Transition From Hospital to Home in Parents of Preterm Infants

Abstract

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.

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

“…However, the “NICU lifeline” with regular visits of the EDP nurse and the possibility for extra contacts increased the families' confidence. The first weeks at home are a critical period for families as they take on all caregiving, responsibilities and activities (Boykova & Kenner, ). Even whilst families of premature infants are occupied after discharge from NICU in “finding the rhythm in our new family” (Wollenhaupt, ) and “becoming a parent” (Hutchinson, Spillett, & Cronin, ), these things can be done in an FCC partnership.…”

“…Every year about 15 million infants are born prematurely, including 10% of European births and 7% of Danish ones (Andersen & Nielsen, ; March of Dimes, PMNCH, Save the Children, & WHO, ). Health authorities recommend family‐centred care (FCC) as a frame of reference for care and treatment in hospital (American Academy of Pediatrics, ; Danish National Board of Health, ; Hutchfield, ), as well as in the transition from hospital to home for premature infants and their families (Boykova & Kenner, ; Danish National Board of Health, ).…”

Paternal and Maternal Concerns for Their Very Low-Birth-Weight Infants Transitioning From the NICU to Home

“…3 Compared with all neonates, they have the longest average length of hospital stay as well as the highest rates of morbidity and rehospitalization, with readmission rates greater than 30% and 15% rehospitalized in the first year. 2,11,12 Despite efforts by the NICU staff, parents frequently feel unprepared for discharge and desire more information than is provided to them. 9,10 However, while parents' experiences in the NICU have been documented, less is known about their experiences during the transition to home, their concerns, and the impact of this transition on parents.…”

Rehospitalization of preterm infants according to the discharge risk level

“…Additionally, in the literature, domestic violence, unfavorable domestic conditions for the infant, low socioeconomic status (Forsythe, Maher, Kirchick, & Bieda, 2007), adolescent parenting (DeVito, 2010), inability to access sources of social and professional support (Boykova, 2008), problems with accommodating to the role of parenting, and experience of feelings such as stress, anxiety, and depression (Poehlman, Schwichtenberg, Bolt, & Dilworth-Bart, 2009) are reported as parentrelated risk factors in terms of discharge. All these factors could cause infants to have postdischarge health problems, and eventually, to be rehospitalized (Boykova & Kenner, 2012;Lamarche-Vadel et al, 2004).…”

“…Indicators of the effectiveness of discharge services include postdischarge problems experienced by the infants and parents, and rehospitalization due to avoidable causes (Boykova & Kenner, 2012). N-DAT is a comprehensive measurement tool that assesses the discharge readiness of preterm infants in five subscales as Medical, Competencies, Risk Robison et al, 2000).…”