Hobbs Janice E, Tschudy Megan M, Hussey-Gardner Brenda, Jennings Jacky M, Boss Renee D
Division of Neonatology/Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Birth. 2017 Dec;44(4):331-336. doi: 10.1111/birt.12301. Epub 2017 Aug 22.
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.
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.
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.
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.
当家庭从新生儿重症监护病房（NICU）过渡到家中时，他们要负责婴儿的日常医疗需求。尽管新生儿科医生会让家庭为出院做好准备，但尚不清楚临床医生对他们的教学和指导如何转化为家庭护理了解多少。本研究的目的是评估家访计划对新生儿科住院医师出院后不久对家庭需求理解的影响。
新生儿科住院医师对一名近期出院的婴儿进行家访。家访前，住院医师回顾了他们原来的出院指导以及有关家庭所在社区的信息。在家访过程中，住院医师与家庭回顾了他们的出院计划，并讨论了遇到的任何挑战。之后，住院医师完成了一次半结构化访谈；这些访谈记录被手动编码以找出主题。
住院医师确定了几个常见的女性/家庭出院挑战。这些挑战分为四个领域：（1）出院准备不足，（2）家庭医疗化，（3）家庭适应新的“常态”，以及（4）社会背景与出院计划的相关性。大多数（90%）住院医师报告说家访经历会影响他们未来在NICU的出院实践，并且所有人都同意家访应该成为新生儿科培训的一部分。
家访让新生儿科住院医师能够审视他们的出院准备工作是否满足了家庭的需求。将家访纳入新生儿科培训可以帮助住院医师了解在住院环境中难以评估的社会和社区因素的相关性。
