Needs for discharge planning among parents of preterm infants in the NICU: a systematic review and meta-synthesis

To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self-efficacy in parents of preterm infants. Parental readiness for hospital discharge and self-efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High-quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self-efficacy. This was a descriptive cross-sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale-Parent Form, and Preterm Parenting and Self-Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self-efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self-efficacy by improving parental readiness for discharge. Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self-efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self-efficacy. Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.

The objectives of this study were to apply empowerment strategies to the establishing of a support group for parents of preterm infants who were recently discharged home and to examine its effectiveness in terms of self-efficacy, perceived stress and depression among the parents. While the concept of empowerment has been applied when establishing various patient support groups, it has not been explicitly used for parents of preterm infants. This study applied a quasi-experimental design. The inclusion criteria were parents of infants with a birth gestational age of <37 weeks who were expected to be discharged home within one week. A total of 70 parents of preterm infants participated in this study, made up of 35 participants each in the intervention and in the control groups. The intervention group received three months of support applying empowerment strategies, while the control group received usual care only. The results, relative to the control group at post-test, demonstrated that the intervention group showed significantly higher scores for self-efficacy when using resources as well as significantly decreased scores for depression. For parents of preterm infants with a very low birth weight, the intervention group showed a significant decrease in perceived stress relative to controls, but this was not seen in parents of preterm infants without very low birth weight. There was no significant difference in the scores for self-efficacy when performing parental roles. his study demonstrated the effectiveness of support groups for parents of preterm infants that apply empowerment strategies, which decreased parental depressive symptomatology and increased parental self-efficacy when utilising resources. The intervention also effectively decreased the perceived stress level in parents of infants with very low birth weight. Health professionals should apply empowerment strategies when establishing parental support groups for preterm infants.

Objectives To assess the extent of the readiness for hospital discharge and the correlation with discharge teaching quality among parents of premature infants' in the NICU. Background Low readiness for discharge from the hospital can lead to negative outcomes in healthcare for infants born prematurely and their parents. Discharge guidelines are a basic approach to ensure the readiness of the parents for discharge from the hospital. No investigation has ever been conducted into the sufficiency of hospital discharge guidelines for premature infants and their impact on parental readiness for hospital discharge. Design Data was collected from four hospitals in China using a correlational descriptive study. Methods Two hundred and eight parents of premature NICU-hospitalized infants of four tertiary hospitals in Henan Province from May to October 2020 were enrolled. The general information questionnaire, the readiness for hospital discharge scale- (RHDS-) parent form, and the quality of discharge teaching scale- (QDTS-) parent form were used for data collection. Spearman correlation analysis and descriptive statistics were used to analyze the data. Results The total score for hospital discharge readiness was high (8.05 ± 1.11). The total score of the quality of discharge guidelines was moderate (7.44 ± 1.44). Moreover, the discharge teaching quality was positively correlated with the parents' readiness. Positive correlations were found between PRHDS and QDTS subscales, including content received and delivery, physical-emotional status, knowledge, and expected support. Conclusion The quality of the discharge guidelines perceived by parents of premature infants was moderate, which may have reduced their readiness for hospital discharge. Relevance to Clinical Practice. This study furnishes basic information on the importance of readiness of discharge for the parents of premature infants. The teaching guides nurses to enhance the quality of discharge teaching and the readiness of parents for discharge from the hospital.

