'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study.

BACKGROUND: A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES: The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS: This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS: The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS: Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.

Nurses' perception of readiness to care for parents of children with special healthcare needs.

PURPOSE: To describe pediatric nurses' perception of readiness to care for parents of children with special healthcare needs. DESIGN AND METHODS: This cross-sectional, exploratory study surveyed 56 pediatric nurses from a large tertiary care center in Appalachia. Participants completed an anonymous electronic survey aimed at evaluating perception of discharge preparation and readiness to care. Data analysis included descriptive statistics and Chi square comparisons. RESULTS: The majority of participants (80%) reported spending 12 h or less preparing parents for discharge. The domains rated lowest on readiness to care included financial, psychological, and emotional. Participants anticipate parents spending an average of 13.9 h a day serving as the child's primary caregiver in the home. CONCLUSIONS: Subjective, 'unseen' domains of readiness are often under-assessed and evaluated. Parents are often discharged with limited preparation to assume around-the-clock care for a child with special healthcare needs, specifically related to their holistic health and wellbeing. PRACTICE IMPLICATIONS: Standardization of discharge preparation and readiness evaluation should focus on overall parent preparedness, including financial, psychological, and emotional domains. Discharge preparation should begin at the time of admission to familiarize parents with care. Clear, frequent communication should be used to emphasize realistic expectations and assess unique needs. Provision of accessible community-based resources should be given early to better equip parents with supportive services once home.

Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature.

BACKGROUND: Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care. METHODS: We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation. RESULTS: The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge. CONCLUSIONS: The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support. PROTOCOL REGISTRATION DETAILS: The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w.

Construction of an evidence-based discharge preparation intervention protocol for stroke patients / 中国实用护理杂志

Objective:Under the guidance of evidence-based theory, the discharge preparation intervention plan for stroke patients was constructed, in order to provide a reference for improving the discharge preparation of stroke patients.Methods:To retrieve the relevant guidelines, consensus, literature and quality evaluation, summarize relevant evidence and evaluate the first draft of the intervention plan, implement two rounds of expert enquiry, according to the expert score and opinions, and improve the entries after the group discussion to form the final intervention plan.Results:In the two rounds of correspondence, the expert positive coefficient was 100%, the expert authority coefficient was 0.81 and 0.84 respectively, and the Kendall harmony coefficient of each entry was 0.165 and 0.453 respectively. The difference was statistical significant ( P<0.05). The ultimate in intervention plan included 6 primary entry, 23 secondary entries. Conclusions:The discharge preparation intervention plan for stroke patients constructed in this study is scientific, reliable and feasible, and is of great significance to improving the discharge preparation of stroke patients.

Study on the effect of discharge preparation service in elderly patients with hip fractures / 中国实用护理杂志

[Objective]:To explore the effect evaluation of discharge preparation service on elderly patients with hip fractures.Methods:Totally 80 elderly patients with hip fractures admitted to Shanghai Sixth People′s Hospital from April 2019 to October 2019 were selected as the research objects, and they were divided into intervention group and control group according to admission time, 40 patients in each group. The control group was given routine nursing care, and the intervention group was given readiness service for hospital discharge.The application effect of the scheme was evaluated by the degree of readiness for discharge and the quality of discharge guidance, Barthel index score, Harris score and incidence of complications.Results:In the intervention group,the total score of readiness for hospital discharge of patients was 83.43±8.10,the total score of the quality of discharge guidance was 151.30±16.61,while those in the control group were 77.13 ± 9.30, 141.58 ± 18.34, the differences between the two groups were statistically significant( t=3.23, 2.49, both P<0.05).In terms of the follow-up after patients were discharged for 3 months, the Harris hip score and Barthel index scores for patients with hip fracture were 82.53 ± 7.83 and 88.13 ± 3.34,while those were 76.03 ± 12.15, 86.13 ± 2.65 in the control group,the differences between the two groups were statistically significant ( t=2.84, 2.97, both P<0.05). Conclusions:The discharge preparation service can effectively improve the readiness for hospital discharge and the quality of discharge guidance. It improves the hip joint function, the quality of life of patients, and the clinical outcome of patients effectively.

