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Franck LS, Kriz RM, Bisgaard R, Gay CL, Sossaman S, Sossaman J, Cormier DM, Joe P, Sasinski JK, Kim JH, Lin C, Sun Y. Parent Readiness for Their Preterm Infant's Neonatal Intensive Care Unit Discharge. J Perinat Neonatal Nurs 2023; 37:68-76. [PMID: 36707751 DOI: 10.1097/jpn.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aims to examine the influence of hospital experience factors on parental discharge readiness, accounting for key background characteristics. Parents/guardians of infants 33 weeks of gestation or less at birth receiving neonatal intensive care at 6 sites were enrolled from April 2017 to August 2018. Participants completed surveys at enrollment, 3 weeks later, and at discharge. Multiple regression analysis assessed relationships between parental experience, well-being, and perceived readiness for infant discharge, adjusting for socioenvironmental, infant clinical, and parent demographic characteristics. Most (77%) of the 139 parents reported high levels of readiness for their infant's discharge and 92% reported high self-efficacy at discharge. The multiple regression model accounted for 40% of the variance in discharge readiness. Perceptions of family-centered care accounted for 12% of the variance; measures of parent well-being, anxiety, and parenting self-efficacy accounted for an additional 16% of the variance; parent characteristics accounted for an additional 9%; and infant characteristics accounted for less than 3% of the variance. Parental perceptions of the family-centeredness of the hospital experience, anxiety, and parenting self-efficacy accounted for a substantial proportion of the variance in readiness for discharge scores among parents of preterm infant. These influential perceptions are potentially modifiable by nursing-led interventions.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing and the California Preterm Birth Initiative, University of California, San Francisco, San Francisco (Drs Franck and Gay and Ms Kriz); Intensive Care Nursery (Mss Bisgaard and S. Sossaman and Mr J. Sossaman) and Division of Neonatology (Dr Sun), UCSF Benioff Children's Hospital, San Francisco, California; Neonatal and Pediatrics, Community Regional Medical Center, Fresno, California (Dr Cormier); Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, California (Dr Joe); Intensive Care Nursery, Santa Monica Medical Center, UCLA Health, Santa Monica, California (Ms Sasinski); Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kim); and Division of Neonatology, Kaiser Permanente, Santa Clara, California (Dr Lin)
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Findlater CK, Gerges S, Litynsky J, Robson K. Implementation of a Meds to Beds Medication Use Program and Parent Experience at the Time of Transition From a Neonatal Intensive Care Unit to Home. J Pediatr Pharmacol Ther 2022; 27:300-305. [DOI: 10.5863/1551-6776-27.4.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
This study aims to describe the overall experience of the neonatal intensive care unit (NICU) parent at time of transition home related to discharge medication use, following implementation of a Meds to Beds program.
METHODS
A descriptive, qualitative study was used to explore parent experiences around medication use during transition home. Eleven parents whose infants required medications at the time of transition home from the NICU participated in a semi-structured telephone interview post-discharge. The data were coded and analyzed for themes.
RESULTS
Major themes nested within the key stages of medication use in preparation for transition home from the NICU were identified: in-hospital preparation (practice early and often, Meds to Beds, and relationship with clinical pharmacist), transition home (schedule and routine, strategies for medication administration) and post-discharge (refills and long-term medication management). Strategies based on parent experiences to improve the process and ameliorate anxiety are presented.
CONCLUSIONS
Parents expressed how effective the Meds to Beds program was on the transition home by increasing parental confidence and knowledge around medications and reducing stress around the acquisition of medications for home. They also reported comfort in having a relationship with the NICU clinical pharmacist, providing a tailored approach to coordinating care both in hospital and during the transition home. Regardless of implementation of a Meds to Beds program, great opportunities remain to refine the transition home. Implementing the suggested improvement strategies could provide significant positive effects with respect to patient care and parental stress during the transition home.
