The Views and Experiences Associated with Discharge Planning of Parents with Newborn Infants - Research Paper Example

The views and experiences associated with discharge planning of parents with newborn infants” In maternity, holistic care is extremely important because all new family members need to be considered during discharge planning. The purpose of this assessment is show the chosen research provide relevance to current nursing practice. Reasons for choosing the articles is firstly because of a consistent personal involvement with childcare duties and a strong maternal side. Secondly, from personal experience as an enrolled nurse have performed a variety of discharges in many areas except maternity. Therefore doing this assignment will provide the opportunity to research maternity focused nursing care and gain personal insight and improve future practice about discharge in the maternity area. There are three main groups of infants to consider:   1. The otherwise well term or near term new born infant following  a hospital delivery 2. term or near term infants with proven or suspected disorders, such as congenital anomaly, which requires medical intervention in the perinatal period and 3. preterm infants who have required varying periods of care on the neonatal unit.   Mupanemunda, and Watkinson (2004) find that there is a dearth of consensus on the optimum postpartum length of stay for healthy term infants. There is a worldwide variation in policies and guidelines on the perinatal stay. Generally, the usual stay for a vaginal delivery in most countries is 1-3 days and up to seven days after a caesarean section. Discharges may, however, be done as early as 6-8h depending on, among social and financial factors. The timing of each discharge is probably best individualized for each infant, depending on the individual medical, social and economic aspects. Prior to discharge, however the following important points should be noted: whether or not the infant is feeding well, if the infant has voided urine and passed stool along with a consideration on if the physical examination of the infant is normal.   This paper will discuss and compare three primary articles concerning various discharge planning interventions adopted by midwifes to improve the experiences of parents with newborn infants. It will critically review and compare the study strengths, limitations, similarities and differences between all three articles. Relevant learning outcomes and two graduate attributes will be described in how they have been addressed during completion of this assignment. Article one is titled “Enhancing early post natal care: findings from a major reform of maternity care in three Australian hospitals” by Yelland, Krastev & Brown (2007). The purpose of this study is to determine the effect the maternity enhancement initiatives have on new mothers views and experiences during early postnatal care. This research was conducted in 1999 and 2001 and was published in 2007. The study method used was a baseline and post - implementation survey. The surveys were given to women from the Monash centre, Clayton campus and Dandenong hospital in 1999 and 2001. A number of global questions were used to capture women’s overall experiences and specific questions aimed to identify women's personal experiences with the medical staff. The questionnaires also used self reported maternal morbidity questions to collect data on personal relationships and home life. The Edinburgh Postnatal Depression Scale (EPDS) was implemented to assess maternal emotional well being. The participants for the baseline survey contained women who had given birth within the 14 week period in 1999, 1922 questionnaires were distributed, 93 refused to be included, 1256 were returned for analysis. The post- implementation survey held in 2001 contained women who had given birth in hospital within the 15 week period. A total of 1829 questionnaires were distributed, 34 women did not participate, 1795 were completed and returned. The study was approved by the La trobe University and the Southern Health Care Network Human Research Ethics Committees. A questionnaire was used to obtain the personal maternal morbidity data and a variety of precoded questions were listed that included asking questions about health issues during and after discharge. In the analysis, a comparative approach was used on the women who were admitted to one of the three hospitals and who participated in the surveys. Results were divided into four categories: inpatient postnatal care, length of hospital stay, post discharge care and maternal care. Three of the four categories showed an overall increase in postnatal care in 2001 compared to 1999. It was suggested that a greater improvement in relationships and interactions with caregivers contributed to this increase. Inpatient postnatal care showed significant improvement in areas of discharge advice in hospital, midwife attitudes, and continuity of care. It was suggested that enhanced communication, individualised approach and philosophy of continuity improved these ratings. Results showed no association between the length of stay and post natal care across both groups. Postnatal care at home showed a great improvement because of the