Parents of children with a diagnosis or at risk of neurodevelopmental disabilities experience varied challenges of psychological adjustment. Many studies report psychological distress, including guilt, helplessness, anxiety and depression while in the Neonatal Intensive Care Unit (NICU)1 and often experience this time as traumatic and stressful.2 Interventions to improve the pyschological adjustment and well-being of parents of these vulnerable infants are varied in framework, dosage and timing.3 In their recent systematic review, Dickinson and colleagues examine the effect of interventions on psychological adjustment of parents of infants with a diagnosis or risk of neurodevelopmental disability compared with usual care.4 This study is different to other reviews that have included only preterm infants, rather than broader neurodevelopmental impairments, or focused primarily on infant development,5 mother-infant attachment6 or NICU-based3 interventions. Based on these papers, Dickinson and colleagues reported that a small number of high-quality studies demonstrated moderate strength of effectiveness in reducing parental psychological symptoms of trauma and stress, which was maintained at follow-up post-intervention (6 months to 8 years). Of the high-quality studies measuring depression and anxiety symptoms, there were no significant effects of interventions immediately post-intervention; however, significant improvements in these symptoms were seen at longer-term follow-up, suggesting a delayed effect of interventions on parental psychological adjustment. This highlights the importance of having psychological and emotional support for parents of high-risk infants both during an admission to the NICU and on discharge home, along with longer-term follow-up. High-quality studies were restricted to studies of preterm or low birth weight infants, highlighting a need for further studies in diverse high-risk infant populations. As a parent's ability to cope and support their infants’ needs is highly influenced by their psychological and emotional state, most interventions commence in the NICU to help parental psychological adjustment from the beginning of their child's journey.4 Similar to therapeutic interventions for infants with neurodevelopmental disabilities such as cerebral palsy,7 many intervention frameworks were explored in this review and no single approach appeared superior over another. This draws attention to the heterogeneity of therapy approaches in this area and the potential for future research to validate one approach over the others. Few included studies focused on both infant and parent outcomes, with only 33% also measuring infant or parent-infant relationship outcomes.4 Future studies may investigate both infant and parent outcomes to more holistically capture the entire family unit. Major strengths of this study were the systematic search strategy and clinically relevant interventions and outcomes. While some included studies had poor methodological quality, these were removed from meta-analyses to establish pooled effect of high-quality studies only. This review, while comprehensive, is limited by the research to date which is primarily focused on infants born preterm or low birth weight. Therefore, further research should explore parental psychological adjustment and well-being in wider neurodevelopmental disabilities. This knowledge is important to health professionals as parental mental health in adjusting to their infant's medical needs is crucial in the care provided to these infants. None. https://ebneo.org/2020/12/support-to-parents-neurodevelopmental-disability

To examine the effect of an educational intervention on parental readiness for premature infant discharge from neonatal intensive care units. Low readiness for discharge can result in negative healthcare outcomes for infants and their parents. However, few studies have examined the effect of discharge education programmes on parental readiness for premature infant discharge in Chinese critical care settings. A quasi-experimental study. Between October 2011-March 2012, 154 parents of premature infants were recruited from neonatal intensive care units of two tertiary hospitals in Central China. These parents were assigned to either the intervention or control group based on their entry order. Parents in the intervention group received two sessions of 60-minute discharge education along with hospital routine care; parents in the control group only received hospital routine care. Parental readiness for discharge and quality of discharge education were assessed on the day of infant discharge from neonatal intensive care units. Independent samples t-test and linear regression were used to analyse the data. Parental readiness for premature infant discharge was in the moderate level. Independent samples t-test showed that both mean scores of parental discharge readiness and discharge teaching quality from the intervention group were significantly higher than those in the control group. Linear regression analysis showed that discharge teaching quality explained 39·7% of the variance in parental readiness for premature infant discharge. Discharge education can improve parental readiness for premature infant discharge. Quality of discharge teaching can significantly predict parental readiness for premature infant discharge.

Readiness for hospital discharge is a multidimensional concept involving needs assessment, collaborative patient-centered care, resource management, and care coordination. It begins with admission assessment and treatment planning and then predicts patient readmission and continuity of care. Different studies have revealed moderate readiness for hospital discharge in various patient groups, with a focus on somatic diseases and less on mental disorders. Low readiness for hospital discharge leads to hospital readmissions, as well as financial and psychosocial burdens on patients and their families. As a result, patients, families, healthcare professionals, and community workers must work together to ensure readiness for hospital discharge. Despite the fact that these procedures are currently performed by nurses, nurses’ heavy workloads may have an impact on patients' preparation for hospital discharge. Additionally, various social demographic factors, illness-related variables, and psychological support have an impact on readiness for hospital discharge. Younger age, urban residence, higher level of education, and better financial status are positively correlated with increased readiness for hospital discharge, but disease severity, long duration of hospital stay, and limited continuity of care are negatively correlated with readiness for hospital discharge. In conclusion, readiness for hospital discharge is crucial for safe transitions; thus, addressing its influencing factors through teamwork and patient-centered methods may enhance understanding and meeting the unique needs of patients, particularly those with chronic and mental illnesses, allowing a successful transition from the hospital to the community.

