Abstract
Purpose
This study evaluated readiness for hospital discharge (RHD) among ophthalmic day surgery patients and identified psychosocial factors associated with RHD to inform clinical practice.
Patients and Methods
A total of 281 adults undergoing elective ophthalmic day surgery at West China Hospital, Sichuan University (December 2024–March 2025), were recruited by convenience sampling. Data were collected using a demographic questionnaire, the Readiness for Hospital Discharge Scale (RHDS) to evaluate discharge readiness among ophthalmic day surgery patients under a rapid-turnover model, the All Aspects of Health Literacy Scale (AAHLS), and the Quality of Discharge Teaching Scale (QDTS). Univariate analysis and stepwise multiple linear regression were used to examine factors associated with RHD.
Results
The mean total RHDS score was 99.48 ± 13.35, with an average item score of 8.29 ± 1.11. Expected support had the highest mean dimension score was for expected support (8.76 ± 1.62), followed by personal status (8.42 ± 1.63) and coping ability (7.99 ± 1.11). Univariate analysis showed that sex, marital status, place of residence, comorbid chronic diseases, low vision at admission, type of surgery, and requirement for special postoperative positioning significantly affected RHDS scores (all P < 0.05). RHDS was weakly correlated with health literacy (r = 0.218, P < 0.01) and moderately correlated with quality of discharge teaching (r = 0.500, P < 0.01). Quality of discharge teaching (skills and effectiveness), health literacy (ability to use written health information), rural residence, male sex, low vision at admission, and requirement for special postoperative positioning were identified as main factors associated with RHDS (R2 = 0.456, P < 0.05).
Conclusion
Adult ophthalmic day surgery patients demonstrated relatively high RHD, although coping ability was comparatively weaker and requires further attention. Clinicians should pay particular attention to rural residents, women, patients with low vision, and those requiring special postoperative positioning. Improving discharge teaching and health literacy may further enhance RHD.
Keywords: ophthalmology, day surgery, readiness for hospital discharge, health literacy, discharge education
Introduction
Day surgery refers to surgical procedures in which both admission and discharge occur within the same day (within 24 hours). This model offers several advantages, including more efficient use of healthcare resources, streamlined treatment processes, shorter surgical waiting times, and reduced financial burden on patients, and has therefore been vigorously promoted in China.1–3 In developed countries such as those in Europe and the United States, day surgery has already become the predominant surgical modality, whereas in many developing countries it remains in the early stages of implementation.4 Ophthalmic surgery, characterized by small incisions, short operative duration, and readily detectable postoperative complications, is particularly well suited to the day surgery setting.2 According to the 2022 Recommended Catalogue of Day Surgery issued by the National Health Commission of China, the number of ophthalmic procedures included has increased to 132, thereby accelerating the nationwide development of ophthalmic day surgery, published by National Health Commission (NHC) in 2022.5 With markedly shortened hospital stays, opportunities for communication and interaction between patients and healthcare providers are limited, and the rapid patient turnover in day surgery units further reduces the time available for adequate discharge preparation. Consequently, it is essential for patients to acquire knowledge and skills for home-based self-care and nursing within this limited timeframe.
RHD is defined as an evaluation of patients’ capacity to continue recovery after leaving the hospital.6 RHD is conceptualized not only as a state but also as a dynamic process. Although the RHDS is typically assessed at the point of discharge, its clinical relevance extends beyond that single time point, as discharge readiness can shape early post-discharge outcomes. Its core dimensions include physical stability (eg, functional capacity and the ability to perform self-care at home); sufficient support to meet post-discharge needs; psychological readiness, reflecting patients’ confidence in managing the transition to home; and adequate information and knowledge to address common post-discharge problems.5 Insufficient discharge readiness has been associated with increased risks of unplanned readmission, emergency visits, and difficulties in health management.7 In contrast, adequate discharge preparation can effectively prevent complications and rehabilitation problems associated with premature discharge, while reducing healthcare costs and alleviating the financial burden on patients and families.8 In day surgery, RHD assessment is commonly used to support discharge decisions by assessing patients’ self-care knowledge, coping capacity, and post-discharge support. Higher RHD scores have been associated with lower disease-related readmission rates.9 Inadequate readiness for hospital discharge is associated with a higher risk of 30-day unplanned readmission and 30-day mortality.10 Therefore, incorporating the RHDS into discharge protocols—and, when appropriate, extending its use to post-discharge follow-up—may help identify vulnerable patients and guide targeted supportive interventions.
With the expansion of day surgery and the constraint of shortened hospital stays, discharge teaching must often be delivered within a limited timeframe. Under such circumstances, the information provided to patients may be rushed or incomplete.11 Although numerous studies have examined RHD in general patient populations, research specifically focusing on ophthalmic day surgery patients remains scarce—particularly in light of the rapid growth in ophthalmic day surgery volume and scope. Therefore, this study aimed to investigate the current status of RHD among adult ophthalmic day surgery patients and to identify psychosocial and clinical factors associated with discharge readiness, with the goal of providing evidence to inform and optimize clinical practice.
