Discharge Of Mothers Research Articles

The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery

BackgroundThe aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery. MethodsThis study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention. ResultsThe results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001). ConclusionThe H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery. Implications to practiceThe results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.

Comparison of Two Pumping Strategies to Improve Exclusive Breastfeeding at Discharge in Mothers of VLBW Infants with Low Milk Output - A Pilot Randomized Controlled Trial.

To compare the effect of two strategies of breast pumping-power pumping (PP) vs. routine pumping (RP) over one week in mothers of very low birth weight (VLBW) infants with low milk output to improve breastfeeding rates at discharge. Mothers with low milk output, defined as inability to express sufficient breastmilk to meet the feeding requirements of their infant on or after post-natal day 14, were randomized to receive power pumping vs. routine pumping - once daily for 7 d coupled with routine lactation support and hand expression 3 hourly in both groups. The primary outcome was exclusive breastfeeding at discharge. There was no difference in the two pumping strategies with respect to exclusive breastfeeding rates [61.1% in PP vs. 50% in RP group; (p = 0.477, RR 1.2; 95%CI 0.76 to 2.17)]. Median milk volume pumped in the individual power pumping session on 7th day of intervention was significantly higher than that in the individual routine pumping session on the 7th day (50 mL vs. 27 mL, p = 0.014). The cumulative median milk volume expressed per individual pumping session over the 7 sessions of power pumping was also higher than that with routine pumping (305 mL vs. 213 mL, p = 0.054). In this pilot trial, expressed milk volume was significantly higher after each individual power pumping session compared to routine pumping. However, the exclusive breastfeeding rates at discharge were similar in the two groups.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

BackgroundVery few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge.MethodsAn observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge.Results308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge.ConclusionsMothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Predictors of readiness for discharge in mothers of preterm infants

Objective: To determine the predictive role of stress, self-efficacy, and perceived social support on readiness for discharge in mothers of preterm infants. Methods: The present cross-sectional, descriptive-analytical study was conducted on 120 mothers of preterm infants admitted to hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. Participants were selected by a convenience sampling method and based on inclusion criteria. Data collection tools included the demographic questionnaire of mothers and infants, parent perceptions of their child's hospital discharge, parental stressor scale: neonatal intensive care unit, perceived maternal parenting, and multidimensional scale of perceived social support. Data were analyzed using Pearson correlation and stepwise regression at the significance level of 0.05. Results: Infant behavior and appearance, situational belief, and family support achieved the highest mean score from parents' stress, self-efficacy, and perceived social support dimensions, respectively. There was a significant relationship between stress, self-efficacy, and perceived social support with readiness for discharge in mothers of preterm infants (P&lt;0.001). The score of mothers' readiness for discharge decreased by 0.07 per 1-point increase in stress score, and the score of readiness for discharge in mothers of preterm infants rose by 0.35 and 0.43, respectively, for a unit increase in the scores of self-efficacy and perceived social support. Conclusions: Stress, self-efficacy, and perceived social support can be considered as predictors of readiness for discharge in mothers of preterm infants. It is suggested that nurses in neonatal intensive care units provide a better platform for the readiness for discharge in mothers of preterm infants by reducing stressors and increasing maternal self-efficacy and social support.

Evaluation of the consequences of early permission of mothers with cesarean delivery

Background: In Iran, there is a high tendency to give birth by cesarean section, while about 75% of them are unnecessary and selective. In many hospitals in the country, mothers who have undergone cesarean section are permission 24 hours after the operation if they have stable vital signs and are in good general condition. The aim of this study was to evaluate the consequences of early discharge in mothers who underwent cesarean section.Methods: This descriptive case-series study was performed on 400 pregnant women aged 18-40 years with a gestational age of 37 weeks and more who were admitted to the hospital in Ardabil city for cesarean section at year 2019. Patients without any preference were divided into two groups. The first group was discharged 24 hours and second group was discharged 72 hours after surgery. Individuals in both groups were followed up by telephone 1 and 6 weeks after permission. The relevant checklist was completed for all of them. Other necessary data were collected through a questionnaire containing demographic and clinical information.Results: Two groups were matched in terms of age and body mass index. At one and six weeks after discharge; there was no significant difference between two groups in terms of fever, readmission, symptoms of infection and use of antibiotics.Conclusions: The results of the present study showed that after cesarean section, if the patient's vital signs are stable, the patient can be discharged after 24 hours.

LATCH Score at Discharge: A Predictor of Weight Gain and Exclusive Breastfeeding at 6 Weeks in Term Healthy Babies.

World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff. This prospective cohort study was conducted in India. Ninety-three mother-infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks. LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32-12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false-positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39-0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25-0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001). LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.

A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design

BackgroundThe well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants.PurposeTo compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs.MethodsA pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge.ResultsPod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy.At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education.ConclusionsFurther study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.

Neonatal screening for hearing loss and its risk factors at a tertiary hospital; A : Prospective Cross sectional study.