IntroductionAlthough culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community.MethodNarrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants’ homes.ResultsAnalysis of data resulted in three threads/themes—respect for the elderly, use of herbal medicines, and communal living.DiscussionCommunity and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival.

Introduction:Birth of a premature infant and subsequent neonatal intensive care leads to psychological distress and trauma in parents. A large proportion of mothers show signs of trauma long after discharge from hospital. Fathers of premature infants are known to experience more stress than fathers of full-term infants. The sorrow experienced by parents of preterm infants is significantly higher than that experienced by parents of full-term infants because they have not been adequately prepared for the experience of birth, and need to cope with the stress caused by the clinical state and intensive care of the infant.Method:This was a descriptive-comparative study conducted in medical centers of Qom, Iran in 2012. In this study, 82 couples (164 mothers and fathers), participated in two groups as parents of preterm and full-term infants and completed demographic, midwifery, posttraumatic stress disorder, Spielberg anxiety questionnaires, and the Coping Inventory with Stressful Situation within 2 months after birth of their infant. Data were analyzed using Chi-square, Fisher’s exact, Mann-Whitney, independent t tests, logistic regression, and Repeated measures ANOVA in SPSS-18 software.Results:Posttraumatic stress disorder in preterm group mothers was significantly higher than in term group mothers (P=0.03), but no significant difference in this disorder was observed between fathers in these groups. There was a significant difference in coping styles with stress between mothers in the two groups (P<0.001) and between fathers in the two groups (P<0.001). Logistic model showed a significant correlation between posttraumatic stress and housing and coping strategies with stress in mothers.Conclusion:Parents of premature infants are more exposed to psychological disorders, and there is a need to adopt educational approaches to improve parents’ coping ability with preterm infant’s circumstance.

Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.

To explore parents of preterm infants' experiences of caring for their preterm infants with the grandmother as their primary support after discharge. Preterm delivery is the major cause of high neonatal mortality in sub-Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not-for-hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. Qualitative narrative inquiry methodology was used. Face-to-face interviews using semi-structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three-dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. Three themes emerged from the data, namely (i) Grandmother's prescriptions, (ii) Fighting for the well-being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents' mental health. As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants.

Preterm infants are at higher risk of sudden infant death syndrome (SIDS) compared with term born infants and the risk is inversely proportional to the gestational age and birthweight. Parents of these infants should have adequate knowledge and practise the recommended SIDS risk reduction measures. A survey was conducted between December 2016 and August 2017 at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur. Parents of preterm infants ≤36 weeks' gestation were invited to answer a self-administered questionnaire to assess their knowledge and practise regarding SIDS risk reduction. Forty-nine (61.33%) of the 80 parents had heard of SIDS prior to the interview, with social media being the commonest source of information (67.3%). Only 35 (43.7%) correctly answered at least five of nine questions on knowledge of SIDS risk reduction ("good knowledge"). When compared with the group of parents who answered less than five questions correctly ("poor knowledge"), there was no significant difference in the demographic and infant characteristics between the groups. The majority (68.8%) of parents practised bed sharing with their infants, and this was significantly more common in the group of parents with poor knowledge (P = 0.01). Household smoking was also significantly more common in the group of parents with poor knowledge (P = 0.048). Knowledge on SIDS risk reduction measures was generally poor among parents of preterm infants in this study. Cigarette smoking, bed sharing and non-supine sleep positions, which are associated with increased risk of SIDS, were common practise among the present subjects.