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Affiliation(s)
- Carla K. Findlater
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandra Gerges
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jacklyn Litynsky
- Department of Pharmacy (JL), Windsor Regional Hospital, Windsor, ON, Canada
| | - Kate Robson
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Finding a New Normal: Maternal Experiences Transitioning to Home From the Neonatal Intensive Care Unit Caring for Technology-Dependent Infants. Adv Neonatal Care 2022; 22:E2-E12. [PMID: 35113827 DOI: 10.1097/anc.0000000000000850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants discharged from the neonatal intensive care unit (NICU) dependent on medical technology (eg, respiratory or nutritional support) are a growing vulnerable population. These infants are medically fragile, prone to emergency department visits and readmissions, and require increased caregiver demands at home. The experiences of their maternal caregiver's after NICU discharge however, are not well understood. PURPOSE This qualitative descriptive study addressed this knowledge gap by interviewing mothers of technology-dependent infants about their experience during their first 2 weeks transitioning to home from the NICU. This is a critical period in which mothers must first assume advanced caretaking responsibilities in the home. METHODS Eight mothers participated in semistructured audio-recorded interviews via the Web conferencing system Zoom and completed demographic questionnaires. RESULTS Five themes emerged from the data that described essential features of the mothers' transition to home: (a) needing coordinated discharge care; (b) establishing a routine; (c) being an advocate; (d) having a support system; and (e) finding normalcy. An additional important finding of this study was the presence of maternal posttraumatic stress and postpartum depression. IMPLICATIONS FOR PRACTICE Results highlight the importance of providing mothers hands-on practice opportunities and identifying social support and home healthcare options prior to discharge of technology-dependent infants. IMPLICATIONS FOR RESEARCH Future research should focus on multidisciplinary interventions targeted toward discharge preparation, transitional support, and understanding maternal psychiatric symptoms among mothers of technology-dependent infants.
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Polizzi C, Perricone G, Morales MR, Burgio S. A Study of Maternal Competence in Preterm Birth Condition, during the Transition from Hospital to Home: An Early Intervention Program's Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168670. [PMID: 34444418 PMCID: PMC8391928 DOI: 10.3390/ijerph18168670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
The study was conducted with 104 mothers (average age 32.5 years, SD 6.1) of preterm infants (very and moderately preterm but still healthy) to monitor the perceived maternal role competence from the time of hospitalisation to post-discharge, in order to define an intervention program to support mothers during this transition. A targeted Q-Sort tool (Maternal Competence Q-Sort in preterm birth) was applied at two different times as a self-observation tool for parenting competence in neonatology. A tendency towards dysregulation of the maternal role competence was detected, mainly in terms of low self-assessment and was found to worsen during post-discharge, particularly with regard to caregiving ability. This study suggests the importance of accompanying parenting competence in preterm birth conditions, not only during hospitalisation in the Neonatal Intensive Care Unit (NICU) but also following discharge in order to promote the development of premature infants. This paper reports in the last part a specific integrated psychoeducational intervention program (psychologist and nurses), which we defined precisely in light of the suggestions offered by the study data on perceived maternal competence created with the Q-sort.
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Affiliation(s)
- Concetta Polizzi
- Italian Society of Pediatric Psychology (S.I.P.Ped.), Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.P.); (G.P.)
| | - Giovanna Perricone
- Italian Society of Pediatric Psychology (S.I.P.Ped.), Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.P.); (G.P.)
| | - Maria Regina Morales
- Italian Society of Pediatric Psychology (S.I.P.Ped.), Mental Health Department, ASST Sette Laghi, 21100 Varese, Italy;
| | - Sofia Burgio
- Italian Society of Pediatric Psychology (S.I.P.Ped.), Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.P.); (G.P.)
- Correspondence:
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Orkin J, Major N, Esser K, Parmar A, Couture E, Daboval T, Kieran E, Ly L, O'Brien K, Patel H, Synnes A, Robson K, Barreira L, Smith WL, Rizakos S, Willan AR, Yaskina M, Moretti ME, Ungar WJ, Ballantyne M, Church PT, Cohen E. Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants. BMJ Open 2021; 11:e046706. [PMID: 34233983 PMCID: PMC8264914 DOI: 10.1136/bmjopen-2020-046706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Having an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months. METHODS AND ANALYSIS This is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention. ETHICS AND DISSEMINATION Research ethics approval was obtained from Clinical Trials Ontario, Children's Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children's and Women's REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03350243).
