2%). CONCLUSION: Postoperative patients with diabetic foot exhibit moderate readiness for hospital discharge, with considerable potential for improvement. Significant associations were observed among self-care agency, perceived social support, quality of discharge teaching, and readiness for hospital discharge in postoperative patients with diabetic foot. Perceived social support and quality of discharge teaching may constitute indirect pathways linking self-care agency to readiness for hospital discharge. PRACTICE IMPLICATIONS: Clinical Healthcare Professionals should systematically strengthen self-care agency, perceived social support, and quality of discharge teaching in postoperative patients with diabetic foot. Based on the serial indirect pathway among these three factors, a hospital-community-family integrated discharge support system should be established to effectively improve patients' readiness for hospital discharge and ensure their transitional safety.