ผลการใช้รูปแบบการวางแผนจำหน่ายต่อผลลัพธ์ทางสุขภาพในผู้สูงอายุ หลังผ่าตัดทำทางเบี่ยงหลอดเลือดหัวใจ

Nipaporn Thaepthap

Authors

Nipaporn Thaepthap Trang hospital, Trang Province

Keywords:

Discharge planning, Older adults, Coronary artery bypass graft surgery, Health outcomes

Abstract

Background and Objectives Older adults following coronary artery bypass graft (CABG) surgery require effective discharge planning to prepare them for transition. This study aimed to evaluate the effects of a discharge planning model developed by integrating the D-METHOD framework with Meleis’s Transition Theory on health outcomes among older adults following CABG surgery at Trang Hospital.

Methods A two-group pretest–posttest quasi-experimental design was conducted among 56 older adults following CABG surgery at Trang Hospital between May 29, 2025, and April 30, 2026. The sample was selected through purposive sampling according to the established criteria and assigned to study groups based on time periods, with 28 participants in the experimental group and 28 in the control group. The control group received routine nursing care, whereas the experimental group received the newly developed discharge planning model, which encompassed three phases:
1) transition readiness assessment, 2) nursing interventions for transitional care preparation, and 3) role enhancement with continuous follow-up, integrated with family caregiver skill-training. Data were collected regarding knowledge, self-care ability, length of hospital stay, postoperative complications, 28-day hospital readmissions, and 1-month post-discharge quality of life. The research instruments were validated for content accuracy by experts, yielding an overall Index of Item-Objective Congruence (IOC) of 0.96. The reliability of the knowledge questionnaire was 0.84, whereas the Cronbach's alpha coefficients for the self-care ability and quality of life questionnaires were 0.82 and 0.88, respectively. Data were analyzed using descriptive statistics, the Mann-Whitney U test, and Fisher’s exact test, with the statistical significance level set at p < .05

Results Before the intervention, no statistically significant differences were observed between the control and experimental groups regarding baseline knowledge and self-care ability scores (p > .05). Post-intervention, the experimental group demonstrated significantly higher median scores for both knowledge (U = 0.50, p < .001) and self-care ability (U = 2.00, p < .001) compared to the control group. Additionally, the experimental group had a significantly shorter length of hospital stay than the control group (U = 625.00, p < .001). However, overall postoperative complication rates, 28-day hospital readmission rates, and quality of life scores did not differ significantly between the two groups (p > .05)

Conclusions and Recommendations The discharge planning model integrating the D-METHOD framework with Meleis’s Transition Theory effectively improves health outcomes by enhancing knowledge and self-care ability while significantly reducing the length of hospital stay among older adults following CABG surgery. This model can serve as a standardized evidence-based guideline to improve discharge planning in this patient population.

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