The Stress of Discharge Assessment Tool (SDAT)
Following Acute Myocardial Infarction

Version Two

Jean C. Toth, R.N., C.S., D.N.Sc.
Associate Professor of Cardiovascular Nursing
The Catholic University of America
Washington, D.C. 20064

Description

The second version of the SDAT is a 60 item paper and pencil, self report test which takes approximately 15 minutes for the patient to answer, and measures the impact of stressors common to acute myocardial infarction (AMI) patients at hospital discharge and during early recovery at home. These stressors include those related to recovery from the illness, and the anticipation of or actual problems during recovery at home and return to work or retirement. Scores on this Likert scale range from 1 to 5 points for each item. Total scores range from 60 to 300 points. A high score indicates high stress and a low score indicates low stress. No differences have been found in scores between subjects who were readers and those to whom the SDAT was read.

Validity

SDAT, Version One. Content for the initial version of the SDAT was determined through a review of the literature, interviews with former AMI patients and their families, and through an eight-member panel of experts in cardiovascular clinical nursing practice and education, and educational testing. Construct validity was evaluated by the concurrent administration of the Anxiety-Depression (A-D) Scale for Medically Ill Patients (Sgroi, Holland, & Solkoff, Department of Psychiatry, School of Medicine, State University of New York at Buffalo). The A-D Scale contains anxiety (15 items) and depression (13 items) subscales. Pearson product-moment correlations between scores on the first version of the SDAT and the Anxiety Subscale [r(104) = 0.18, p = 0.03] and the Depression Subscale [r(104) = 0.34, p < 0.001] were statistically significant but low to moderately low in magnitude. These findings lend some evidence for the validity of the constructs of anxiety and depression of the SDAT at the time of hospital discharge. In addition, since the A-D Scale measures only anxiety and depression, some support exists for the discriminant validity of the SDAT, Version One.

Item analysis was used to measure the contribution of individual items to the total score and to guide revisions of the SDAT. These revisions were minor and included the rewording of items to improve clarity and to reflect the magnitude of stress AMI patients experience whether answering at hospital discharge or during recovery at home. These revisions were reviewed by panel members and resulted in the second version of the SDAT.

SDAT, Version Two. Construct validity was supported through the internal consistency of items on the SDAT. Item analysis revealed that all but one item contributed to the internal consistency of the total score. At hospital discharge, 50 items (83.3%) had item to total correlations > 0.20 (range 0.20 to 0.56). During early recovery at home, 53 items (38.3%) had item to total correlations > 0.20 (range 0.20 to 0.64). One item had an item to total correlation close to zero.

Reliability

Cronbach's coefficient alpha was used as the measure of internal consistency reliability of the SDAT. Reliability of the first version of the SDAT, computed on a sample of 104 AMI patients from 1 to 48 hours prior to their hospital discharge, was alpha = 0.85. Reliability of the second version of the SDAT was computed on a sample of 138 AMI patients from 1 to 48 hours prior to hospital discharge (alpha 0.85) and on 90 AMI patients during early recovery at home (12 to 14 days following hospital discharge) (alpha = 0.89).

Scoring

Scores range from 1 to 5 points for each of the 60 items with a high score representing high stress for that item. For 39 items, SA = 1 point, A = 2 points, U = 3 points, D = 4 points, and SD = 5 points. For the remaining items (n = 21), scores are reversed (recoded), so that SA = 5 points, A = 4 points, U = 3 points, D = 2 points, and SD = 1 point and include the following items: 2, 8, 10, 16, 17, 19, 25, 27, 29, 30, 31, 34, 43, 45, 43, 51, 52, 54, 55, 56, and 59. In items 47 through 60, NA = 1 point always.

References

Toth, J.C. (1984). Variables Associated with the Stressful Experience of Hospital Discharge Following Acute Myocardial Infarction (Doctoral dissertation, The Catholic University of America, 1984). Dissertation Abstracts International, A82857.

Toth, J.C. (1985, June). Measuring the Stressful Experience of Hospital Discharge Following Acute Myocardial Infarction (Abstract). The Measurement of Clinical and Educational Nursing Outcomes Conference, New Orleans, LA.

Toth, J.C. (1987). Stressors Affecting Older and Younger Acute Myocardial Infarction Patients at Hospital Discharge. Dimensions in Critical Care Nursing, May/June, 6 (3), 147-157.

Toth, J.C. (1996). Stress of Discharge Assessment Tool (SDAT) Version Two: Stress during early recovery at home. In Health and Psychosocial Instruments (HaPI) (online, CD-ROM), Evelyn Perloff (Ed.) University of Pittsburgh.

Toth, J.C. (1987). Measuring the Stressful Experience of Hospital Discharge Following Acute Myocardial Infarction. In Carolyn F. Waltz, & Ora L. Stickland (Eds). Measurement of Nursing Outcomes, Volume One, (pp. 3-23). New York: Springer Publishing Company.

Toth, J.C. (1992). Faith in Recovery: Spiritual Support After an Acute MI. Journal of Christian Nursing, Fall, 28-31.

Toth, J.C. (1993). Is Stress at Hospital Discharge After Acute Myocardial Infarction Greater in Women than in Men? American Journal of Critical Care, 2 (1), 35-40.

The SDAT is copyrighted. Permission to use it can be obtained from the author. Copies can be requested by writing to Jean C. Toth, R.N., D.N.Sc., The Catholic University of America, School of Nursing, Washington, D.C. 20064, e-mail toth@cua.edu.