Coming Home, Staying Home: Adopters' Stories about Transitioning Their New Dog into Their Home and Family

Published research estimates shelter dogs' post-adoption returns at 7-20%, with a significant percentage of these occurring in the first month post-adoption. To better understand factors that contribute to the success or failure of long-term rehoming outcomes, this study sought to understand post-adoption challenges up to four years post-adoption, targeting dogs identified as more likely to be returned. Thirty-one adopters participated in semi-interviews. Thematic analysis of their responses yielded three themes: (1) The adoption process takes time and requires patience; (2) Building trust and learning limits are essential to lasting adoptive relationships; and (3) Human-dog relationships are idiosyncratic because they involve unique individuals. These results have potential application in programs designed to guide adopters and dogs through a successful adoption process. Access to real-life adoption stories, such as those uncovered in this study, might help new adopters develop reasonable expectations and learn from others' experiences as they work to develop lasting relationships with their dogs.

Transition from intensive care unit to a portable ventilator in children with severe bronchopulmonary dysplasia

As the population of ventilator-dependent children (VDC) with tracheostomies due to underlying severe bronchopulmonary dysplasia grows, there is an increasing need to shift the care of these children from hospital to home. Transitioning the ventilator-dependent child from the hospital to home is a complex process that requires coordination between the medical team and the family. One crucial step in the process is transitioning from an Intensive care unit (ICU) ventilator to a portable home ventilator (PHV). The Clinical team needs to understand the nuances in transitioning to PHV, including assessing readiness to transition and choosing the optimum settings on an available home ventilator. In recent years, various ventilator modes have been available in PHV that can help achieve synchronous breathing to allow for adequate gas exchange for the infant. This review details some approaches to asses readiness to transition and the process of Transition along with commonly used modes of support available in PHV, as well as the primary and secondary settings in which we should be mindful in supporting a child with chronic respiratory failure in the home setting.

Defining a new normal: A qualitative exploration of the parent experience during the single ventricle congenital heart disease interstage period

AIM

To explore parents' experience of transition in the period between the palliative cardiac surgeries (i.e., the interstage period) of an infant with single ventricle congenital heart disease.

DESIGN

We conducted an exploratory naturalistic inquiry using a qualitative descriptive approach.

METHODS

A purposive sample of 11 parents of children with single ventricle disease was selected among families that participated in an interstage-period parental home monitoring program during the past 2 years. Interviews and field observations were conducted September-October 2019, and data were analyzed for themes. Analysis of data was inductive, although study questions and the interpretation of results were informed by Meleis' transition theory.

RESULTS

Parents described the experience of transition in interstage as a striving for normality, a theme that was clustered in subthemes of home, self, and infant.

CONCLUSION

Parents' experiences of striving for normality indicated a need for more targeted efforts to address parents' psychosocial needs during the highly stressful interstage transition.

IMPACT

This research underscored the complexity of parents' psychosocial support needs on returning home after their child's first palliative surgery. The findings also suggest need for examination of the transition following the second palliative heart surgery, when the home monitoring program is withdrawn. Understanding parent needs will help guide healthcare teams in developing ways to support parents as they adjust to home, self, and child.

Prevalence and Characteristics of Neonatal Comfort Care Patients: A Single-Center, 5-Year, Retrospective, Observational Study

Objective: To investigate the prevalence and characteristics of neonates with life-limiting or life-threatening conditions who receive care focused exclusively on comfort. Methods:Retrospective chart review of all newborn infants admitted to a level III perinatal center within a 5 year period. Results:1,777 of 9,878 infants (18.0%) had life-limiting or life-threatening conditions. 149 (1.5% of all neonates) were categorized as comfort care patients with death being anticipated within hours to weeks. 34.2% of comfort care patients suffered from conditions specific to the neonatal period, 28.9% were preterm infants at the limit of viability, and 22.8% were patients with congenital complex chronic conditions. In 80.5% of all comfort care patients treatment goals were re-directed toward a comfort-care-only regimen only once that life-prolonging therapies were demonstrated to be unhelpful. 136/149 comfort care patients (91.3%) died in hospital, while 13 (8.7%) were discharged home or into a hospice. Median age at death for comfort care patients was 3 days after birth (interquartile range 1-15.5 days), and delivery room death immediately after birth occurred in 37 patients (27.2%). Conclusions: The vast majority of neonatal comfort care patients died in the hospital during the first week of life. However, almost one in 10 comfort care patients were discharged to home or hospice, suggesting that planning transition out of the NICU should be routinely discussed for all infants receiving comfort care.

Parents experiences of discharge readiness from a Swedish neonatal intensive care unit

Aim

The aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home.

Design

A qualitative design with quantitative elements was applied.

Methods

A questionnaire study. Data were analysed using qualitative content analysis with quantitative elements.

Results

The majority of included parents felt adequately prepared for going home and sufficiently supported during the first period home. Negative experiences were related to lack of time for preparation, lack of support and information, especially about the infant's food intake, breastfeeding, and tube feeding, and lack of follow‐up counselling post discharge. This study supports that parents who are closely involved in their infant's care at the NICU, and who stay with the infant at the NICU around the clock, are well prepared for the transition to home.

A preterm lifeline: Early discharge programme based on family-centred care

PURPOSE

To present an Early Discharge Programme model for preterm infants based on family-centred care, and to describe its impact on the infants and families.

DESIGN AND METHODS

Methods included longitudinal growth assessments of 218 premature infants and a qualitative synthesis of two focus group interviews with 15 parents.

RESULTS

The main finding was the experience of "parents in control with lifeline to neonatal intensive care unit" based on five syntheses.

PRACTICE IMPLICATIONS

An early discharge programme based on family-centred care has been implemented and integrated into our neonatal intensive care unit that could be implemented by other hospitals.

Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline

Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of userfriendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.