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.
Reaching the stage of data collection or generation is often a momentous occasion in the life of a research project. It follows long hours of planning and revising study protocols, completing ethical review and the frequently arduous task of participant recruitment. So how do you ensure this stage of research is meaningful and productive? What factors threaten to derail this stage of your project and what strategies can be adopted to mitigate this risk? These were the driving questions behind my exploration of arts-based research methods and the decision to incorporate visual elicitation strategies into my study exploring the transition home from NICU for adolescent mothers.
Using my PhD project – the NICU-to-Home Transitions study – as a study example, this article focuses on the operational or ‘how to’ aspects of incorporating visual elicitation tools or tasks within a semi-structured qualitative interview for the purpose of generating rich qualitative data. The considerations for planning and execution described in this article represent the deliberations that guided my adoption of these methods; however because they are presented as general strategies they can be applied broadly across study populations and contexts – particularly when factors such as power differentials or developmental processes threaten achieving the depth or detail required for the selected study design.
Generating rich, in-depth data and thus saving valuable time and resources was the impetus for exploring innovative approaches to qualitative interviews and the incorporation visual elicitation into my study protocol. However, the reason I will consider such activities in future studies – in addition to their contribution to rich and detailed interview data – is the value and meaning such tasks can have for the research participant (this was neither anticipated nor planned for). When a parent-participant asked me to keep their drawings so they could continue adding to them beyond the interview encounter I realized the methods I had carefully chosen – albeit for a different purpose – were meaningful for the participants in a way that would not be possible through semi-structured interviewing alone. It is my hope that with the clear guidance given in this article for the use of visual elicitation in qualitative data generation, that others will explore, adopt and experience the possibilities these methods hold.
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A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now.