Date of Award

Summer 2021

Document Type

Open Access Dissertation

Department

College of Nursing

First Advisor

Cynthia F. Corbett

Abstract

Social support is now part of the social determinants of health objective in Healthy People 2030. Positive social support improves health and well-being. Social support is concerned with people having the support they need within the community, including interacting and communicating with others on a regular basis. Instrumental support is a type of social support that is action oriented, involving one person directly assisting another person. A concept analysis of instrumental support was completed and revealed that the concept is well defined, but the terms used to describe it vary. Other terms in the research literature, most commonly “tangible support”, are used in the same context as “instrumental support”. In addition, tangible support and instrumental support were used interchangeably by some researchers. However, “instrumental support” is the most common term used in the health-related research literature and has been identified as essential for people recovering at home after a hospitalization. A lack of instrumental support has been linked to an increased risk of hospital readmission. A scoping review completed on the topic of social support and hospital readmissions identified instrumental support as the specific type of social support needed by people after a hospital stay.

Nurses spend time interacting with patients and their family members in the acute care setting. They assess the post-discharge needs of the patient as well as the potential ability of the caregiver to provide needed help at home after discharge. Using data from an ongoing study of patient readiness for hospital discharge, we used responses to two items on the Readiness for Hospital Discharge Survey (RHDS) to assess nurses’ and v patients’ perceptions of the potential instrumental support the patient would have at home after discharge. Findings revealed that nurses, as compared to patients, perceived patients would have less instrumental support after discharge. In addition, findings revealed that nurses’ perceptions of the amount of support the patient would have at home were related to subsequent acute care utilization whereas patients’ perceptions of expected support were not related to subsequent utilization in most cases. When there was a relationship between patients’ perceptions of expected support and subsequent acute care utilization, it was in the wrong direction such that perceptions of more available support were related to more acute care use following the initial hospital discharge. Instrumental support is an important element of hospital to home care transitions. Accurate ways to assess it during the discharge planning process are needed, and patients and caregivers are critical members of the team planning for care beyond the hospital setting.

Rights

© 2021, Beth E. Schultz

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