The effects of a solution-focused model discharge readiness coaching intervention on the parents of Chinese pediatric liver transplantation patients: a single-center observational study

Introduction

Liver transplantation (LT) is currently the only effective treatment for pediatric cholestatic diseases, liver malignancies, genetic metabolic diseases, and acute liver failure (1). With the continuous improvement of pediatric LT technology in China, the long-term survival of patients after surgery has been increasing (2). However, due to the development and application of the concept of rapid rehabilitation surgery in clinical practice and the lack of medical resources, the length of stay for LT patients has been shortened from more than 1 month to half a month (3). As a result, children are often discharged from the hospital without having fully recovered from their illnesses (4).

Parents of pediatric LT patients face significant psychological challenges, including anxiety, depression, and a lack of confidence in their ability to provide postoperative care (5). These challenges are compounded by the fact that in most pediatric LT cases, one of the parents is the donor. If the donor is also the primary caregiver, they must endure their own physical discomfort and recovery while also caring for their child, leading to high levels of psychological pressure and physical strain (6). Given these challenging circumstances, there is a need to explore psychological resources that can promote effective coping and positive adjustment.

The solution-focused approach, which includes five phases—description of the problem, goal setting, exploration of exceptions, provision of responses, and evaluation of results—has been shown to be effective in clinical practice (7). This approach places full focus on the individual and believes in individual potential and resource value in the context of positive psychology (8). The clinical application of the solution-focused model can effectively alleviate the negative mentality of nurses and improve their psychological resilience and happiness (9). However, no study has examined whether there is a relationship between the readiness for discharge of parents of pediatric LT patients and the solution-focused model. In this study, parents of pediatric LT patients were offered an intervention based on the solution-focused model to improve their ability to provide postoperative care to pediatric LT patients (10).

Current knowledge gaps in this area include a lack of comprehensive studies on the psychological challenges faced by parents of pediatric LT patients and the effectiveness of interventions aimed at improving their discharge readiness and mental health (11). Additionally, there is a need for more research on the development and application of the solution-focused model in clinical settings (12-14). This study aimed to address these gaps by evaluating the impact of a solution-focused model intervention on the discharge readiness and mental health status of parents of pediatric LT patients. We present this article in accordance with the STROBE reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-66/rc).

Methods

Study design

This study employed a quasi-experimental design with a control group and an experimental group to assess the impact of a solution-focused model discharge readiness coaching intervention on the parents of pediatric LT patients. The study was conducted in the Organ Transplantation Department of The First Affiliated Hospital of Guangxi Medical University. A convenience sampling method was used to select either the father or the mother of 110 pediatric LT patients hospitalized between January 2022 and December 2023. The study period was divided into two phases: the control group consisted of 55 parents of children who underwent LT between January and December 2022, while the experimental group included 55 parents of children who underwent LT between January and December 2023. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was reviewed and approved by the Medical Ethics Committee of The First Affiliated Hospital of Guangxi Medical University (No. 2023-S061-01). Informed consent was taken from the patients’ parents or legal guardians.

Sample size estimation

The sample size was determined based on previous studies and the availability of eligible participants within the specified time frame (4-6). Assuming a medium effect size (Cohen’s d =0.5) and aiming for a power of 0.80 at a significance level of 0.05, a minimum of 55 participants per group was required. This estimation was based on a two-sided test, considering the primary outcome measure of discharge readiness scores.

Quality control measures

To ensure the quality and reliability of the study, several measures were implemented:

• Training of researchers: all researchers involved in the intervention were trained in the solution-focused model and the specific counseling techniques to be used. Training sessions were conducted by experienced psychologists and included both theoretical and practical components.
• Standardized intervention protocol: a detailed intervention protocol was developed and followed by all researchers. This protocol outlined the specific steps and content of each counseling session, ensuring consistency across all interventions.
• Supervision and monitoring: regular supervision meetings were held to review the progress of the intervention and address any issues or deviations from the protocol. Researchers were required to maintain detailed records of each session, including the content covered and any challenges encountered.
• Data quality assurance: data collection tools were pilot-tested to ensure their reliability and validity. Data entry was performed by trained personnel, and double-checking was conducted to minimize errors.

Study subjects

Using the convenience sampling method, 110 parents of pediatric LT patients who received an organ transplant at The First Affiliated Hospital of Guangxi Medical University between January 2022 to December 2023 were selected. To be eligible for inclusion in this study, participants were required to meet the following inclusion criteria: (I) have a child aged <18 years who had undergone their first LT; and (II) the children’s parents provided informed consent to participate in this study. Participants were excluded from the study if they met any of the following exclusion criteria: (I) the postoperative survival time of the pediatric patient with LT was <30 days; (II) the pediatric LT patient had severe, significant organ disease; and (III) they had to be withdrawn from the study by the investigator for various reasons.