Materials and Methods
Ethical Approval
This study was conducted in accordance with the Declaration of Helsinki. This study received approval from the hospital’s ethics committee of West China Hospital, Sichuan University (Approval No. 2024–2291), and informed consent was obtained from all patients. All patient information remained confidential throughout the study.
Study Participants
A convenience sampling method was used to recruit patients who underwent elective ophthalmic day surgery in the Department of Ophthalmology, West China Hospital of Sichuan University, between December 2024 and March 2025. Inclusion criteria: 1) Age ≥18 years and voluntary participation in this study; 2) Patients undergoing ophthalmic surgery in our department for the first time; 3) Absence of communication disorders and ability to engage in basic verbal or written communication; 4) Postoperative condition stable and meeting discharge criteria.
Exclusion criteria: 1) Patients undergoing a second or subsequent ophthalmic surgery in our department; 2) Refusal to participate in this study. A total number of 286 eligible patients who met the inclusion and exclusion criteria, five were excluded due to incomplete questionnaire data. Consequently, 281 participants were included in the final analysis (Figure 1).
Figure 1.
Flowchart of patient enrollment in the ophthalmology day-surgery unit.
Research Tools
General Information Questionnaire
A self-designed general information questionnaire was developed by the researchers to collect demographic and clinical characteristics, including sex, age, educational level, marital status, occupation, monthly household income, place of residence, primary caregiver, living arrangements, and disease-related information. Among these variables, pre-admission visual acuity was assessed using the International Standard Visual Acuity Chart.12 Visual acuity was categorized according to the classification of visual impairment revised by the World Health Organization (WHO) in 2003,13 as shown in Table 1.
Table 1.
Proposed Revision of Categories of Visual Impairment
| Category | Presenting Distance Visual Acuity | |
|---|---|---|
| Worse Than: | Equal to or Better Than: | |
| Mild or no visual impairment 0 | 3/10 (0.3) | |
| Moderate visual impairment 1 | 3.2/10 (0.3) | 1/10 (0.1) |
| Severe visual impairment 2 | 1/10 (0.1) | 1/20 (0.05) |
| Blindness 3 | 1/20 (0.05) | 1/50 (0.02)* |
| Blindness 4 | 1/50 (0.02)* | Light perception |
| Blindness 5 | No light perception | |
Notes: * Or counts fingers (CF) at 1 metre; Low vision refers to categories of moderate and severe visual impairment.
Readiness for Hospital Discharge Scale
This study employed the Chinese version of the RHDS, originally developed by Weiss et al14 and later translated and revised by Lin et al15 in Taiwan, to evaluate patients’ readiness for discharge. The scale comprises three dimensions—personal status, coping ability, and expected support—with a total of 12 items. Each item is rated on a scale from 0 to 10, with higher scores indicating greater readiness for discharge.
According to the classification proposed by Weiss et al,16 the mean item score of the RHDS can be categorized into four levels: high (9–10), relatively high (8–8.99), moderate (7–7.99), and low (<7). The original scale demonstrated good internal consistency (Cronbach’s α = 0.89), with subscale α coefficients of 0.73, 0.90, and 0.89. In the present study, the scale also showed acceptable internal consistency (Cronbach’s α = 0.81), and the three subscales yielded α coefficients of 0.85, 0.78, and 0.84, respectively.
All Aspects of Health Literacy Scale
This study adopted the All Aspects of Health Literacy Scale (AAHLS), originally developed by Chinn et al17 in the United Kingdom and introduced and culturally adapted into Chinese by Wu et al18 in 2017. The scale comprises three dimensions: ability to use written health information, ability to communicate with healthcare providers, and ability to evaluate and apply health information, with a total of 11 items. Each item is rated on a 3-point Likert scale (“rarely,” “sometimes,” and “often”), scored from 1 to 3, with higher scores indicating higher levels of health literacy. The original instrument showed acceptable internal consistency (Cronbach’s α = 0.81), with subscale α coefficients ranging from 0.72 to 0.76. In the present study, the overall internal consistency remained acceptable (Cronbach’s α = 0.80), with subscale α coefficients of 0.66, 0.78, and 0.68, respectively.
Quality of Discharge Teaching Scale
This study employed the Chinese version of the Quality of Discharge Teaching Scale (QDTS), originally developed by Weiss et al14 in the United States and translated, back-translated, and culturally adapted by Wang et al19 in 2016. The scale consists of 24 items across three dimensions: content needed, content received, and delivery skills and effectiveness. The total score for discharge teaching quality is calculated as the sum of the scores from the content received and delivery skills and effectiveness dimensions. Each item is rated on a scale from 0 to 10, yielding a total score ranging from 0 to 180, with higher scores indicating better quality of discharge teaching. The original scale demonstrated excellent internal consistency (Cronbach’s α = 0.92), with subscale α coefficients ranging from 0.82 to 0.93. In this study, the overall internal consistency was also excellent (Cronbach’s α = 0.93), and the three subscales yielded α coefficients of 0.81, 0.85, and 0.95, respectively.