Evidence-based practice in the management of maternal discharge preparation services / 中国实用护理杂志

Objective:To implement evidence-based practice of discharge preparation service in maternal and to explore the clinical effect.Methods:Based on the evidence-based continuous quality improvement framework, apply the evidence on the clinical through evidence acquisition, baseline evaluation, evidence introduction, and after-effect evaluation. Sixty women hospitalized in the obstetrics department of the Affiliated Hospital of Chengde Medical College from January to March 2021 were selected as the baseline group, and 60 women hospitalized in the obstetrics department of the hospital from April to July 2021 were selected as the evidence application group, to evaluate and compare the quality of discharge guidance for practitioners, discharge readiness level, maternal and newborn management knowledge level, incidence of maternal and newborn complications and the compliance of practitioners to evidence.Results:Finally, 10 pieces of evidence applied to clinical practice were included and 15 review indicators were translated. After the application of evidence, the quality of discharge guidance of practitioners increases from (141.83±24.66) to (166.13±10.30), the maternal discharge readiness increased from (127.12 ± 26.29) to (137.63 ± 22.59) , the score of maternal knowledge level increased from (164.58 ± 20.10) to (176.08 ± 24.25) , t values were -7.04, -2.39 and -2.83, all P<0.05. The incidence of postpartum women breast disease, postnatal constipation and newborn eczema, newborn red buttocks, newborn diarrhea, newborn jaundice decreased significantly, the difference were statistically significant, χ2 values were 5.21-7.50, all P<0.05. After the application of evidence, the implementation rate of the review indicators increased from ≤31.67% to ≥86.66%. Conclusions:The evidence-based practice of discharge preparation service in postpartum women improve the quality of discharge guidance for practitioners and compliance with evidence, promote clinical quality improvement, can be used for clinical reference.

Evaluation of electronic health record-integrated digital health tools to engage hospitalized patients in discharge preparation.

OBJECTIVE: To evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge. MATERIALS AND METHODS: English-speaking, general medicine patients (>18 years) hospitalized at least 24 hours at an academic medical center in Boston, MA were enrolled before and after implementation. A structured checklist and video were administered on a mobile device via a patient portal or web-based survey at least 24 hours prior to anticipated discharge. Checklist responses were available for clinicians to review in real time via an EHR-integrated safety dashboard. The primary outcome was patient activation at discharge assessed by patient activation (PAM)-13. Secondary outcomes included postdischarge patient activation, hospital operational metrics, healthcare resource utilization assessed by 30-day follow-up calls and administrative data and change in patient activation from discharge to 30 days postdischarge. RESULTS: Of 673 patients approached, 484 (71.9%) enrolled. The proportion of activated patients (PAM level 3 or 4) at discharge was nonsignificantly higher for the 234 postimplementation compared with the 245 preimplementation participants (59.8% vs 56.7%, adjusted OR 1.23 [0.38, 3.96], P = .73). Postimplementation participants reported 3.75 (3.02) concerns via the checklist. Mean length of stay was significantly higher for postimplementation compared with preimplementation participants (10.13 vs 6.21, P < .01). While there was no effect on postdischarge outcomes, there was a nonsignificant decrease in change in patient activation within participants from pre- to postimplementation (adjusted difference-in-difference of -16.1% (9.6), P = .09). CONCLUSIONS: EHR-integrated digital health tools to prepare patients for discharge did not significantly increase patient activation and was associated with a longer length of stay. While issues uncovered by the checklist may have encouraged patients to inquire about their discharge preparedness, other factors associated with patient activation and length of stay may explain our observations. We offer insights for using PAM-13 in context of real-world health-IT implementations. TRIAL REGISTRATION: NIH US National Library of Medicine, NCT03116074, clinicaltrials.gov.

Understanding preparation for preterm infant discharge from parents' and healthcare providers' perspectives: Challenges and opportunities.