The purpose of this study was to assess the stress among parents (either the mother or the father) of infants with neural tube defects (NTDs) and its associated factors. Using Parenting Stress Index-Short Form (PSI-SF), 100 parents of infants with NTDs were compared with 100 parents as a normative group. The total mean score for parents of infants with NTDs was 104.0 (standard deviation (SD) = 22.9) compared with 84.3 (SD = 18.9) for parents of infants without NTDs. Fifty-three (53.5%) parents of infants with NTDs and 15% of the control group had clinically significant high total stress score. Parents of infants with NTDs had a significantly higher score of distress in all scales of PSI-SF compared with those of infants without NTDs. Multivariate analysis found that mothers of infants with NTDs had a significantly higher average score for parental distress, parent-child dysfunctional interaction and total stress than fathers. Parents' lower education, unemployed parents and lower family income per month were significantly associated with increased parent-child dysfunctional interaction and parental distress. Parents with lower education and lower family income are in need for psychological and emotional support from health-care professionals.

BackgroundDuring the postpartum period, new parents frequently experience emotional stress and exhibit symptoms of depression and anxiety, accompanied by substantial endocrine changes. However, evidence predominantly exists from parents of full-term infants, while data on parents of preterm infants are scarce. In this exploratory, cross-sectional study, we compared psychological well-being and endocrine parameters in parents of very preterm and term born infants.MethodsMothers (N = 28) and fathers (N = 30) of full-term infants as well as mothers (N = 18) and fathers (N = 21) of very or extreme preterm infants (< 32nd gestational week) were recruited in the days following birth. Anxiety, depression, and perceived stress were assessed with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Perceived Stress Questionnaire (PSQ), respectively. Physiological measures included serum levels of estradiol, progesterone, prolactin, and thyroid-stimulating hormone (mothers only), as well as the salivary cortisol awakening response (mothers and fathers).ResultsNew mothers and fathers of very preterm infants exhibited higher scores of depression, anxiety and stress than parents of term infants. Besides, mothers of very preterm infants showed lower levels of estradiol, progesterone, and prolactin, as well as a heightened post-awakening cortisol response compared to mothers of term infants. Furthermore, in mothers of preterm infants we found significant negative associations between serum prolactin levels and BDI and STAI scores, respectively.ConclusionsParents of very preterm infants suffered from a higher burden of psychological distress than parents of full-term infants. The affective symptoms in preterm mothers were accompanied by altered endocrine profiles that, at least to some extent, may contribute to the psychological changes. The profound psychological and physiological disturbances in mothers of preterm infants may have an impact on long-term mental health and early pharmacological and psychological interventions may help to ameliorate postpartum affective symptoms.

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

Background: Developmental supportive carerecognizes the physical, psychological and emotional vulnerabilities of premature and low birth weight infants. The aim of this study was to assess knowledge and practice of nurses regarding developmental supportive care for preterm and low birth weight infants in Neonatal Intensive Care Unit (NICU). Subjects and method: design: A descriptive designwas used, the study was carried out on 180 nurses at the governmental hospitals at Mansoura City. Tools: Tool (1) Structured interview for nurses' personal characteristics and their knowledge about preterm infant and developmental supportive care. Tool (2) an observational checklist for nurses' practice of developmental supportive care for preterm and low birth weight infants during daily nursing care procedures. Results revealed that most of the studied nurses had satisfactory level of knowledge regarding developmental supportive care for preterm and low birth weight infants while of them had inadequate practice of developmental supportive care for preterm and low birth weight infants, there were no statistically significant relation between nurses' knowledge and their actual practice (p < 0.05). Conclusion: 64.4% of the studied nurses had satisfactory level of knowledge regarding developmental supportive care for preterm and low birth weight infants, while more than half of studied nurses (56.7%) had inadequate level of practicing developmental supportive care for preterm and low birth weight infants. Recommendations. Setting training and educational programs for nurses to improve their knowledge and their performance regarding developmental supportive care for preterm and low birth weight infants.