NICU discharge preparation and transition planning: guidelines and recommendations

Abstract

In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The foundation for these guidelines and recommendations is based on existing literature, practice, available policy statements, and expert opinions. These guidelines and recommendations are divided into the following sections: Basic Information, Anticipatory Guidance, Family and Home Needs Assessment, Transfer and Coordination of Care, and Other Important Considerations. Each section includes brief introductory comments, followed by the text of the guidelines and recommendations in table format. After each table, there may be further details or descriptions that support a guideline or recommendation. Our goal was to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU’s implementation of this guidance will be dependent on the unique makeup and skills of their team, as well as the availability of local programs and resources. The recommendations based only on expert opinion could be topics for future research.

Preparing Parents for Discharge from the Neonatal Unit, the Transition, and Care of Their Preterm Children at Home

“…(3) Within the specific context of the neonatal unit, preparing for discharge supposes obtaining skills and technical knowledge, emotional comfort and trust in caring for preterm children upon discharge. (15) This process also aims to facilitate the transition to the home by the parents (4,15) who must assume the care of their children independently away from the accompaniment of the nursing staff characteristic of the hospital context, which is in itself a critical process. (8) It should be noted that this is a continuous process that starts at the moment of the premature newborn's admission to the neonatal unit (4,15) and includes formal and informal education.…”

“…(15) This process also aims to facilitate the transition to the home by the parents (4,15) who must assume the care of their children independently away from the accompaniment of the nursing staff characteristic of the hospital context, which is in itself a critical process. (8) It should be noted that this is a continuous process that starts at the moment of the premature newborn's admission to the neonatal unit (4,15) and includes formal and informal education. (14) Parents learn from the routine, the context, and from the nursing practice, even when there is no educational intention, which reaffirms the importance of a professional nursing practice aware and reflective of the process.…”

“…Parents must learn to care for their children, with the help of the health staff, principally from nursing who plays a leading role in the educational processes related with the preparation for discharge. (3) Before going home with their children, parents must acquire knowledge, skills and trust for care, (4) which becomes an important criterion for discharge from the neonatal unit. (4)(5)(6) This is a complex process, given that the premature birth, hospitalization in the neonatal unit, transition to the home, and care after discharge are critical events for the parents, (7) who tend to experience high levels of stress, anxiety, guilt, fear, and uncertainty.…”

“…(3) Before going home with their children, parents must acquire knowledge, skills and trust for care, (4) which becomes an important criterion for discharge from the neonatal unit. (4)(5)(6) This is a complex process, given that the premature birth, hospitalization in the neonatal unit, transition to the home, and care after discharge are critical events for the parents, (7) who tend to experience high levels of stress, anxiety, guilt, fear, and uncertainty. (8) These feelings can limit their participation in the process and affect their capacity to care for the preterm children.…”

HOPE and DREAM: A Two-Clinic NICU Follow-up Model

“…This overall improvement in survival of infants at the earliest gestational ages has led to a cohort of children at high-risk for significant medical and developmental problems. In the 1990s, the American Academy of Pediatrics highlighted the developmental challenges premature infants face and emphasized the importance of neonatal intensive care unit (NICU) follow-up programs (5)(6)(7)(8)(9)(10). A National Institute of Child Health and Development (NICHD) workshop held in 2002 helped define the target patient population who may benefit most from NICU follow-up.…”