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Affiliation(s)
- Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathalie Major
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arpita Parmar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elise Couture
- Division of Neonatology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Thierry Daboval
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Emily Kieran
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Linh Ly
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel O'Brien
- Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hema Patel
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Anne Synnes
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Kate Robson
- Neonatal Follow Up Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Barreira
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wanda L Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sara Rizakos
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Clinical Research Services, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Myla E Moretti
- Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Ballantyne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Paige Terrien Church
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Higgins Joyce A, Sengupta A, Garfield CF, Myers P. When is My Baby Going Home? Moderate to Late Preterm Infants are Discharged at 36 Weeks Based on Admission Data. Am J Perinatol 2021; 38:773-778. [PMID: 31887744 DOI: 10.1055/s-0039-3401850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study evaluates the effect of admission characteristics of uncomplicated moderate to late preterm infants on timing of discharge. One of the first questions that families of infants admitted to the Neonatal Intensive Care Unit (NICU) ask is, "When is my baby going home?" Moderate to late preterm infants are the largest cohort of NICU patients but little data exist about their length of stay (LOS). STUDY DESIGN A retrospective electronic chart review was completed on 12,498 infants admitted to our NICU between January 1, 2009 and December 31, 2015. All inborn infants with a gestational age between 320/7 and 366/7 weeks were studied. RESULTS A total of 3,240 infants met our inclusion criteria. The mean postmenstrual age at discharge was 363/7 weeks. Infants who were small for gestational age were significantly more likely to have an increased LOS. Infants born between 34 and 366/7 weeks had a significantly increased LOS if they had respiratory distress syndrome. Admission diagnoses of neonatal abstinence syndrome, meconium aspiration syndrome, hydrops, hypoxic ischemic encephalopathy, biliary emesis, ABO incompatibly, and a genetic diagnosis all had increased LOS for all late preterm infants. CONCLUSION For uncomplicated moderate to late preterm infants, clinicians can counsel families that their infants will likely be discharged at 36 weeks of postmenstrual age. Small for gestational age infants and those with specific diagnoses may stay longer.
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Affiliation(s)
- Alanna Higgins Joyce
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arnab Sengupta
- Department of Pediatrics, Mercy Hospital, Springfield, Miami
| | - Craig F Garfield
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Myers
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Salmani N, Zare Marvast M, Kahdouei S, Weiss ME. Adaptation of the parent readiness for hospital discharge scale with mothers of preterm infants discharged from the neonatal intensive care unit. J Clin Nurs 2020; 29:4544-4553. [PMID: 32886812 DOI: 10.1111/jocn.15479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/24/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the psychometric properties of a new Persian translation of the Readiness for Hospital Discharge Scale. BACKGROUND Globally, one in 10 newborns are born preterm and many require care in a neonatal intensive care unit (NICU). A primary role of NICU nurses is to assure parents are well prepared to take their newborns home from the hospital. Assessment of parent perception of discharge readiness provides important input into discharge decisions. The availability of reliable and valid instruments tested within the geographical and cultural context is needed for a comprehensive assessment of predischarge readiness, so that parent needs can be identified and the necessary interventions designed and implemented. DESIGN This psychometrics study included a convenience sample of 200 mothers with preterm infants being discharged from the NICU of Shahid Sadoughi Hospital in Yazd, Iran. The original 29-item version of the Readiness for Hospital Discharge Scale-Parent questionnaire was translated into Persian using the standard forward-backward method. Face, content and construct validity (principal components analysis), and reliability (internal consistency-Cronbach's alpha) were assessed. Methods followed STROBE criteria as applicable (see Appendix S1). RESULTS The content validity index and content validity ratio were both 0.93. Construct validity testing identified 6 factors (mother and infant physical-psychological readiness, expected support, knowledge of future events and care, knowledge of infant personal care, pain and therapeutic interventions). Using Cronbach's alpha coefficient, the reliability of the whole instrument was estimated to be 0.87. CONCLUSION The Persian Readiness for Hospital Discharge-Parental Form for use with mothers of preterm infants being discharged from an Iranian NICU has acceptable validity and reliability. RELEVANCE TO PRACTICE This tool can be used before discharge to determine the needs of mothers and design the necessary measures to improve quality of discharge care.