Study methods

A total of 55 parents of pediatric LT patients between January 2022 and December 2022 were selected as the control group and 55 parents of pediatric LT patients between January 2023 and December 2023 were selected as the experimental group.

Implementation plan for the control group

The control group received the hospital’s routine education process. This included details of the admission registration process, information about hospital conditions and visitation rules, information about the public microblogging platform, and relevant content pushes.

Implementation plan for the experimental group

After consulting the relevant literature and considering the actual clinical situation of the organ transplant department of our hospital, the researchers designed an intervention program for the parents of pediatric LT patients. In addition to the routine educational content provided to the control group, a one-on-one intervention was conducted using the solution-focused model. The most important intervention steps are shown in Table 1.

Researchers visited the department classroom every Tuesday and Friday for the intervention, which lasted approximately 20 to 30 minutes each. The specific timing of the meeting was discussed with the parents of the pediatric LT patients. At the end of each intervention step, the researcher discussed planning the next intervention step with the parents of the LT children.

If the parents encountered problems at any time during the intervention process, they were able to report them to the researcher, who helped them accordingly and recorded the difficulties encountered by the parents in a timely manner; if the intervention effect did not reach the expected state, the intervention was adjusted in a timely manner or the successes of the other primary caregivers of LT children were shared in a timely manner in order to increase the motivation of the parents.

Study tools

The following tools were used in this study: (I) (i) general data questionnaire: this questionnaire collected data about the patient, including gender, age, only child (yes/no), date of hospitalization, and payment of medical expenses medical reimbursement rate; (ii) demographic data of the primary caregiver, including age, gender, race, occupation, education level, home address, and monthly family income. (II) Chinese version of the Readiness for Hospital Discharge Scale (RHDS): developed by American scientists Weiss et al., further compiled and published by Chinese scientists Lin et al. simplified (15,16). The scale includes 12 items in the following three dimensions: personal status (3 items), adaptability (5 items), and proactive support (4 items). Each item is scored from 0 to 10 and the total score is between 0 and 120. Higher scores indicate better readiness for hospital discharge. The Cronbach α coefficient of this scale is 0.890. (III) The Quality of Discharge Teaching Scale (QDTS). The QDTS was developed by Weiss et al. developed and translated to Chinese by Wang et al. (17,18). This scale includes 24 items in the following three dimensions: required content (6 items), received content (6 items), and teaching skills and impact (12 items). Each item is rated 0–10 points. The higher the value, the better the quality of discharge counseling for the discharged patients.

Statistical analysis

Statistical analysis was performed using SPSS software (version 18.0). Measurement data were expressed as mean ± standard deviation (SD) and analyzed using the independent sample t-test or the paired within-group t-test. Count data were expressed as cases (percentage) and analyzed using the χ² test. To ensure the comparability of the two samples, we conducted a Chi-squared test for categorical variables and an independent sample t-test for continuous variables. A P value <0.05 was considered statistically significant, and all tests were two-sided. Effect sizes were calculated to quantify the magnitude of the differences observed.

Results

Comparison of general data between the two groups

General data of pediatric LT patients

There were no significant differences between the pediatric LT patients in the two groups in terms of gender, age, complications, independence, donor source, hospitalization days, and payment method for medical expenses (all P>0.05) (Table 2).

General data of parents

There was no statistical difference between parents regarding gender, age, education level, duration of care, daily care, basic illness, occupation, ethnicity, place of residence and monthly family income (all P>0.05) (Table 3).

Comparison of parents’ discharge readiness and counseling quality scores between the two groups

Parents’ discharge readiness scores before the intervention

There was no statistically significant difference between the total score and the mean of all dimensions between the two groups (all P>0.05) (Table 4).

Parents’ discharge readiness scores after the intervention

The total discharge readiness score as well as the personal status scores, coping ability scores, and anticipatory support dimensions of the parents of children with LT in the experimental group were higher compared to those of the control group parents, and the difference was statistically significant (P<0.05) (Table 5). Pre- and post-intervention outcomes were compared between groups. After the intervention, the total scores and means of all dimensions of the parents were higher than before in both groups. The differences were statistically significant for the total score and the coping ability dimension scores in the control group (P<0.05) and for the total score, the personal status dimension score, the coping ability dimension score and the anticipatory support dimension score in the experimental group (P<0.05) (Table 6).

Parents’ discharge counseling quality scores after the intervention

The overall discharge counseling quality score was higher in the experimental group than in the control group, and the difference was statistically significant (P<0.05) (Table 7).

