Enhancing Parents’ Well-Being after Preterm Birth—A Qualitative Evaluation of the “Transition to Home” Model of Care
Abstract
:1. Introduction
1.1. Models of Care to Provide Family Support
1.2. The “Transition to Home (TtH)” Model
1.3. Aims
2. Materials and Methods
2.1. Participants
2.2. Semi-Structured Interview Guide
2.3. Data Collection Procedures
2.4. Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Findings
“In the beginning we didn’t really know, well, what do we need to do? What (support) can we actually ask for? […] It wasn’t fully comprehensible. We didn’t know in detail what “Transition to Home” meant for us.”(D10; 10:18)
3.2.1. TtH and the Relevance of Continuity of Care
“[…] it (the in-patient care) does not end all of a sudden […], it is a somewhat stepwise leaving the hospital. In my view this is very good.”(D7, 7:160)
“In my view you need the support especially after discharge, then, actually, you would need it 24 h/7 days. But pretty soon thereafter you don’t need it anymore.”(D64; 64:14)
“Without her (lactation consultant) I hadn’t managed the breastfeeding.”(D5; 5:22)
The Advanced Practice Nurse: The Bridge Home
“Well, surely, many issues could be recognized early on that otherwise had potentially caused problems.”(D2; 2:114)
“When she (the APN) visited us the first time, it was just the right moment. He (the child) had cried all night and didn’t drink. I was glad to know that she (the APN) was due to visit such that I could ask her whether this behaviour was normal or not […] she then checked him […] and gave me an all-clear […] this was such a relief.”(D4; 4:37)
“What was most important, in my view, was this contact person. The APN […] who we could contact […] she knew us and knew how things were…”(D11; 11:40)
Continuity of Care and Parents’ Unmet Expectations
“When I came to the NICU, the bed of my child had gone.”(D24; 24:68)
“I think what the experts don’t understand so much is the fact that the cultures are so very different.”(D3; 3:119)
“Well, this was a huge difference to the neonatal intensive care unit. At the NICU, we basically had to ask for permission if we wanted to do something, and now on the intermediate care unit, they assumed that we’d just do and only ask if we needed something.”(D20; 20:17)
3.2.2. Enhancement of Parents’ Autonomy and Self-Confidence
“[…] (it was a) triangle: work, hospital, going home to sleep and again work, hospital, home to sleep […] a tight timetable also without any time for us as a couple.”(D50; 50:31)
“She (the APN) always pointed-out options […] and left it to us to decide […] and whatever we went for, it was good. We felt very well supported.”(D20; 20:53)
Acquiring Knowledge
“We noticed that she (the APN) was very well prepared for the home visits. She got back to topics that we had mentioned during our last conversation, and she had answers. She really made an effort to impart knowledge. This was a huge additional value.”(D25; 25:46)
“The APN and this program helped us to see the difference in her (the child’s) development from the beginning until now. […] So, we really pay more attention to how things go.”(D39; 39:127)
“Body weight is a key factor, you want to know if she (the child) is gaining weight, is drinking enough, you feed her correctly […] in this aspect she (the APN) helped.”(D41; 41:185)
“Sometimes the consultations were not about fields in which she (the APN) was strong […] perhaps this was because of my questions, but, when you are at home, it is about the child at home, not so much about preterm birth.”(D4; 4:11)
Parental Emotional Support
“Most important is this encouragement, to know that you’re doing it right.”(D42; 42:63)
“Relaxing, taking time […] the music is supporting […] it calms down […] and it is also unconsciously knowing that nothing else will happen for the next 20 min.”(D50; 50:67)
“I saw the psychologist. She was very supportive such that I felt more confident and comfortable in my role as a mother and started to build trust in the relationship (to the child). I no longer felt anxious or guilty as at the beginning.”(D6; 6:82)
3.2.3. Perception of Interprofessional Collaboration
Perception of Health Care Professionals’ Roles and Competencies
“At the beginning, when the role (of the APN) wasn’t fully clear to me, I sometimes wondered why she was also present. There were already so many people.”(D26; 26:78)
“The APN and the midwife had arranged alternating visits. Thus, someone came to see us at home every week. This was very convenient.”(D8; 8:345)
The Impact of Different Forms of Communication
“…if they didn’t communicate such things (diagnostic findings). You can’t communicate nothing to a waiting family. Even if one doesn’t say anything, you realize their facial expressions and you know what’s up.”(D50; 50:89)
“They were always positive, even if something was going on, they always saw something positive. Not like the others, who then said, oh the child is ill, so ill.”(D16; 16:44)
The Impact of Interprofessional Roundtable Discussions
“I see it like this: you learn about the problem and then discuss together how to handle it”(D50; 50:69)
“There were so many people. At first we thought that we massively underestimated the situation. Does it need so many people to support us?”(D12; 12:50)
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Components of Model | Description |
---|---|