Data Collection Method
In this study, adult patients who underwent ophthalmic day surgery in our hospital were surveyed. Prior to data collection, a standardized explanation was provided by the researchers. At the time of discharge, questionnaires were distributed individually via Wenjuanxing (an online survey platform) through WeChat, and patients completed the survey independently. For those unable to complete the questionnaire online due to visual impairment, the researchers conducted face-to-face, one-on-one interviews, during which patients provided responses themselves. All questionnaires were completed and submitted on-site. Disease-related information in the general information questionnaire was obtained by investigators through medical record review. A total of 286 questionnaires were distributed, of which 281 were valid, yielding an effective response rate of 98.3%.
Statistical Analysis
All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Normally distributed continuous variables were expressed as mean ± standard deviation (
). Between-group comparisons were conducted using the independent-samples t-test, while comparisons among multiple groups were performed using one-way analysis of variance (ANOVA). Categorical variables were described as frequencies and percentages. Pearson correlation analysis was used to examine associations, and stepwise multiple linear regression analysis was conducted to identify influencing factors. P value < 0.05 was considered statistically significant.
Results
Demographic and Disease-Related Characteristics
A total of 286 questionnaires were distributed, and 5 invalid questionnaires were excluded, leaving 281 valid cases for analysis. Of the participants, 128 were male (45.6%) and 153 were female (54.4%). Most patients were aged 18–65 years (66.5%), married (77.6%), and had attained at least a junior college education (45.9%). A total of 33.1% were retired, and 33.1% reported a monthly per capita household income of 3001–6000 RMB. The spouse was identified as the primary caregiver in 42.7% of cases. Detailed characteristics are presented in Table 1.
As shown in Table 2, RHDS scores differed significantly by sex, marital status, place of residence, presence of comorbid chronic diseases, pre-admission visual acuity (low vision vs normal), type of surgery, and the requirement for special postoperative positioning (all P < 0.05).
Table 2.
Comparison of RHDS Scores by Patient Characteristics
| Variables | n (%) | RHDS Score ( ) |
F/T | P |
|---|---|---|---|---|
| Sex | ||||
| Female | 153 (54.4) | 96.80±14.78 | 3.764 | 0.000 |
| Male | 128 (45.6) | 102.69±10.6 | ||
| Age (years) | ||||
| 18~65 | 187 (66.5) | 99.53±13.85 | 0.887 | 0.413 |
| 66~79 | 83 (29.5) | 100.06±12.18 | ||
| ≥80 | 11 (3.9) | 94.36±13.16 | ||
| Education level | ||||
| Primary school or below | 55 (19.6) | 96.51±14.52 | 1.895 | 0.131 |
| Junior high school | 57 (20.3) | 98.11±14.89 | ||
| Senior high school/technical secondary school | 40 (14.2) | 102.00±12.36 | ||
| Junior college or above | 129 (45.9) | 100.58±12.23 | ||
| Occupation | ||||
| Farmer/worker | 63 (22.4) | 97.75±16.45 | 1.897 | 0.130 |
| Freelancer/others | 86 (30.6) | 101.31±10.17 | ||
| Government employee/professional | 39 (13.9) | 102.15±12.76 | ||
| Retired | 93 (33.1) | 97.85±13.65 | ||
| Marital status | ||||
| Single | 38 (13.5) | 103.00±8.18 | 2.870 | 0.037 |
| Married | 218 (77.6) | 99.56±13.43 | ||
| Divorced/separated | 10 (3.6) | 96.30±18.00 | ||
| Widowed | 15 (5.3) | 91.60±16.67 | ||
| Living arrangement | ||||
| Alone | 20 (7.1) | 97.00±17.87 | 1.212 | 0.299 |
| With family | 257 (91.5) | 99.54±13.00 | ||
| With relatives or nanny | 4 (1.4) | 108.25±6.60 | ||
| Primary caregiver | ||||
| Self | 71 (25.3) | 100.39±13.37 | 0.148 | 0.931 |
| Spouse | 120 (42.7) | 99.15±12.61 | ||
| Parents/children | 80 (28.5) | 99.25±14.67 | ||
| Others (relatives/nanny) | 10 (3.6) | 98.90±12.40 | ||
| Place of residence | ||||
| Urban | 215 (76.5) | 100.62±11.99 | 6.702 | 0.001 |