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Affiliation(s)
- Naiire Salmani
- School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Marzieh Zare Marvast
- School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Quality improvement initiative to improve mother's own milk usage till hospital discharge in very low birth weight infants from a tertiary care NICU. J Perinatol 2020; 40:1273-1281. [PMID: 32514008 DOI: 10.1038/s41372-020-0707-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/13/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022]
Abstract
IMPORTANCE Mother's own milk (MOM) for premature infants is a complete nutrition. It is an ideal issue for a quality improvement (QI) initiative. OBJECTIVE To increase the proportionate usage of MOM as enteral feeds. METHODS A QI study conducted in Tertiary care NICU involving all eligible very low birth weight (VLBW) infants and mother dyads. The proportionate usages of MOM as enteral feeds were the main outcomes. EXPOSURE Education, milk expression, and mother-infant interaction formed the key drivers. RESULTS We studied 282 mother infant dyads during the QI period. The proportionate usage of MOM as the enteral feed increased from 55% (±34) at baseline to 80% (±27) during the intervention and to 88% (±16) in sustenance phase. CONCLUSIONS A QI initiative resulted in 60% relative improvement in proportionate usage of MOM as enteral feeds in VLBW infants during hospital stay.
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Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth. Adv Neonatal Care 2020; 20:301-313. [PMID: 32108660 PMCID: PMC7379044 DOI: 10.1097/anc.0000000000000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers.
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Abstract
A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.
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Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress. J Perinat Neonatal Nurs 2018; 32:E11-E21. [PMID: 29782436 DOI: 10.1097/jpn.0000000000000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.
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Osorio Galeano SP, Ochoa Marín SC, Semenic S. Preparing for post-discharge care of premature infants: Experiences of parents. INVESTIGACION Y EDUCACION EN ENFERMERIA 2017; 35:100-106. [PMID: 29767929 DOI: 10.17533/udea.iee.v35n1a12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/31/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The study sought to describe the experiences of parents of premature children regarding discharge from the neonatal unit. METHODS This was a qualitative study, in which 10 semi-structured interviews were conducted with parents of premature infants upon discharge from the neonatal unit. Data were analyzed following principles of grounded theory; open and axial coding was performed. RESULTS The following categories emerged from the analysis of the information: feelings experienced upon discharge, and experience of the discharge as a process; the latter category clearly identified barriers and facilitators. The results highlight that the parents experience ambivalent feelings; joy is mixed with the fear of caring for a premature child at home. CONCLUSIONS For parents, discharge of premature children from the neonatal unit is a complex process during which conflicting feelings are experienced. Nursing must develop strategies to involve parents early in the care of their children during the hospital stay.
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Delgado Galeano M, Villamizar Carvajal B. Coping in Mothers of Premature Newborns After Hospital Discharge. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ingram J, Blair PS, Powell JE, Manns S, Burden H, Pontin D, Redshaw M, Beasant L, Rose C, Johnson D, Gaunt D, Fleming P. Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.ObjectivesTo implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.DesignA before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.SettingFour local neonatal units in South West England.ParticipantsInfants without major anomalies, born at 27–33 weeks’ gestation, admitted to the participating units, and their parents.Train-to-Home interventionA parent-orientated package that incorporated approaches to improving parents’ involvement in, and understanding of, their baby’s needs. It comprised a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress through the neonatal unit, combined with improved estimation, soon after hospital admission, of the baby’s likely discharge date.Main outcome measuresPrimary – Perceived Maternal Parenting Self-Efficacy (PMPS-E) scores before and after implementing the Train-to-Home package; secondary – infant LOS and health-care utilisation after discharge.ResultsWe recruited 128 and 117 infants, respectively, in phase 1 (before implementation) and phase 2 (after implementation). In phase 2, parents reported improved understanding of babies’ progress, and preparedness for discharge, although PMPS-E scores did not change. The number of visits to emergency departments (EDs) fell from 31 in phase 1 to 20 in phase 2 (p < 0.05), with a significant reduction in associated health-care costs (from £3400 to £2200;p < 0.05) after hospital discharge. LOS did not change, but in both phases of the study > 50% of infants went home at > 3 weeks before their estimated date of delivery. Many nurses felt that the estimated discharge dates were over-optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.HarmsNo adverse consequences were identified.ConclusionsThe very early discharge of most babies made further shortening of LOS very difficult to achieve. Despite the lack of change of the parental self-efficacy scores, parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home package, and the reduction in ED attendance and associated costs supports this assessment. The present study was limited by the tight time constraints for implementation, limited cascading of staff training and lack of staff confidence in the estimated dates of discharge.Future workProvision of the Train-to-Home package as a web-based system, allowing individual neonatal units and parents to access and use the materials, may allow more effective implementation in the future.