Advanced Practice Nurse (APN) support | All team members contribute to a comprehensive plan for individual discharges, hold consultations, coordinate and collaborate closely with different HCPs so that information flows freely, and they participate in regular interprofessional exchanges. The APN takes a family-centered approach in assessing the needs of the families and in making shared decisions. The APN regularly visits, consults with and educates parents and acts as a continuous partner. After discharge, the APN offers three systematic follow-up calls, telephone support when needed and up to nine follow-up home visits to assess the physical health of infants and parents and the mental health of parents, with a view of evaluating interventions and adapting the care as the family’s needs evolve. |
Psychological support | A psychologist provides psychological support to all families, comprising assessment and at least three follow-up consultations before the infant is discharged. The goal is to re-establish emotional stability, improve parents’ ability to cope, prevent the parents and family from developing adaptive disorders and protect the infant from developmental disorders. |
Lactation consultation | During hospitalization, the lactation consultant responds to the needs of the families, including fathers. The aim is to strengthen parent–child bonds and to show parents how to meet their child’s nutritional needs. |
Physical therapy | The physical therapist provides treatment after an assessment. In a single consultation, the family learns how to handle their premature infant in everyday life, in a manner appropriate to the infant’s developmental stage. |
Support by social worker | Social workers collaborate closely with the APN and are involved with every family. They help families cope with daily life after preterm birth and during and after hospitalization. |
Music therapy | A music therapist offers music therapy during hospitalization to stabilize the child, support its development, reduce parents’ anxiety and enhance their self-efficacy. |
Interprofessional roundtable discussion | Interprofessional roundtable discussions with involved HCPs and parents are held twice while the preterm infant is hospitalized and once three months after discharge. The meetings seek consensus on the optimal support for families in care. |
Characteristic | Mothers N = 20 | Fathers N = 19 | Infants N = 22 |
---|---|---|---|
n (%) or median (IQ-range) or mean ± sd | n (%) or median (IQ-range) or mean ± sd | n (%) or median (IQ-range) or mean ± sd | |
Age, years | 32.5 (31.0; 35.8) 33.3 ± 2.8 | 35.0 (31.0; 38.0) 36.5 ± 8.1 | |
Nationality | |||
Swiss | 16 (80%) | 16 (84%) | |
German | 1 (5%) | 2 (11%) | |
Macedonian | 1 (5%) | ||
Italian | 1 (5%) | ||
Other | 2 (10%) | ||
Marital status | |||
Married | 14 (70%) | ||
Unmarried | 6 (30%) | ||
Living in Switzerland since | |||
Birth | 15 (75%) | 16 (84%) | |
>20 years | 1 (5%) | 2 (11%) | |
>5 years | 2 (10%) | ||
>2 years | 1 (5%) | 1 (5%) | |
<2 years | 1 (5%) | ||
Highest education level | |||
Primary and secondary school | 2 (10%) | ||
Apprenticeship | 3 (15%) | 5 (26%) | |
College of higher education | 6 (30%) | 1 (5%) | |
University of applied science | 3 (15%) | 2 (11%) | |
University | 6 (30%) | 9 (47%) | |
Other | 2 (11%) | ||
Employment status | |||
Full-time | 5 (25%) | 11 (58%) | |
Part-time | 11 (55%) | 5 (26%) | |
Not employed | 4 (20%) | 3 (16%) | |
Yearly family income | |||
40,000–60,000 Swiss francs | 1 (5%) | ||
60,000–80,000 Swiss francs | 3 (15%) | ||
80,000–100,000 Swiss francs | 5 (25%) | ||
>100,000 Swiss francs | 11 (55%) | ||
Method of delivery | |||
Planned caesarean | 6 (30%) | ||
Unplanned caesarean | 12 (60%) | ||
Vaginal delivery | 2 (10%) | ||
Multiple birth | 2 (10%) | ||
Infant’s gender | |||
Male | 11 (50%) | ||
Female | 11 (50%) | ||
Gestational age at birth, weeks | 28.0 (26.0; 32.8) 29.0 ± 3.3 | ||
Birth weight, g | 1097.5 (706.3; 1677.5) 1209.5 ± 548.3 | ||
Birth length, cm | 40.0 (32.8; 43.5) 38.6 ± 5.8 | ||
Length of hospital stay, days | 63.0 (28.3; 94.8) 71.7 ± 52.9 |
Thematic Analysis of the Parent Interviews | |||
---|---|---|---|
Main theme | TtH and the relevance of continuity of care | Enhancement of parents’ autonomy and self-confidence | Perception of interprofessional collaboration |
Sub-themes |
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Schuetz Haemmerli, N.; Stoffel, L.; Schmitt, K.-U.; Khan, J.; Humpl, T.; Nelle, M.; Cignacco, E. Enhancing Parents’ Well-Being after Preterm Birth—A Qualitative Evaluation of the “Transition to Home” Model of Care. Int. J. Environ. Res. Public Health 2022, 19, 4309. https://doi.org/10.3390/ijerph19074309
Schuetz Haemmerli N, Stoffel L, Schmitt K-U, Khan J, Humpl T, Nelle M, Cignacco E. Enhancing Parents’ Well-Being after Preterm Birth—A Qualitative Evaluation of the “Transition to Home” Model of Care. International Journal of Environmental Research and Public Health. 2022; 19(7):4309. https://doi.org/10.3390/ijerph19074309
Chicago/Turabian StyleSchuetz Haemmerli, Natascha, Liliane Stoffel, Kai-Uwe Schmitt, Jeannine Khan, Tilman Humpl, Mathias Nelle, and Eva Cignacco. 2022. "Enhancing Parents’ Well-Being after Preterm Birth—A Qualitative Evaluation of the “Transition to Home” Model of Care" International Journal of Environmental Research and Public Health 19, no. 7: 4309. https://doi.org/10.3390/ijerph19074309