| Town | 38 (13.5) | 99.29±13.31 | ||
| Rural | 28 (10.0) | 91.00±18.54 | ||
| Monthly per capita household income (RMB) | ||||
| ≤1000 | 33 (11.7) | 96.33±16.68 | 1.123 | 0.340 |
| 1001 ~ 3000 | 65 (23.1) | 98.94±13.17 | ||
| 3001 ~ 6000 | 93 (33.1) | 99.37±11.73 | ||
| ≥ 6001 | 90 (32.0) | 101.16±13.67 | ||
| Payment method | ||||
| Self-pay | 50 (17.8) | 102.20±10.32 | 1.591 | 0.113 |
| Medical insurance/new rural cooperative/commercial insurance | 231 (82.2) | 98.90±13.87 | ||
| Comorbid chronic diseases | ||||
| No | 204 (72.6) | 100.46±11.67 | 1.997 | 0.047 |
| Yes | 77 (27.4) | 96.91±16.85 | ||
| Pre-admission low vision or blindness | ||||
| No | 104 (37.0) | 96.96±14.05 | 2.449 | 0.015 |
| Yes | 177 (63.0) | 100.97±12.73 | ||
| Type of surgery | ||||
| Cataract (combined with glaucoma) | 164 (58.4) | 99.91±12.79 | 2.647 | 0.049 |
| Vitreoretinal surgery | 46 (16.4) | 94.78±15.95 | ||
| ICL (implantable collamer lens) surgery | 40 (14.2) | 102.22±10.88 | ||
| Others (strabismus/tumor/pterygium/entropion, etc.) | 31 (11.0) | 100.68±13.90 | ||
| Postoperative special positioning | ||||
| Yes | 35 (12.5) | 90.11±20.31 | 4.594 | 0.000 |
| No | 246 (87.5) | 100.82±11.49 | ||
| Anesthesia type | ||||
| General anesthesia | 16 (5.7) | 97.81±11.43 | 0.515 | 0.607 |
| Local anesthesia | 265 (94.3) | 99.58±13.47 | ||
| Complications during hospitalization (Ocular hypertension) | ||||
| Yes | 18 (6.4) | 95.06±22.60 | 1.457 | 0.146 |
| No | 263 (93.6) | 99.79±12.49 |
RHDS Scores
As presented in Table 3, ophthalmic day surgery patients demonstrated a mean total RHDS score of 99.48 ± 13.35, corresponding to a mean item score of 8.29 ± 1.11, which reflects a relatively high level of discharge readiness. Among the subscales, expected support yielded the highest mean item score (8.76 ± 1.62), followed by personal status (8.42 ± 1.63) and coping ability (7.99 ± 1.11).
Table 3.
RHDS Scores
| Dimension | Score Range | Mean Total Score ( ) |
Mean Item Score ( ) |
|---|---|---|---|
| Personal status | 2-30 | 25.26±4.88 | 8.42±1.63 |
| Coping ability | 20-59 | 47.94±6.64 | 7.99±1.11 |
| Expected support | 0-30 | 26.28±4.86 | 8.76±1.62 |
| Total RHDS score | 34-118 | 99.48±13.35 | 8.29±1.11 |
Correlation Analysis of RHD, Health Literacy, and Quality of Discharge Teaching
Pearson correlation analysis showed that RHD was weakly positively correlated with health literacy (r = 0.218, P < 0.01) and moderately positively correlated with the quality of discharge teaching (r = 0.500, P < 0.01) among ophthalmic day surgery patients (Table 4).
Table 4.
Pearson Correlation Matrix of RHD, Health Literacy, and Quality of Discharge Teaching
| Variables | RHDS Total | Personal Status | Coping Ability | Expected Support | Health Literacy Total | Use of Written Health Information | Communication | Evaluation & Application of Health Information |
QDTS | Content Needed | Content Received | Delivery Skills & Effectiveness |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RHDS total | 1 | |||||||||||
| Personal status | 0.834** | 1 | ||||||||||
| Coping ability | 0.862** | 0.602** | 1 | |||||||||
| Expected support | 0.731** | 0.465** | 0.396** | 1 | ||||||||
| Health literacy total | 0.218** | 0.231** | 0.130* | 0.189** | 1 | |||||||
| Use of written health information | 0.287** | 0.306** | 0.212** | 0.191** | 0.557** | 1 | ||||||
| Communication | 0.025 | 0.061 | −0.035 | 0.055 | 0.792** | 0.186** | 1 | |||||
| Evaluation & application | 0.161** | 0.139* | 0.104 | 0.160** | 0.785** | 0.085 | 0.514** | 1 | ||||
| QDTS total | 0.500** | 0.432** | 0.379** | 0.420** | 0.285** | 0.204** | 0.167** | 0.237** | 1 | |||
| Content needed | 0.147* | 0.134* | 0.089 | 0.148* | 0.023 | −0.153** | 0.04 | 0.137* | 0.569** | 1 | ||
| Content received | 0.303** | 0.243** | 0.214** | 0.295** | 0.202** | 0.096 | 0.102 | 0.222** | 0.852** | 0.690** | 1 | |
| Delivery skills and effectiveness | 0.549** | 0.486** | 0.425** | 0.437** | 0.295** | 0.241** | 0.183** | 0.211** | 0.947** | 0.413** | 0.638** | 1 |
Notes: * P < 0.05; ** P < 0.01.
