NICU to Home Transitions for Adolescent Mothers

The latest featured article is titled “The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis’ Transitions Theory Applied” by
Elizabeth Orr, MSc; Marilyn Ballantyne, PhD; Andrea Gonzalez, PhD and
Susan M. Jack, PhD. This article presents an exemplar of the application of nursing theory in nursing practice, and is available to download at no cost while it is featured. The primary author, Elizabeth Orr, provided this message about this work:

Elizabeth Orr

As a nurse in a busy Neonatal Intensive Care Unit (NICU) you quickly become accustomed to the ‘revolving door’ nature of admissions, transfers and discharges – as one infant leaves the unit, they are swiftly replaced by another. During my 13 years as an RN in the NICU, I found admissions very fulfilling; the whole team would spring into action, working together to stabilize a critically ill infant or prepare newborns and their families for urgent surgery. Discharges and transfers were somewhat less satisfying. Being well enough to be discharged from intensive care was always something to be celebrated, however I often found myself wondering how infants and families fared post discharge; hoping someone in the community would notice, and tie up any loose ends that may have gone overlooked on account of the complexity and acuity of the NICU patient population and environment. These feelings of uneasiness at discharge – in particular with the more vulnerable adolescent mother/baby dyads in the NICU – served as the impetus to explore the NICU-to-home experience further.

The importance of successful care transitions and the need for novel patient- and family-centered care approaches to ensure safety in the hospital-to-home process is becoming a recognized priority within healthcare. However, while exploring the existing literature on NICU-to-home transitions, what I found striking was the primary and often exclusive focus on the discharge event. Very little attention was given to the fact that, according to Meleis’ Transitions Theory, at the time of discharge from NICU adolescent mothers are experiencing at least 4 transitions: (i) a health-illness transition—NICU admission; caring for an infant with increased risk of developmental-delay/complex health needs; (ii) a developmental transition—becoming a mother; (iii) a situational transition—discharge home from the NICU and notably, these 3 transitions occur within the context of a fourth transition; (iv) the developmental transition of the adolescent mother to adulthood.

This paper applies Meleis’ Transitions Theory to the example of hospital-to-home transitions for adolescent mothers and their infants and argues for and increased recognition of the importance of overlapping and intersecting transitions and an overall more holistic, theory-informed approach to understanding hospital to home care transitions.