Background Hearing loss is one of the commonest childhood disabilities with a huge burden in developing countries like India. Detecting and rehabilitating neonates with hearing impairment is a healthcare priority. Prevalence of hearing impairment among neonates is high. Early identification and early rehabilitation is the key in addressing this disability. Behavioral observation audiometry is a dependable screening tool compared to Auditory Brainstem Response.Objectives 1. To screen neonates for hearing impairment using behavioral observation audiometry 2.To confirm hearing impairment using Auditory Brainstem Response among screen positive neonatesMethodology A cross sectional study was conducted among 160 randomly selected neonates. A questionnaire was administered followed by free field testing of Behavioral Observation Audiometry was done on all neonates. Risk factors for neonatal hearing loss was assessed among all neonates.Results The prevalence of hearing impairment on screening with BOA was found to be 2.5 . Risk factors for hearing impairment are more prevalent in our study. 27.5 of the neonates were born preterm being the most common risk factor followed by hyperbilirubinaemia 21.9 low birth weight 13.13 NICU admissions 9.4 and vaginal discharge in mothers during antenatal period being 6.9.Conclusions Prevalence of hearing impairment among newborns and its risk factors are high among normal newborns. Hence there is a need for a routine neonatal hearing screening program.

The Implementation of the Discharge Nurse on a Mother–Baby Unit: A Conduit to Increased Patient Satisfaction

Paper Presentation Purpose for the Program The discharge nurse (DN) position was presented to hospital administration in 2011 for permission to grant a trial as a strategy to improve patient satisfaction with the mother–baby unit (MBU) discharge process. We hoped to improve consistency of parent education before discharge and improve patient satisfaction with the process. We also felt this position would affect throughput between the labor and delivery unit and the MBU simply through facilitation of timely discharges. We projected an increase in our Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores as a result of this innovative program. Proposed Change A DN would work five 8‐hour shifts Monday through Friday. The DN would meet patients on their first day admitted to the MBU and begin their plan for discharge. Furthermore, the DN would review all prescriptions on the day of discharge, including the effects of medication and potential adverse effects, review and prepare necessary paperwork, review discharge instructions for the mom and infant, review all screening tests and results, and review follow‐up appointments for the mom and infant. Patients discharged in the coming day or days would attend a daily parent education class taught by the DN. The final car seat check would also be executed by the DN. After the mom and infant were discharged, the DN would document the discharge and complete the process. Implementation, Outcomes, and Evaluation The position was trialed for 3 months and made permanent late spring 2012 after evaluation of outcomes were realized. Press Ganey as well as HCAHP scores validated an increase in patient satisfaction with the discharge process and patient education class time. The hospital administration recognized the positive outcomes and is presently using this best practice on another unit. Implications for Nursing Practice This innovative program can be used on any unit struggling with discharge‐related patient satisfaction scores. The efficiency gained as a result of this process can be extrapolated for admission as well, and an admission and discharge team can be used to generate improved satisfaction in addition to improved throughput between units. Standardization ensures that the education surrounding discharge of mothers and newborns is consistent from one patient to the next. Nurse satisfaction was improved from this process and left more time for the staff nurse to monitor, care for, and teach patients with less fragmentation.

A qualitative study on adaptation process of home life after discharge in mothers of children hospitalized for childhood cancer

A qualitative study on adaptation process of home life after discharge in mothers of children hospitalized for childhood cancer

Discharge of Mothers and Babies from Hospital after Birth of a Healthy Full-term Infant: Developing Criteria Through a Community-wide Consensus Process

To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services. Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed. Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines. Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.

Postpartum Home Visits: Infant Outcomes

Early postpartum discharge of mothers and infants has increased as health care providers and payers attempt to control health care cost. Questions regarding patient safety have been raised. Literature supports the safety of early discharge when providers adhere to strict discharge guidelines and when clients comply with home follow-up. Previous studies calculated hospital readmission rates, but few examined other outcomes or characteristics. The purposes of this descriptive study were to examine outcome data for infant participants in a postpartum home visit program and to explore factors that may influence hospital readmissions for infants. Using an audit tool with established reliability and validity, a convenience sample of 199 infant medical records was reviewed for demographic information, characteristics, and outcomes. The hospital readmission rate for all infants within 3 weeks of discharge was comparable to other studies; however, the rate for only early discharge infants was higher than the rate reported in other studies. The study of postdelivery outcomes for infants provides additional insight into the issue of early discharge and may reflect the significance of postpartum follow-up care and education.

Early newborn specimen: Survey of practices among newborn screening programs in the United States

Introduction: Hospital discharge of mothers and their infants within 24 h after delivery is becoming very frequent in the United States as part of the effort to constrain rising costs of health care. This poses a potential problem in newborn screening since the newborn blood specimen is most certainly and most efficiently collected prior to nursery discharge. We surveyed newborn screening programs about current practices in regard to these early specimens. Methods: Two survey forms were sent to the programs. The first requested information about recommendations and regulations for collection of specimens from early discharged infants, for collection of repeat specimens and the responsible agent for these collections. The second form asked which disorders were screened in the first and repeat specimens. Results: All programs recommend collection of a newborn screening specimen before discharge, regardless of how early that occurs, and all but one program recommends a repeat specimen for infants initially screened less than 24 h after birth. The agents designated as responsible for collecting the newborn specimen included hospital administrator and/or attending physician and/or physician following infant. Most of the programs gave written notification for a repeat specimen on early discharged infants but some notified the birth facility and follow-up physician, a few notified only one or the other and several notified the parents. All programs re-tested the repeat specimen for PKU and most re-tested for congenital hypothyroidism and the other disorders screened in the initial specimen. Discussion: Balancing the physiological suitability of early specimens against logistical issues encountered by delaying specimen collection until after discharge is a concern for newborn screening programs. This survey provides background information for guidelines on specimen collection in the early discharged infant.