Factors Influencing RHDS Among Ophthalmic Day Surgery Patients
RHDS among the 281 patients was set as the dependent variable, while independent variables were those identified as statistically significant in univariate and correlation analyses. Stepwise multiple linear regression analysis was conducted, with variable coding presented in Table 5.
Table 5.
Variables Assignments for Multiple Linear Regression Analysis
| Variables | Coding |
|---|---|
| Sex | Female = 0, 0; Male = 0, 1 |
| Place of residence | Urban = 0, 0, 0; Town =0, 1, 0; Rural =0, 0, 1 |
| Pre-admission low vision or blindness | No = 0, 0; Yes = 0, 1 |
| Postoperative special positioning | No = 0, 0; Yes = 0, 1 |
| Marital status | Single = 0.0, 0, 0; Married = 0, 1, 0, 0; Divorced/separated = 0, 0, 1, 0; Widowed =0, 0, 0, 1 |
| Comorbid chronic diseases | No = 0, 0; Yes = 0, 1 |
| Type of surgery | Cataract = 0, 0, 0, 0; Vitreoretinal surgery = 0, 1, 0, 0; ICL surgery = 0, 0, 1, 0; Others = 0, 0, 0, 1 |
| Health literacy | Each dimension entered as continuous variables |
| Quality of discharge teaching | Each dimension entered as continuous variables |
The results (Table 6) showed that quality of discharge teaching (delivery skills and effectiveness), health literacy (use of written health information), male sex, rural residence, pre-admission low vision or blindness, and the requirement for special postoperative positioning were the principal factors associated with RHD in ophthalmic day surgery patients, collectively accounting for 41.8% of the variance (all P < 0.05).
Table 6.
Multiple Linear Regression Analysis of Factors Influencing RHDS Among Ophthalmic Day Surgery Patients
| Independent Variables | B | SE | β | t | P |
|---|---|---|---|---|---|
| Constant | 53.418 | 4.9 | _ | 10.902 | 0.000 |
| Quality of discharge teaching (delivery skills and effectiveness) | 0.352 | 0.036 | 0.466 | 9.783 | 0.000 |
| Postoperative special positioning (Yes) | −9.502 | 1.856 | −0.235 | −5.119 | 0.000 |
| Health literacy (use of written health information) | 1.215 | 0.427 | 0.136 | 2.846 | 0.005 |
| Sex (Male) | 3.47 | 1.236 | 0.13 | 2.806 | 0.005 |
| Place of residence (Rural) | −5.889 | 2.086 | −0.132 | −2.823 | 0.005 |
| Pre-admission low vision or blindness | −2.979 | 1.266 | −0.108 | −2.353 | 0.019 |
Discussion
Current Status of RHDS Among Ophthalmic Day Surgery Patients
RHDS reflects a patient’s ability to engage in self-care after returning home, encompassing not only the capacity to manage daily living activities but also the competence to address medical and nursing needs during recovery.6 In the context of day surgery—a model characterized by short hospitalization, high turnover efficiency, streamlined processes, and relatively rapid recovery—discharge readiness plays a critical role in determining postoperative outcomes.20
In this study, the mean total RHDS scores of ophthalmic day surgery patients was 99.48 ± 13.35, with a mean item score of 8.29 ± 1.11, reflecting a relatively high level of discharge readiness. This was slightly higher than the findings of Weiss et al14 (mean item score 8.0 ± 0.90) and Qiu et al20 in cataract patients (8.04 ± 1.11). The differences may be attributable to variations in study instruments, patient populations, and healthcare contexts. Moreover, the study hospital has implemented a well-established day surgery program with standardized admission procedures, comprehensive preoperative preparation, and structured postoperative and discharge education, which may have contributed to the higher RHDS scores observed.
Regarding the RHDS subscales, the highest mean item score was for expected support (8.76 ± 1.62), followed by personal status (8.42 ± 1.63) and coping ability (7.99 ± 1.11). Coping ability remained at a moderate level, with the lowest scores on items such as “ability to care for oneself at discharge” and “knowledge of self-care after discharge”, consistent with the findings of Qiu et al.21 Potential explanations include postoperative eye bandaging, the need for special positioning, and residual effects of general anesthesia, all of which may compromise self-care capacity at discharge. Furthermore, given that many participants were middle-aged or elderly, the brief hospitalization period may have limited their opportunity to acquire adequate disease-related nursing knowledge.
These findings highlight the importance of healthcare providers placing greater emphasis on patients’ coping ability, particularly in vulnerable subgroups. Tailored health education and individualized nursing interventions should be prioritized to enhance adaptive capacity, strengthen self-care knowledge, and foster confidence in managing postoperative recovery at home.
