Hospital readmissions within 30 days: contribution of nursing diagnoses to health empowerment

Vollständiger Abstract

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Introduction: Hospital readmissions within 30 days are an indicator of the quality of care and are a multifactorial phenomenon. Nursing interventions focused on empowering patients to self-manage their condition have been linked to a reduction in readmissions. Objectives: To characterize 30-day hospital readmissions and analyze nursing diagnoses in the domain of health empowerment. Methodology: An exploratory, retrospective, descriptive and correlational study based on the analysis of clinical data from a teaching hospital. The study included readmission episodes among adults over a 2-year period and identified nursing diagnoses related to health empowerment. Results: A total of 1,985 initial admissions, each followed by at least one 30-day readmission, generated 2,457 readmission episodes. Readmissions ranged from 1 to 10 episodes, and 23.7% of initial admissions were followed by multiple readmissions. 55.5% of patients were aged ≥65 years, and the sex distribution was balanced (50.1% male). A positive correlation between age and length of stay was observed for the initial admission (R0) and the first two readmission episodes (R1 and R2). Most readmissions originated from the Accident and Emergency Department and were primarily associated with injuries and poisonings, neoplasms, and diseases of the circulatory system. A total of 3,207 nursing diagnoses were identified, of which 1,696 showed a documented positive status change. Overall, 87.87% of nursing diagnoses were recorded during the first readmission, and empowerment processes were predominantly person-centered (79.01%), focusing on perioperative care and the prevention of adverse events such as falls. Conclusion: Readmissions within 30 days reflect high clinical complexity, and are not always related to preventable events. Nursing diagnoses in the training domain point to a practice oriented toward acute care, with less focus on self-care and the family/carer, highlighting opportunities for improvement.