1
|
Petersen M, Nordlund HL, Koreska M, Brødsgaard A. Bridging the gap between healthcare sectors: Facilitating the transition from NICU to the municipality and home for families with premature infants. J SPEC PEDIATR NURS 2024; 29:e12426. [PMID: 38615233 DOI: 10.1111/jspn.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE The transition from hospital to home can be challenging for parents of prematurely born infants. The aim of this ethnographic study was to describe a multidisciplinary and cross-sectoral discharge conference for families with premature infants transitioning from a neonatal intensive care unit to municipal healthcare services. DESIGN AND METHODS An ethnographically/anthropologically inspired qualitative design was adopted. We conducted four participant observations of multidisciplinary and cross-sectoral discharge conferences and 12 semistructured interviews with four neonatologists, four nurses, and four health visitors who had attended one of the conferences. Salient themes were generated by two-part analysis consisting of a thematic analysis followed by Turner's ritual analysis. RESULTS This study illustrated how multidisciplinary and cross-sectoral discharge conferences improved the quality of care for premature infants and their families in their transition process which was perceived as complex. These conferences contributed to promoting a sense of coherence and continuity of care. The healthcare professionals experienced that this event may be characterized as a ritual, which created structures that promoted cross-sectoral cooperation and communication while increasing interdisciplinary knowledge sharing. Thus, the conferences triggered a sense that the participants were building bridges to unite healthcare sectors, ensuring a holistic and coordinated approach to meet the unique needs of the infants and their families. IMPLICATIONS FOR PRACTICE This study presented a unique holistic and family-centered approach to constructing multidisciplinary and cross-sectoral discharge conferences that seemed to underpin the quality of interdisciplinary and health-related knowledge sharing and establish a crucial starting point for early interventions, preventive measures, and health-promoting efforts. Hopefully, our findings will encourage others to rethink the discharge conference as a transitional ritual that may potentially bridge the gap between healthcare sectors. Specifically, our findings contribute to the mounting body of knowledge of family-centered care by showing how healthcare professionals may-in a meaningful and tangible manner-operate, develop, and implement this somewhat elusive theoretical foundation in their clinical practice.
Collapse
Affiliation(s)
- Mette Petersen
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | | | - Mai Koreska
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Public Health, Nursing and Health Care, University of Aarhus, Aarhus, Denmark
| |
Collapse
|
2
|
Dallas A, Ryan A, Mestan K, Helner K, Foster C. Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity. Adv Neonatal Care 2023; 23:40-50. [PMID: 35797366 PMCID: PMC9810763 DOI: 10.1097/anc.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parents in the neonatal intensive care unit (NICU) report low self-confidence managing their children's ongoing medical and social needs. While bedside nurses provide critical support for families throughout their NICU admission, there may be a role for nursing coordination throughout hospitalization, discharge, and in the transition to outpatient care. PURPOSE This program evaluation explores parent and provider experiences of a novel longitudinal care coordination program for infants with medical complexity from the NICU through their first year of life post-discharge. METHODS First, a sequential exploratory mixed-methods approach was used to evaluate parental experiences (n = 5 interviewed followed by n = 23 surveyed). Provider perspectives were elicited through semi-structured interviews (n = 8) and focus groups (n = 26 in 3 groups). RESULTS Parent-reported benefits included frequent communication and personalized support that met families' and patients' evolving needs. Care coordinators, who were trained as nurses and social workers, developed longitudinal relationships with parents. This seemed to facilitate individualized support throughout the first year of life. Providers reported that smaller caseloads were central to the success of the program. IMPLICATIONS FOR PRACTICE AND RESEARCH This longitudinal care coordination program can be used as a translatable model in NICUs elsewhere to address the unique needs of families of infants with medical complexity throughout the first year of life. Future implementations should consider how to expand program size while maintaining individualized supports. As the care coordinators are former NICU nurses and social workers, there may be a growing role for nursing coordination of care in the neonatal population.
Collapse
Affiliation(s)
- Abbey Dallas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexandra Ryan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Karen Mestan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Khrystyna Helner
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Carolyn Foster
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Smith H, Harvey C, Portela A. Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature. BMC Pregnancy Childbirth 2022; 22:281. [PMID: 35382773 PMCID: PMC8985304 DOI: 10.1186/s12884-022-04577-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care. METHODS We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation. RESULTS The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge. CONCLUSIONS The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support. PROTOCOL REGISTRATION DETAILS The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w.