AIM: To describe the facilitating/inhibiting factors of preparation for preterm infant discharge and recommendations for increasing discharge readiness from parents' and healthcare providers' perspectives based on Meleis's Transitions Theory. DESIGN: A qualitative cross-sectional descriptive design. METHODS: We selected a purposive sample of 17 parents (9 fathers and 8 mothers) and 13 healthcare providers (10 nurses and 3 clinicians) from the neonatal intensive care unit of a tertiary hospital in Eastern China. Data were collected between May -July 2018. Data from audio-recorded semi-structured individual interviews were coded with content analysis both inductively and deductively. RESULTS: The analyses yielded four themes: personal conditions, community conditions, nursing therapeutics, and patterns of response. Parents and healthcare providers had unique opinions about the themes. CONCLUSION: Meleis's Transitions Theory seems to be an applicable and practicable framework for understanding the discharge preparation of parents with preterm infants and may be used to help healthcare providers to develop appropriate interventions on discharge preparation practice. IMPACT: To address the lack of discharge readiness of preterm infants in China and countries with a similar clinical context, healthcare providers should help parents play a more active role to promote their engagement in discharge preparation. In a wider global community, healthcare providers should consider parents' personal conditions and their practical needs in performing discharge preparation.

Formulation and implementation of discharge preparation intervention program for elderly patients with urinary incontinence / 中国实用护理杂志

Objective:To evaluate the practicability and effectiveness of nursing plan for elderly patients with urinary incontinence after operation.Methods:The patients admitted to the Department of Urology and Gynecology in a Grade 3A general hospital from September to October 2019 were selected as the control group, and the patients admitted from December 2019 to January 2020 as the intervention group. In the quasi-experimental study, the control group was given routine discharge guidance, and the intervention group was given a nursing plan for elderly patients with urinary incontinence to observe the preliminary effect of the nursing program for a period of 2 months.Results:Two months after implementation, the total scores of discharge preparation, quality of life and satisfaction of urinary incontinence in the intervention group was (125.08 ±17.64), (58.79 ±5.52) and (96.09 ±2.53) respectively, which were significantly different from those in the control group ( P<0.05). Conclusion:The preliminary verification of the scheme has a certain feasibility, has a certain guiding significance for nurses, and is helpful to improve the discharge preparation of elderly surgical patients with urinary incontinence and improve their satisfaction and quality of life when they are discharged.

Research progress in clinical practice of discharge preparation services / 中国实用护理杂志

The discharge preparation service is a complete process, which is of great significance for ensuring the patients′ discharge safety and the home sustainability of rehabilitation nursing. It has become a hot issue among international nursing scholars. This paper reviews the concept, implementation content, assessment tools, nursing practice of patient discharge preparation services, so as to provide theoretical basis for forming patient discharge preparation services system with medical environment in China.

"I don't know what I was expecting": Home visits by neonatology fellows for infants discharged from the NICU.

BACKGROUND: When families transition from the neonatal intensive care unit (NICU) to the home, they become responsible for their infant's daily medical needs. Though neonatology physicians prepare families for hospital discharge, it is unclear how much clinicians understand about how their teaching and instructions translate into home care. The goal of this study was to evaluate the influence of a home visiting program on neonatology fellows' understanding of family needs soon after hospital discharge. METHODS: Neonatology fellows conducted a home visit for an infant recently discharged. Before the visit, fellows reviewed their original discharge instructions, along with information about the family's neighborhood. During the home visit, fellows reviewed their discharge planning with families and discussed any challenges experienced. Afterwards, fellows completed a semi-structured interview; these transcriptions were manually coded for themes. RESULTS: Fellows identified several common women/family discharge challenges. These challenges fall into four domains: (1) inadequate discharge preparation, (2) medicalization of the home, (3) family adjustment to new "normal," and (4) the relevance of social context to discharge planning. Most (90%) fellows reported the home visit experience would affect their future NICU discharge practices and all agreed that home visits should be a part of neonatology training. CONCLUSIONS: Home visits allowed neonatology fellows to examine how their discharge preparation did, or did not, meet the family's needs. Incorporating home visits into neonatology training could help fellows learn about the relevance of social and community factors that are difficult to assess in the inpatient setting.

Quasi-experimental evaluation of a home care model for patients with stroke in China.

PURPOSE: To evaluate the effectiveness of a modified home care model in China. METHODS: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n = 168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n = 173) who received routine care. RESULTS: Modified home care was associated with shorter acute hospitalisation (11.29 ± 2.18 vs. 12.36 ± 4.33 d, p = 0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p = 0.004] and ability to perform daily activities (38.25 ± 10.22 vs. 32.08 ± 10.32, p = 0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p = 0.02]. CONCLUSIONS: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China. Implications for Rehabilitation Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China. The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation. Home care models for stroke survivors should be adapted to local healthcare policies and resources.

