A discharge planning tool for use with families of high-risk infants

Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process

Increasingly newborn intensive care units (NICUs) are embracing family-centered care principles. Family-centered newborn intensive care requires that families are welcomed as partners in caregiving and decision making. Traditionally, discharge planning has been done without significant family involvement. In fact, parent participation in caregiving may still be limited until discharge is imminent. By increasing parental involvement in caregiving throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant caregiving. This article reviews common discharge practices and processes in the NICU and offers strategies to assist nurses in integrating a family-centered approach into discharge planning.

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.

The difficult first week at home with a premature infant

The results reported were obtained from the findings of a larger descriptive study that surveyed the support needs of 56 mothers of high-risk premature infants. Forty-eight percent of the mothers found the first week after their infant's discharge home difficult. Data analysis indicated the more premature the infant (birth weight r = 0.29, P = 0.03; gestational age r = 0.34, P = 0.008), and the greater the severity of illness as determined by length of hospital stay (r = -0.27, P = 0.04), the more likely the mother was to have a difficult first postdischarge week. The visit of the community health nurse during that first week was a significant factor in whether the mothers perceived the time as difficult (Fisher's exact test, P = 0.02). It was found, as well, that the community health nurses were less likely to visit mothers of very low-birth-weight infants during that week (Fisher's exact test, P = 0.02). Other variables related to difficulty during the first week were whether the infants had apnea in hospital (r = 0.33, P = 0.01), mothers' need for specific kinds of information such as knowledge about colic (chi 2 = 24.31, df = 12, P = 0.02), and an earlier scheduled visit to a physician for mothers whose infants were of lower birth weight (r = -0.26, P = 0.05), earlier gestational age (r = -0.34, P = 0.009), and had spent longer time in hospital (r = 0.37, P = 0.006).

Care coordination: a resource-intensive component of home health nursing practice

Coordinating patient care is an activity central to home health nursing practice. Nurses believe that this component of care contributes in a meaningful way to patient well-being. Yet changes in the home care environment at the patient, agency, and system levels could jeopardize nurses' care coordination activities. This study describes the nature of the care coordination activities delivered by home health nurses and explicates the amount of time expended in these activities. A convenience sample of 143 nurses, employed in 24 home health agencies in a southeastern state, participated. They recorded their time, in 15-minute intervals, for 10 consecutive working days. On average, they spent 29% of their time in direct care (i.e., home visits), 18% in travel, 18% in record-keeping activities, and 16% in care coordinating activities. New mechanisms to reimburse home care are on the horizon. Studies such as this that begin to explicate the nature of care requirements are critical if appropriate decisions are to be made about the structure of a reimbursement system for home health care.

Home care of the high-risk newborn

When a newborn at high risk because of prematurity is discharged from the hospital, the family involved faces a time of crisis. Because parents experience increased stress during the transition to home care, both the parents and their infant are vulnerable to the effects of the added stress on the family's health and well-being. Community nursing intervention is a necessary component of care for the family of a high-risk newborn. Nursing strategies that address specific counseling and teaching needs of the family of a high-risk newborn are presented.

Evaluation of a Discharge Planning Tool for Use with Families of High-risk Infants

The effectiveness of using a discharge planning tool for families with high-risk infants in a special care nursery is evaluated. Consistent use of the discharge planning tool resulted in parents' increased feeling of preparedness for discharge of their high-risk infants. Implications that resulted from the evaluation are presented.