implementation of the extended postnatal care program. There was a 38 percent increase of women in 2001 who stayed five days or more receiving a domiciliary visit. Although in 2001 one third of women reported that the domicillary midwife did not find the advice about own health very helpful. It was suggested that factors of improved discharge education or lack of experience in caregivers lead to this response. In 2001 only 45.6 percent of women wanted more help and advice about own health compared to 54 percent in 1999. The edinburgh post depression scale showed little change between both groups. A small proportion of women from each year that scored 13 and higher which suggested they were depressed at the time of completion. Article two is titled “Descriptive study of mother’s experience feeding their preterm infants after discharge. The purpose of this study was to determine if the new intervention programme implemented within the neonatal intensive care unit led to positive or negative experiences of the parents of preterm infants during their transition home. This study used a non- experimental, exploratory and descriptive survey carried out over two years plus a one year evaluation. The article used quantitative and qualitative research methods developed into semi structured questionnaires and formal interviews. The Method used in the article is qualitative, wherein both multiple choice and open ended answer based interviews were conducted. The research makes use of the Likert style questionnaire as defined by Burns and Grove (2008). The questionnaire also used direct questions to grasp parents opinions about how the new interventions met their needs. The questionnaires were mailed out when the infants were 4-14 months of age. Non- danish families completed their questionaires with interperters. A total twenty seven mothers participated in the study. Most of them were black, unmarried, and unemployed.the 1st of October,1998 to 31 September 1999. Two families did not participate because of personal reasons. A total of 39 infants who live in Cophenhagen and were born before 34 weeks participated. 22 families had intentions to participate in the focus group interviews but only 18 families attended. These families were divided into in to three groups. Data analysis and interpretation was carried out through the use of the phenomenologic approach. In this step, transcripts were read and analyzed inductively by the first 2 authors individually to obtain an overall sense of the information and to reflect on its meaning. The transcripts were then reread several times to extract themes. Comparison of themes across interviews was made and similar themes were grouped and analyzed. The research found three dominant themes by way of analyses. The first was the interpretation of infant behavior, wherein recognized that variables such as feeding readiness included considerations on the part of mothers of their infants' motor and behavior state organization before a feeding, particularly the infants' level of alertness. The second theme worked with respect to the management of the evolution of the feeding process, wherein the focus was on the mother's evaluation of her infant's skill at bottle feeding, meeting the demands of the feeding schedule, and controlling her time and resources. Here it was found that mothers would appreciate the changes in their infants' feeding abilities since discharge. There was a high level of anxiety among mothers with respect to what would happen if they missed a feeding and abnormal feeding behavior would illicit strong reactions. The final theme was the realization of the knowledge gaps, wherein the research found that mothers tended to feel scared and apprehensive about their infants after discharge, but these concerns would tend to diminish in number and degree once infant's cues became clearer and the feeding patterns became more predictable. The research concluded with a stress on the need for anticipatory guidance to mothers in postnatal care before discharge regarding the expected changes in feeding habits over the first 2 to 3 weeks at home. Discharge teaching should include scenarios to help the mother think through decisions that are necessary during the early post-discharge period. The third article by Broedsgaard and Wagner (2005), entitled, How to facilitate parents and their premature infant for the transition home, focused on carrying out an intervention based programme in a neonatal intensive care unit at the Copenhagen University Hospital in Denmark in 1998/99. It was made up of the educational programmes during hospitalization for parents with premature infants; (2) visit and orientation about the neonatal intensive care unit by the family’s health visitor; a multidisciplinary and cross-sector discharge conference; and (3) publication of relevant booklets for parents and health care providers. The purpose of the programme was to form a presentation of the parents’ experiences from the research based intervention, concerning support and coordination following delivery of a premature infant. The study focused mostly on pre term infants in Denmark, a country where over 70 000 infants are born each year, 1.7% of which are born before week 34 of gestation. The research