Factors Influencing RHDS
The present study identified quality of discharge teaching (delivery skills and effectiveness), health literacy (use of written health information), male sex, rural residence, pre-admission low vision, and postoperative special positioning as major factors influencing discharge readiness among ophthalmic day surgery patients. The possible explanations are as follows:
Sex
Our findings indicated that male patients had higher discharge readiness scores than female patients, consistent with the results of Qiu et al.21 This difference may be attributable to gender-specific psychological characteristics. Women are often more meticulous, tend to repeatedly reflect on surgical experiences, and are more focused on illness and related emotions. Such tendencies are associated with higher levels of ruminative thinking, defined as repetitive, persistent, and prolonged negative thoughts concerning self-perceptions, worries, and distressing experiences.22 Therefore, healthcare professionals should provide targeted support for female patients by encouraging emotional expression and reinforcing education on disease-related nursing knowledge to improve their discharge readiness.
Place of Residence
This study demonstrated that patients residing in rural areas had lower discharge readiness compared with those living in urban or suburban regions, consistent with previous reports.6,23 Urban and suburban patients generally benefit from better access to transportation and medical services, which facilitates greater support and healthcare resources after discharge,6 thereby reducing concerns and psychological burden. By contrast, rural patients often face limited resources and higher uncertainty, resulting in lower discharge readiness. Accordingly, healthcare providers should prioritize rural patients, assess their specific needs, and deliver tailored support to address practical challenges, ultimately enhancing their discharge readiness.
Pre-Admission Low Vision or Blindness
The results demonstrated that patients with low vision or blindness had lower discharge readiness compared with those without visual impairment, consistent with the findings of Gao et al.6 Visual impairment exerts a substantial negative impact on multiple domains of quality of life.24,25 Patients with visual impairment often experience challenges in reading, performing daily activities, and managing postoperative self-care. Therefore, greater emphasis should be placed on this subgroup, with particular attention to caregiver involvement. Strengthening caregiver education and support is crucial to ensure effective home care and to enhance discharge readiness among visually impaired patients.
Postoperative Special Positioning
Patients with retinal detachment who undergo pars plana vitrectomy combined with gas or silicone oil tamponade are required to maintain specific head positioning—such as prone, lateral decubitus, or upright—depending on the location of the retinal break. These positions must typically be maintained for 1–2 weeks and, in some cases, for 3–6 months or even longer.26,27 The purpose of this strategy is to ensure that the silicone oil or gas within the vitreous cavity applies sustained pressure on the detached retina, facilitating reattachment and closure of the retinal break.6
In the present study, patients requiring postoperative special positioning had lower discharge readiness, consistent with the findings of Gao et al6 in retinal detachment patients. Special positioning usually requires patients to maintain designated postures for ≥16 hours per day,6 which markedly reduces self-care ability, restricts daily activities, and is associated with poor adherence due to the extended duration of positioning.26 Therefore, healthcare providers should reinforce education through multimodal approaches, including video-based instructional materials, to emphasize the importance of postoperative positioning, demonstrate correct postures and rehabilitation techniques, and provide individualized guidance. In addition, strengthening follow-up after discharge and monitoring adherence to positioning regimens are essential to enhance patients’ self-efficacy, thereby improving their discharge readiness.
Impact of the Quality of Discharge Teaching
The quality of discharge teaching has consistently been identified as the strongest positive predictor of RHDS.14 In the present study, RHDS was moderately correlated with discharge teaching quality (r = 0.500, P < 0.01), indicating that better teaching quality is associated with higher readiness for discharge.7,21,28,29
In the multiple linear regression analysis, the subdimension of “delivery skills and effectiveness” emerged as the key determinant of discharge readiness. This underscores the need to enhance teaching delivery in clinical practice, with instructions tailored to patients’ individual needs rather than following a standardized, one-size-fits-all model.30 Furthermore, systematic evaluation of teaching effectiveness is crucial to ensure that patients have adequately understood and can apply knowledge related to postoperative recovery and discharge care. Regular competency assessments of nursing staff, together with targeted training to improve communication skills and health education strategies, are recommended to strengthen discharge teaching quality and ultimately improve patient outcomes.
Impact of Health Literacy
Health literacy is defined as the capacity of individuals to access, understand, and utilize health information and services to make informed health-related decisions and take appropriate actions for themselves and others.30 In this study, RHDS was positively correlated with health literacy (r = 0.218, P < 0.01), indicating that higher health literacy is associated with greater readiness for discharge.
Health literacy is a well-recognized determinant of health-related behaviors, including medication adherence, treatment beliefs, and self-management skills.31,32 In the multiple linear regression analysis, the subdimension “ability to use written health information” was identified as a significant predictor of RHDS. This finding suggests that patients with stronger skills in processing written health information are more capable of comprehending discharge instructions, acquiring relevant self-care competencies, and effectively applying health information, thereby achieving higher levels of discharge readiness.
For patients with limited health literacy, healthcare professionals should enhance the readability, clarity, and practical applicability of educational materials to facilitate understanding and implementation.33 Furthermore, clinicians are encouraged to promote active patient engagement in learning, foster effective communication between patients and caregivers, and provide structured guidance on managing health information. Such interventions may gradually improve health literacy and, in turn, strengthen patients’ readiness for discharge.