Discussion

The solution-focused model improved discharge readiness among parents of pediatric LT patients

In this study, the overall discharge readiness of the parents of pediatric LT patients in the two groups was low before the intervention for the following reasons: (I) before the intervention, the parents of the pediatric patients with LT did not have confidence in their knowledge about how to care for pediatric patients with LT after surgery at home. After LT, patients must take immune priming medications and maintain a controlled diet, and their medication levels must be monitored regularly. Many parents of pediatric LT patients fear that they do not have sufficient expertise and cannot care well for their children at home (19). (II) In most pediatric LT cases, one of the parents is the donor. If the donor is also the primary caregiver, the caregiver not only has to endure their own physical discomfort and recover from surgery but also care for their child; Therefore, both psychological pressure and physical strain are high (20).

This study also compared the discharge readiness scores of the two groups before and after the intervention and found that the total score, personal status dimension score, coping ability dimension, and expected support dimension score were higher in the experimental group than in the control group. The discharge readiness of the parents of pediatric LT patients in the two groups was higher after the intervention than before the intervention. The main reasons are as follows: (I) medical staff formulated LT booklets to improve the knowledge of the parents. In addition, when primary caregivers were unable to receive medical support, a WeChat group and public account were created and remote consultations were offered. Finally, when the donor was the primary caregiver, increased attention was given to these caregivers to prepare them for the discharge of their children (21). (II) Clinical intervention based on a solution-oriented model increases trust. It focuses on solving problems. Traditional intervention models get to the root of the problem. The experimental group received an intervention based on the solution-focused model of positive psychology, which required caregivers to focus their attention not only on the problem itself but also to improve parents’ adaptability and ability to regulate poor psychological states. By adjusting the resources and potential of the parents of pediatric LT patients, setting goals with the children and medical staff, and gradually achieving them, the discharge readiness of the parents of pediatric LT patients improved.

Focusing on the solution-focused model can effectively improve the quality of discharge counseling provided by nurses

The overall score for the quality of parental discharge counseling in this study was moderate in both groups. This may be due to the following reasons: (I) the hospital nurses ensure, in their daily work, personalized training according to the real needs of the children and their caregivers. The typical length of stay for pediatric LT patients is 1 to 3 months, and parents of pediatric LT patients have more time to interact with healthcare professionals during the hospitalization of their pediatric LT patients, expanding their understanding and knowledge of their child’s disease and improving their nursing skills. (II) Parents of pediatric LT patients can obtain more expertise about pediatric LT by following the public account “Organ Transplantation Home” of the organ transplant department of the hospital. If they have any doubts about the disease, they can first post in the WeChat group for parents of pediatric LT patients and receive timely answers from professional medical staff. Therefore, medical staff should improve the quality of discharge counseling for primary caregivers through activities such as holding regular health lectures, updating information on public accounts, distributing brochures, and setting up WeChat groups for children’s families.

This study found that the overall discharge counseling quality score and the average score of all dimensions were higher in the experimental group than in the control group. There may be several reasons for this finding. First, the solution-focused model is a clinical psychological intervention based on the development of positive psychology that can increase a person’s confidence and strength. When caring for their children, parents of pediatric LT patients often experience negative emotions such as guilt, sadness, and self-blame, and feel unsure when they encounter care difficulties. A solution-oriented psychological intervention can mobilize the trust of parents caring for pediatric LT patients (22). Second, parents of pediatric LT patients who received the intervention based on a solution-focused model were more active in seeking social support. Some studies have shown that the higher the level of social support, the higher the quality of care provided by primary caregivers (17-21). Good family support has a positive impact on parents of pediatric LT patients. The social support provided to parents of pediatric LT patients comes primarily from their families, particularly their spouses (23). In addition, social support made a positive impact on the physical and mental health of patients’ parents. The parents of pediatric LT patients in the experimental group were more active in seeking help from professional medical institutions and subsequently received more help.

Conclusions

The present study utilized a solution-focused model to provide a clinical intervention for the parents of pediatric LT patients, which demonstrated significant improvements in parental discharge readiness, the quality of discharge counseling provided by medical staff, and the establishment of a positive nurse-patient relationship. These findings underscore the potential effectiveness of the solution-focused model in enhancing the psychological preparedness and caregiving capabilities of parents, thereby contributing to better postoperative outcomes for pediatric LT patients.

However, it is crucial to acknowledge the limitations inherent in our study design. The recruitment of participants from a single tertiary hospital and the relatively small sample size may limit the generalizability of our findings. Additionally, the short follow-up duration and the non-randomized nature of the study could introduce biases and affect the robustness of our conclusions.

Future research should address these limitations by conducting multicenter, randomized controlled trials with larger and more diverse samples. Such studies would provide a more comprehensive understanding of the long-term effects of solution-focused interventions on parental mental health and patient outcomes. Furthermore, exploring the potential benefits of integrating solution-focused strategies into routine clinical care could offer valuable insights for healthcare providers aiming to optimize postoperative support for families of pediatric LT patients.

In summary, while our study provides promising evidence for the efficacy of the solution-focused model in improving discharge readiness and counseling quality, further rigorous research is warranted to validate these findings and to explore the broader applicability of this approach in clinical settings.