was based on the innate assumption that given the fact that the number of preterm infants was relatively low vis-à-vis the total number of children born, there would, first be a host of special needs that these families would have and that these children and their families would need special care. So the study would aim at finding characteristics and innate meanings of this care variable. The study design made use of quantitative and qualitative methods as semi-structured questionnaires and focus interviews to grasp the parents’ experiences. In the neonatal unit at the Hvidovre Hospital in Copenhagen approximately 70 infants are born before week 34 each year. During the time of the study period, there were 50 infants in the neonatal unit who met the inclusion criteria. The study focused first on a pilot testing method by which questionnaires were used among comparable groups. The questions were developed following the principles of a Likert-scale where the respondent in essence answers questions based on a range that ranged from very satisfactory to unsatisfactory. The answers were arrow marked. Detailed opened answers/comments could also be provided to some questions. For the purpose of the interview, 63 mothers were invited to participate, of them fifty-five mothers (89%), including 3 mothers of twins, consented. Of those who gave consent, 27 (49%) of the mothers and 30 infants returned for the interviews.The participants included twenty-seven mothers, most of whom were more than 24 years of age, first-time mothers, black, unmarried, and unemployed. Among them were 24 singleton infants and 3 sets of twins. Data Analysis for the study was carried out with the help of frequencies and percentages for the quantitative questionnaire numbers. The qualitative statements were analysed separately and further developed for questions in the following focus group interview guide which included the following themes: admission to the hospital at the neonatal unit; rooming-in; rooming-home; discharge and everyday life at home. The first finding of the study was that the nurse coordinator held an important position with respect to the integration of the new born into the family and into the mother’s life. The mothers, given the fact that she would be psychologically burdened by the early delivery could have lasting consequences, inhibiting the mother’s ability to produce milk. The recommendation in this context was that health care system’s efforts should work in a cohesive process with goal-orientated information and guidance directed to the needs and resources of individual mothers and families, and to avoid separating mother and child. Hence the study found the coordinator should remain as a permanent feature, with main functions as a connecting role, a consultation function and to develop relevant materials for parents and personnel. If one were to compare the three articles one would find that in terms of wide scope of research and credibility of methodology, the first two articles remain faithful, given especially the fact that results and their tabulation is dedicated to numerical propositions. The third article however is a good study if one needs to understand human natue reactions to childbirth and the manner in which the healcare professional should deal with such situations. The second article for example is not able to bring out the problems of post pregnancy depression that faces most mothers, the reasons of abnormal feeding behavior, and the role of the nurse in educating the mother best practices on feeding the child. Where the first article was concerned, the problem is with respect to the fact that there is an inordinate amount of focus on the family and none on the mother. Also, pre-discharge planning have been completely ignored. Through the study of these articles one was able to pick up two important attributes. First and foremost, one was able to understand the fact that for mothers and their families to be comfortable and aid in the overall process of childbirth. Second, one was also able to underastand the fact that in most such cases the overall time of worry and pain could be lessened considerably by nsuring that there is a continuing interaction that happens with the family of the mother so that the process of dialogue and help in patient satisfaction remains open. References: Yelland, J., Krastev, A., and Brown., S., (2006). ‘Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals’. Journal of Mother and Child Health Research.Vol. 25. pp392–402. Mupanemunda, R. H., and Watkinson, M., (2004). Key topics in neonatology. Taylor & Francis publishing. p99 Broedsgaard, A., and Wagner, L., (2005). ‘How to facilitate parents and their premature infant for the transition home’. International Nursing Review. Vol.56. pp196-203 Barbara, R., Pickler, R., Thompson, A. R., (2006). ‘A descriptive study of mother’s experiences fir their preterm infants after discharge.’ Advances in Neonatal Care. 6(6). Pp333-340 Nancy Burns, Susan K. Grove (2008), The Practice Of Nursing Research: Appraisal, Synthesis, And Generation Of Evidence [With EBook], W. B. Saunders Company, Edition: 6th Edition, Pp: 532 - 750 Miles, M. B. & Huberman, A. M. (1994). Qualitative Data Analysis. Thousand Oaks, CA: Sage. Read More