Limitations and Recommendations
This study has several limitations. First, participants were recruited exclusively from a single tertiary hospital with abundant medical resources, which may compromise the representativeness of the sample and limit the generalizability of the findings. Future studies should enlarge sample sizes and include patients from different geographic regions and hospitals of various levels to improve external validity. Second, due to its cross-sectional design, this study cannot establish causal relationships between the examined variables and RHD. Longitudinal or interventional studies are warranted to clarify causal pathways. Finally, only a restricted range of potential influencing factors was examined, and other clinical, psychological, and social determinants may not have been captured. Future research should incorporate a broader set of variables to comprehensively elucidate the factors influencing discharge readiness among ophthalmic day surgery patients.
Conclusion
Ophthalmic day surgery patients demonstrated a relatively high level of RHD. Factors independently associated with discharge readiness included male gender, rural residence, impaired vision at admission, the need for special postoperative positioning, the quality of discharge teaching (particularly delivery skills and effectiveness), and health literacy (especially the ability to use written health information). These findings underscore the importance of prioritizing patients from rural areas, female patients, those with visual impairment, and individuals requiring specific postoperative positioning. Implementing tailored discharge education, enhancing the delivery of teaching, and strengthening health literacy may collectively improve discharge readiness and facilitate a smoother transition to home recovery in this population.
Acknowledgments
We would like to express our special gratitude to all study participants for their time during data collection. We are grateful to our colleagues who strongly supported the study.
Disclosure
The author(s) report no conflicts of interest in this work.
References
- 1.Fang S, Yilin Z. The current status and analysis of continuing care in ophthalmic day surgery in China. Chin Gen Pract Nurs. 2025;23(13):2456–12. doi: 10.12104/j.issn.1674-4748.2025.13.013 [DOI] [Google Scholar]
- 2.Haihan D, Changfei Z, Hengli L, Ning T, Lezhen Z, Hui L. The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals. Cost Eff Resour Alloc. 2024;22(1). doi: 10.1186/s12962-024-00558-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chen L, Wang W. Improving safety and quality of nursing care of day surgery with centralized management. Asian J Surg. 2024;47(5):2408–2409. doi: 10.1016/j.asjsur.2024.01.076 [DOI] [PubMed] [Google Scholar]
- 4.Luo J, Xie C, Fan D. Historical development and experience of day surgery in china: from the perspective of anesthesiologists. Paediatr Anaesth. 2025;35(6):412–423. doi: 10.1111/pan.15078 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Galvin E, Wills T, Coffey A. Readiness for hospital discharge: a concept analysis. J Adv Nurs. 2017;73(11):2547–2557. doi: 10.1111/jan.13324 [DOI] [PubMed] [Google Scholar]
- 6.Gao S, Huang N, Huang W, Lian Y, Xiao H, Yao S. Position adherence in patients underwent pars plana vitrectomy with silicone oil tamponade. Patient Prefer Adherence. 2024;18:829–838. doi: 10.2147/PPA.S453683 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Shu P, Xuan L, Jiang X. Discharge readiness and associated factors among patients with coronary heart disease after stent implantation: a cross-sectional single center study. Patient Prefer Adherence. 2024;18:1373–1383. doi: 10.2147/PPA.S465918 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Liu L, Jin W, Yan L, Xiaoling L. Status and influencing factors of discharge readiness of patients with intestinal tuberculosis. Chinese Evid Dased Nurs. 2024;10(18):3371–3375. doi: 10.12102/j.issn.2095-8668.2024.18.022 [DOI] [Google Scholar]
- 9.Zhang A, Feng X, Qiu C. Discharge teaching, readiness for hospital discharge and post-discharge outcomes in cataract patients: a structural equation model analysis. J Nurs Manag. 2021;29(3):543–552. doi: 10.1111/jonm.13169 [DOI] [PubMed] [Google Scholar]
- 10.Kaya S, Sain Guven G, Aydan S, et al. Patients’ readiness for discharge: predictors and effects on unplanned readmissions, emergency department visits and death. J Nurs Manag. 2018;26(6):707–716. doi: 10.1111/jonm.12605 [DOI] [PubMed] [Google Scholar]
- 11.Zhang J, Yao S, Huang F, et al. Exploring the role of social support between discharge teaching and readiness for discharge in ocular fundus disease patients: a cross-sectional study. J Ophthalmol. 2021;2021:1–9. doi: 10.1155/2021/5547351 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Xu H, Yin Z, Wang F. Discussion on issues with the current vision charts used in China. Recent Adv Op Hthalmol. 2002;22(5):367–369. doi: 10.3969/j.issn.1003-5141.2002.05.027 [DOI] [Google Scholar]
