Patients’ readiness for hospital discharge scale after hip arthroplasty in older adults: development and psychometric evaluation

ABSTRACT Background: Readiness for hospital discharge indicates successful health and illness transition. Assessing readiness for hospital discharge and transition to home in patients after hip arthroplasty has become increasingly important to patient safety, satisfaction, and outcomes. Nurses play an essential role in assessing readiness for the hospital discharge needs of patients. Currently, there are no specific instruments to assess the readiness for hospital discharge of patients with hip arthroplasty. Readiness for hospital discharge requires a valid, accurate, and reliable scale and is easy to use. Objectives: To develop and validate the psychometric properties of a new patient’s readiness for hospital discharge scale for hip arthroplasty (RHD-HA). Theoretical framework: Meleis' Transition theory guides the conceptualization of the readiness of older people for discharge from hospital to home. Methods: First, items were generated based on the literature review and with help from orthopedic surgeons, orthopedic nurse practitioners, and experts in questionnaire design. Then, content validity was carried out. Accordingly, a cross-sectional study was conducted, which was carried out in 4-tertiary governmental hospitals. The data were collected from June 2020 to February 2021. Two hundred patients completed a questionnaire. Content validity and Intraclass Correlation Coefficient (ICC) were carried out. The psychometric properties evaluation comprised exploratory and confirmatory factor analysis, internal consistency reliability, concurrent validity, and predictive validity. The cut-off point for RHD-HA was identified using the receiver operating characteristic (ROC). Results: Based on exploratory factor analysis and confirmatory factor analysis, two factors were identified. The factors could explain 62% of the total variance observed. The model had an acceptable fit: (CFA; X2=0.056, df =24, (p=<0.001), CLI=0.974, TLI=0.967, SRMR=0.044, and RMSEA of 0.116). The scale had adequate internal consistency; Cronbach’s alpha coefficient (0.87), inter-rater reliability (0.96), content validity (0.97), and concurrent validity (0.70). The ROC analysis represented the cut-off point at 0.9 (score=10), AUC=0.893, Sensitivity=90.7%, Specificity=70.1%, and Accuracy=89.0%. An application of the discharge screening tool was created to use. Conclusions: The RHD-HA 9-item established favorable psychometric evaluations. The new instrument describes a specific measure in older people who underwent hip arthroplasty, which recognizes and defines the interventions for improving readiness for hospital discharge after hip arthroplasty.