Collapse
Affiliation(s)
- Helen Smith
- International Health Consulting Services Ltd, Merseyside, UK.
| | | | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| |
Collapse
|
4
|
Orr E, Ballantyne M, Gonzalez A, Jack SM. Mobilizing Forward: An Interpretive Description of Supporting Successful Neonatal Intensive Care Unit-To-Home Transitions for Adolescent Parents. QUALITATIVE HEALTH RESEARCH 2022; 32:831-846. [PMID: 35316117 PMCID: PMC9152603 DOI: 10.1177/10497323221079785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnancy and parenting in adolescence and the transition home following the hospitalization of an infant in the neonatal intensive care unit (NICU) are two relatively complex phenomena; and whilst each have been consistently explored within the relevant literature, little is understood about the care required when they intersect. Using interpretive description methodology to guide our exploration, we conducted semi-structured interviews with 23 expert providers caring for adolescent parents involved in NICU-to-home transitions to describe this process in their practice. Findings suggest that supporting successful NICU-to-home transitions for adolescent parents relied strongly on understanding the impact of the NICU experience, establishing therapeutic relationships and facilitating supportive partnerships between the NICU and parents as well as the NICU and supportive services post-discharge. Findings highlight the opportunity for more integrated models of care within the NICU and extending into the community to address the complex biopsychosocial care needs of this parent population.
Collapse
Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University Faculty of Applied Health
Science, St. Catharines, Ontario, Canada
| | - Marilyn Ballantyne
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Holland Bloorview Kids Rehabilitation
Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural
Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
5
|
Vasli P, Valipour S, Estebsari F, Nasiri M. Predictors of readiness for discharge in mothers of preterm infants: The role of stress, self-efficacy and perceived social support. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2022. [DOI: 10.4103/2305-0500.356845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
6
|
Yoon S, Park J, Lee H, Min A. Influence of Partnerships with Nurses and Social Support on Readiness for Discharge among Mothers of Premature Infants. CHILD HEALTH NURSING RESEARCH 2019; 25:417-424. [PMID: 35004433 PMCID: PMC8650988 DOI: 10.4094/chnr.2019.25.4.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/29/2023] Open
|
7
|
Astuti ES, Nursalam N, Devy SR, Etika R. Knowledge, Family Support and Self-Reliance Capital when Caring for Low Birth Weight Babies. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Low birth weight (LBW) infants are very susceptible to illness.LBW treatment with the principle of preventing infection is very important athome. The purpose of this study was to determine the relationship betweenmaternal knowledge and family support with the prevention of infection at home.Methods: This study used a correlation design. The samples were 160 motherswho had low birth weight infants with inclusion criteria mothers give birth tobabies weighing less than 2,500 grams with ages 0-2 months. The samples wereobtained through purposive sampling. The dependent variable was the mother'sability to prevent infection while the independent variable was the mother'sknowledge and family support. The instruments used were questionnaires. Thisresearch analyzed using Spearman Rho.Results: The results showed that there was a strong correlation betweenknowledge and the ability to prevent infection in treating low birth weight (r =0.696; p = 0.00) and that there was a moderate correlation between familysupport and infection prevention ability when treating a low birth weight (r =0.54. p = 0.000).Conclusion: Factors of maternal knowledge about infection prevention andfamily support need to be considered in increasing the ability of mothers to carefor babies with LBW. The factor of maternal knowledge about prevention ofinfection has a strong correlation value when compared to family support factors.Further research is needed on the model of increasing maternal knowledge aboutLBW infants during home care.
Collapse
|
8
|
Quist M, Kaciroti N, Poehlmann-Tynan J, Weeks HM, Asta K, Singh P, Shah PE. Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample. Acad Pediatr 2019; 19:917-924. [PMID: 30867136 PMCID: PMC6736763 DOI: 10.1016/j.acap.2019.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/22/2018] [Accepted: 02/08/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample. METHODS Our sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24-31 weeks), moderate/late preterm (MLPT, 32-36 weeks) and full term (FT, 37-41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression. RESULTS Infant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19-4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40-3.80, and aOR, 1.74; 95% CI, 1.40-2.16, respectively). CONCLUSIONS Mothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.
Collapse
Affiliation(s)
- Megan Quist
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan School of Medicine (M Quist and PE Shah)
| | - Niko Kaciroti
- Center for Human Growth and Development (N Kaciroti and PE Shah)
| | | | - Heidi M Weeks
- Department of Nutritional Sciences, School of Public of Health (HM Weeks), University of Michigan, Ann Arbor
| | | | - Priya Singh
- Northeast Ohio Medical University, Rootstown (P Singh)
| | - Prachi E Shah
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan School of Medicine (M Quist and PE Shah); Center for Human Growth and Development (N Kaciroti and PE Shah).
| |
Collapse
|
9
|
Tomlin AM, Deloian B, Wollesen L. Infant/Early Childhood Mental Health and Collaborative Partnerships: Beyond the NICU. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|