- 13.WHO. Consultation on Development of Standards for Characterization of Vision Loss and Visual functioning. [Google Scholar]
- 14.Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec. 2007;21(1):31–42. doi: 10.1097/00002800-200701000-00008 [DOI] [PubMed] [Google Scholar]
- 15.Lin YH, Kao CC, Huang AM, Chi MT, Chou FH. Psychometric testing of the Chinese version of the readiness for hospital discharge scale. J Nurs. 2014;61(4):56–65. doi: 10.6224/JN.61.4.56 [DOI] [PubMed] [Google Scholar]
- 16.Weiss ME, Costa LL, Yakusheva O, Bobay KL. Validation of patient and nurse short forms of the readiness for hospital discharge scale and their relationship to return to the hospital. Health Serv Res. 2014;49(1):304–317. doi: 10.1111/1475-6773.12092 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Chinn D, McCarthy C. All Aspects of Health Literacy Scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient Educ Couns. 2013;90(2):247–253. doi: 10.1016/j.pec.2012.10.019 [DOI] [PubMed] [Google Scholar]
- 18.Wu Q, Ye X, Wu Y, Zhao L, Wu J. The chinesization of All Aspects of Health Literacy Scale and its reliability and validity. Chin Gen Pract. 2017;20(10):1229–1233. doi: 10.3969/j.issn.1007-9572.2017.10.018 [DOI] [Google Scholar]
- 19.Wang B, Wang H, Yang C. Reliability and validity of the Chinese version of the quality of discharge teaching scale. Chin J Nurs. 2016;51(6). doi: 10.3761/j.issn.0254-1769.2016.06.025 [DOI] [Google Scholar]
- 20.Xu M, Chen L. Readiness for hospital discharge and its influencing factors among inguinal hernia patients in a day surgery setting. Mod Dig Interv. 2022;27(1):63–67. doi: 10.3969/j.issn.1672-2159.2022.01.014 [DOI] [Google Scholar]
- 21.Qiu C, Feng X, Zeng J, Luo H, Lai Z. Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: a cross-sectional stud. Indian J Ophthalmol. 2019;67(5):612–617. doi: 10.4103/ijo.IJO_1116_18 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Stelmach-Lask L, Glebov-Russinov I, Henik A. What is high rumination? Acta Psychol. 2024;248. doi: 10.1016/j.actpsy.2024.104331 [DOI] [PubMed] [Google Scholar]
- 23.Qian J, Qian M, Ren Y, et al. Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery. BMC Surg. 2021;21(1). doi: 10.1186/s12893-021-01119-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Asimadu IN, Okeke S, Onyebueke GC. Vision-related quality of life amongst patients with low vision and blindness in a resource-limited country. Int Ophthalmol. 2023;43(4):1291–1302. doi: 10.1007/s10792-022-02527-8 [DOI] [PubMed] [Google Scholar]
- 25.Senjam SS, Tandon R, Vashist P, Mounica B, Gupta V, Aggarwal S. Guidelines for setting up low‑vision and rehabilitation services in India. Indian J Ophthalmol. 2024;72(11):1580–1585. doi: 10.4103/IJO.IJO_2712_23 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Li Y, Li J, Shao Y, Feng R, Li J, Duan Y. Factors influencing compliance in RRD patients with the face-down position via grounded theory approach. Sci Rep. 2022;12(1). doi: 10.1038/s41598-022-24121-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Chronopoulos A, Schutz JS, Finger RP. Prevention of rhegmatogenous retinal detachment. Surv Ophthalmol. doi: 10.1016/j.survophthal.2025.04.006 [DOI] [PubMed] [Google Scholar]
- 28.Yu Q, He LJ, Zhong JD, Zhang JE. Readiness for hospital discharge and its association with post-discharge outcomes among oesophageal cancer patients after oesophagectomy: a prospective observational study. J Clin Nurs. 2024;33(10):3969–3978. doi: 10.1111/jocn.17055 [DOI] [PubMed] [Google Scholar]
- 29.Qiu C, Feng X, Zeng J, Jiang Y. Relationships between cataract surgery patient-perceived discharge teaching quality, discharge readiness, and post-discharge outcomes: a cross-sectional study based on regression modeling analysis. Ophthalmic Res. 2023;66(1):328–338. doi: 10.1159/000527958 [DOI] [PubMed] [Google Scholar]
- 30.Thoen CW, Sæle M, Strandberg RB, Eide PH, Kinn LG. Patients’ experiences of day surgery and recovery: a meta-ethnography. Nurs Open. 2024;11(1). doi: 10.1002/nop2.2055 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Gao Y, Yan K, Yan X, Xi N, Gao J, Ren H. Correlation between health literacy and health-related quality of life in patients with diabetic peripheral neuropathy: the mediating role of self-management. Nurs Open. 2023;10(5):3164–3177. doi: 10.1002/nop2.1566 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Pharmaceutics. 2021;13(7):1100. doi: 10.3390/pharmaceutics13071100 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Tucker CA. Promoting personal health literacy through readability, understandability, and actionability of online patient education material. J Am Heart Assoc. 2024;13(8). doi: 10.1161/JAHA.124.033916 [DOI] [PMC free article] [PubMed] [Google Scholar]