Acknowledgments

The authors would like to thank the staff of The First Affiliated Hospital of Guangxi Medical University for their help in this study.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-66/rc

Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-66/dss

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-66/prf

Funding: This work was supported by the Innovation Project of the Nursing Clinical Research Climbing Program of The First Affiliated Hospital of Guangxi Medical University (No. YYZS2023021).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-66/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was reviewed and approved by the Medical Ethics Committee of The First Affiliated Hospital of Guangxi Medical University (No. 2023-S061-01). Informed consent was taken from the patients’ parents or legal guardians.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Lee EJ, Vakili K. Pediatric liver transplantation. In: Shapiro R, Sarwal MM, Raina R, et al. editors. Pediatric Solid Organ Transplantation: A Practical Handbook. Singapore: Springer; 2023:415-27.
2. Ebel NH, Lai JC, Bucuvalas JC, et al. A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation. Liver Transpl 2022;28:1520-8. [Crossref] [PubMed]
3. Nikeghbalian S, Malekhosseini SA, Kazemi K, et al. The Largest Single Center Report on Pediatric Liver Transplantation: Experiences and Lessons Learned. Ann Surg 2021;273:e70-2. [Crossref] [PubMed]
4. Zhang N, Zhang HH, Liu Y. Factors associated with postoperative discharge readiness and continuing care needs in patients with lung cancer undergoing fast-track surgery: A prospective cohort study. Medicine (Baltimore) 2024;103:e39314. [Crossref] [PubMed]
5. Mi S, Jin Z, Qiu G, et al. Liver transplantation in China: Achievements over the past 30 years and prospects for the future. Biosci Trends 2022;16:212-20. [Crossref] [PubMed]
6. Zhao Y, Liu J, Li M, et al. The mediating effects of parenting self-efficacy between readiness for hospital discharge and post-discharge coping difficulty among mothers of preterm infants. Sci Rep 2024;14:19404. [Crossref] [PubMed]
7. Rodríguez-Laiz GP, Melgar-Requena P, Alcázar-López CF, et al. Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol. World J Surg 2021;45:1262-71. [Crossref] [PubMed]
8. Golder HJ, Papalois V. Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery. J Clin Med 2021;10:1634. [Crossref] [PubMed]
9. Tian M, Wang B, Xue Z, et al. Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study. JMIR Med Inform 2021;9:e27175. [Crossref] [PubMed]
10. Corcoran J, Pillai V. A review of the research on solution-focused therapy. British Journal of Social Work 2009;39:234-42.
11. Berg IK. Family-based services: A solution-focused approach. New York: WW Norton & Co; 1994.
12. Zhang B, Guo HM, Luan YQ, et al. Focus on the application of solution mode in psychological intervention and research progress. Journal of Nurses Training 2021;36:704-7.
13. Ren GZ, Fan HF, Bao LH. Effect of health education based on focused solution mode on cognition and behavior of patients with hyperlipidemia. Chinese Nursing Research 2020;34:1787-90.
14. Liao HL, Xiao AQ. Status and influencing factors of parents in neonatal intensive care unit. International Journal of Nursing 2024;43:2841-4.
15. Lin YH, Kao CC, Huang AM, et al. Psychometric testing of the Chinese version of the readiness for hospital discharge scale. Hu Li Za Zhi 2014;61:56-65. [Crossref] [PubMed]
16. Weiss ME, Piacentine LB. Psychometric properties of the Readiness for Hospital Discharge Scale. J Nurs Meas 2006;14:163-80. [Crossref] [PubMed]
17. Wang BH, Wang H, Yang CZ. Reliability and validity of the Chinese version of the Quality of Discharge Teaching Scale. Chinese Journal of Nursing 2016;51:752-5.
18. Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec 2007;21:31-42. [Crossref] [PubMed]
19. Surgical Nursing Committee of Shanghai Nursing Society. Expert consensus on perioperative nursing standards for pediatric kidney transplantation. Organ Transplantation 2023;14:343-51.
20. He T, Teng XY, Yang QL, et al. Analysis of the current status and influencing factors of the care burden of donors for pediatric liver transplantation. China Medical Herald 2021;18:72-5.
21. Lu LY, Wang HF, Lu FY, et al. Experience of readiness for discharge of family caregivers of children with liver transplantation: a qualitative study. Journal of Nursing 2023;30:13-7.
22. Li T, Zhou YE, Zi WL. Investigation and Study on the Present Status and Influence Factors of Parents' Readiness for Discharge of High-risk Neonates. Journal of Kunming Medical University 2023;44:183-8.
23. Li L, Yang L, Sun H, et al. Status and influencing factors of mental health of father and maternal donor patients and their partners in pediatric liver transplantation. Guangxi Medical Journal 2021;43:126-9.