Preparo para alta pós-cirúrgica: resultados da ação andragógica observados durante a Visita Domiciliar / Preparation for patient discharge: results from andragogical practice observed during nurse home visit

Devido à precocidade cada vez maior da alta hospitalar pós-cirúrgica, a orientação do paciente torna-se de grande valor para a melhoria do auto cuidado. A aferição dos resultados dessa orientação é uma das formas de garantir a efetividade da intervenção do enfermeiro. Acredita-se que a aplicação de um modelo educativo que atenda as necessidades específicas do aprendiz adulto possa auxiliar o desempenho competente do enfermeiro no cumprimento da sua tarefa como educador. Portanto, realizou-se uma investigação com os objetivos específicos de: 1) levantar o número de pacientes que tiveram problemas de seguimento relacionados às orientações sobre aspectos gerais, complicações e iniciativas, e 2) verificar a opinião dos pacientes sobre a estratégia utilizada para a realização da ação educativa. O método utilizado desenvolveu-se em duas etapas. Na primeira etapa (intra hospitalar) realizou-se uma ação educativa baseada no modelo Andragógico e na fase extra hospitalar utilizou-se a visita domiciliar como estratégia para observar o seguimento do paciente às orientações ministradas. As principais conclusões do presente estudo demonstram que: a) a metade dos pacientes apresentou problemas indicativos do não seguimento das recomendações técnicas; b) a taxa de 1,4 problemas por paciente parece pequena em relação ao número de problemas possíveis (36); c) o cuidado com a ferida operatória foi o aspecto geral que apresentou maior número de pacientes com problemas; d) a alimentação e a postura corporal foram outros aspectos gerais que apresentaram taxas mais expressivas de pacientes com problemas de adesão; e) no presente estudo chama a atenção o fato dos pacientes que receberam orientações específicas relacionadas aos aspectos gerais apresentarem maior número de problemas que aqueles que não receberam essa orientações; f) quanto ao seguimento das orientações relacionadas as complicações os resultados demonstram que os ) pacientes seguiram essas orientações; g) a forma como as orientações foram ministradas não ocasionou grandes dificuldades para a compreensão dos pacientes e parece ter sido suficiente e agradável; h) a visita domiciliar, neste estudo, parece ser de grande importância para sanar falhas e atender as necessidades não previstas. Finalmente, parece que os resultados obtidos demonstram que o Modelo de Educação de Adulto (Andragogia) adotado pode ser considerado efetivo e que é de extrema importância o planejamento da alta do paciente cirúrgico e o preparo para o seu auto cuidado.

As post-surgery patients are discharged earlier from hospitals, instruction is of great value in improving self-care. One of the ways of assuring the effectiveness of nurse intervention is to measure the results of the instruction. It is believed that the application of an educational model which addresses the specific needs of the adult learner can improve nurse performance in patient education. This way, the current research aims to: 1) investigate the number of patients who had problems following the instructions in terms of general aspects, complications and initiatives; 2) verify patient opinion vis-à-vis the strategy employed in the educational action. The method used consists of two parts. In the first phase (in hospital), the educational action taken was based on an andragogical model. And, in the extra hospital phase, home visits were used to observe how patients were dealing with the instructions presented to them. The main conclusions of this research point out that: a) half of the patients had problems which indicates that they did not follow the tecnical recommendations; b) the rate of 1,4 problem per patient seems low when one considers the number of possible problems (36); c) surgical wound care was the general aspect which caused most problems among patients; d) eating and body posture were the other general aspects which presented the highest rates of patients with compliance problems; e) the current research calls attention to the fact that patients who received specific instructions related to general aspects presented more problems than those who did not receive these instructions; f) in term of following the instructions related to the complications, results demonstrate that patients followed these instructions; g) the manner in which the instructions were presented to the patients did not cause understanding difficulties and were apparently enough and pleasant; h) home visits, in this research, seem to be of great importance to solve flaws and respond to unforeseen needs. Finally, the results demonstrate that the adopted Adult Education Model (Andragogy) might be considered effective and of extreme importance when planning the discharge of post-surgical patient and preparing for self-care.