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jennifer Ingram
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jane E Powell
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Sarah Manns
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Heather Burden
- South West Neonatal Network, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Pontin
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Margaret Redshaw
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Lucy Beasant
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Claire Rose
- Neonatal Medicine, North Bristol NHS Trust, Bristol, UK
| | - Deborah Johnson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Peter Fleming
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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15
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Murray CH, Joseph RA. Transition from NICU to Home: Are the Parents Ready to Manage Any Emergency? An Evidence-Based Project. Neonatal Netw 2016; 35:151-155. [PMID: 27194609 DOI: 10.1891/0730-0832.35.3.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Transitioning the care of a previously critically ill infant to home poses many challenges for the parents. Prior to the infant's discharge, the parents undergo rigorous training to continue the care of their infants at home. Even after training, parents may feel overwhelmed by the thought of managing an emergency at home. This evidence-based practice project aims to provide parents with additional hands-on practice of cardiopulmonary resuscitation (CPR) prior to their infant's discharge. Based on this project, a program of teaching CPR regularly is established currently in the NICU at Nemours Alfred I. duPont Hospital for Children.
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16
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Preterm Infants' Mothers' Experiences With Milk Expression and Breastfeeding: An Integrative Review. Adv Neonatal Care 2015; 15:394-406. [PMID: 26536173 DOI: 10.1097/anc.0000000000000232] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking. PURPOSE The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding. METHODS/SEARCH STRATEGY A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis. FINDINGS Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding. IMPLICATIONS FOR PRACTICE Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation. IMPLICATIONS FOR RESEARCH Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.
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17
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Alkozei A, McMahon E, Lahav A. Stress levels and depressive symptoms in NICU mothers in the early postpartum period. J Matern Fetal Neonatal Med 2014; 27:1738-43. [PMID: 25005861 DOI: 10.3109/14767058.2014.942626] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined whether particular maternal and infant factors can identify mothers at risk for increased stress upon admission to the neonatal intensive care unit (NICU). METHODS Eighty-five mothers of preterm infants (25-34 weeks gestation) were assessed using the Parental Stressor Scale (PSS:NICU) and the Edinburgh Postnatal Depression Scale (EPDS) within 3.24 ± 1.58 d postpartum. Hierarchical linear regression models were used to determine the extent to which maternal stress is influenced by individual factors. RESULTS Fifty-two percent of mothers experienced increased stress (PSS:NICU score ≥3) and 38% had significant depressive symptoms (EPDS score ≥10). Stress related to alterations in parental role was the most significant source of stress among NICU mothers. Distance from the hospital and married marital status were significant predictors for stress related to alterations in parental role (p = 0.003) and NICU sights and sounds (p = 0.01), respectively. Higher stress levels were associated with higher depressive scores (p = 0.001). Maternal mental health factors, demographic factors, pregnancy factors and infant characteristics were not associated with increased stress. CONCLUSION Elevated stress levels and depressive symptoms are already present in mothers of preterm infants upon NICU admission. Being married or living long distance from the hospital is associated with higher stress. Future work is needed to develop effective interventions for alleviating stress in NICU mothers and preventing its potential development into postnatal depression.
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Affiliation(s)
- Anna Alkozei
- Department of Pediatrics & Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston MA , USA and
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