Discharge Readiness for Families with a Premature Infant Living in Appalachia

286 Pages·2017·2.37 MB·English

East Tennessee State University
Digital Commons @ East
Tennessee State University
Electronic Theses and Dissertations Student Works
12-2017
Discharge Readiness for Families with a Premature
Infant Living in Appalachia
Kathy Zimmerman
Follow this and additional works at:https://dc.etsu.edu/etd
Part of theFamily Practice Nursing Commons,Maternal, Child Health and Neonatal Nursing
Commons, and theNursing Midwifery Commons
Recommended Citation
Zimmerman, Kathy, "Discharge Readiness for Families with a Premature Infant Living in Appalachia" (2017).Electronic Theses and
Dissertations.Paper 3314. https://dc.etsu.edu/etd/3314
This Dissertation - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State
University. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ East
Tennessee State University. For more information, please [email protected].
Discharge Readiness for Families with a Premature Infant Living in Appalachia
______________________________
A dissertation
presented to
the faculty of the Department of Nursing
East Tennessee State University
In partial fulfillment
of the requirement for the degree
Doctor of Philosophy in Nursing
________________________
by
Kathy Zimmerman
December 2017
________________________
Dr. Masoud Ghaffari, Chair
Dr. Sharon Loury
Dr. JoAnn Marrs
Dr. Carole Kenner
Key words: Discharge, Preparedness, Prematurity, Appalachia, Parents, Infants, Transition,
NICU
ABSTRACT
Discharge Readiness for Families with a Premature Infant Living in Appalachia
by
Kathy Zimmerman
With increased advances in technology, the overall survival rates in the Neonatal Intensive Care
Unit (NICU) for premature infants at lower gestational ages have improved. Although premature
infants survive at lower gestational ages, they are often discharged to home with unresolved
medical issues. While the birth of a new baby for parents is a joyous occasion, they often have
difficulty coping and transitioning into a parental role. Premature infants also have ongoing
complications such as difficulty with feeding, developmental delays in growth, and long-term
eye and respiratory complications. As a result of chronic health sequelae, premature infants
require extensive utilization of hospital and community health resources. In addition, hospitals
must coordinate between community resources, while preparing parents for specialized discharge
teaching. Furthermore, individuals living in rural and underserved areas face unique challenges
and barriers to access healthcare resources. An interpretive phenomenology study was conducted
to bring insight and develop an understanding into how families perceive discharge readiness,
accessing health care resources, and ability to cope at home after discharge from a Level III
NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three
couples, three married mothers, and two single mothers. Interviews were conducted over a period
of six months and transcript analysis revealed development of major and minor themes. The
studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which
described parents experience of being prepared for discharge and their transition to home. Three
major themes related to discharge readiness from detailed analysis included; 1) Riding out the
2
storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported
development of the major these were 1a) having the carpet pulled out from under me, 1b) things
I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me,
care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert,
3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for
discharge readiness include providing customized support for parents as they adjust to a new
normal for their family, identify necessary resources, and become self-reliant once home.

3
Copyright 2017 by Kathryn A Zimmerman
All Rights Reserved

4
DEDICATION
A dissertation is never completed without help from many sources. It takes a village to be
successful and I would not have been able to complete my dissertation without the support and
love from my family, friends, and colleagues. I especially want to thank my wonderful and
beloved husband, Mike Zimmerman, for his undying love and concern for my welfare
throughout this process. He has been the consummate caregiver, taking over all things related to
running our household, listening to my frustrations, and being my cheerleader. I am forever
grateful and will always appreciate your being there for me. Also I am thankful to my parents,
Howard and Maxine Teel for your constant encouragement and always believing in me. Your
guidance and care for my upbringing, empowering me with a vision that anything is possible,
instilling faith in a higher power, living one’s life as a true and humble person, and provided me
with the foundation and skills to succeed in this journey.
I also dedicate this dissertation to my family and friends, who supported me all
throughout the doctorate journey. Special thanks to Debra Rose Wilson, who first encouraged me
to start this process, and often, challenged and inspired me to forge ahead. I want to thank Cheryl
Postlewaite, Connie Bauersachs, and Olena Bolyensky for your patience, moral support, and
feedback. In addition, all the other family and friends who’s encouragement and support kept me
grounded, balanced, on task as I completed coursework, conducted research, and while writing
my dissertation. You shared in each of my successes, celebrations, struggles, and
accomplishments.
Lastly, I would like to thank all the families who allowed me into their home and shared
their personal story. You opened up your hearts and shared those tender moments and difficult
challenges you experienced. I was honored to have shared a small part of your parenting journey
5
and this experience has enriched my life in many ways. The love and pride for your new family
was evident, and despite struggles and adjustments, each of you maintained a warrior spirit in
overcoming obstacles to find your new normal. When working directly in the NICU with parents
of premature infant, I always felt that parents were the real heroes and your stories confirmed my
belief.

6
ACKNOWLEDGEMENTS
I wish to thank my dissertation committee members, Drs. Masoud Ghaffari, Sharon
Loury, Jo Ann Marrs, and Carole Kenner for being willing to be on my committee and
generously offering their time and support. I am especially thankful to my chair, Dr. Ghaffari for
his endless hours of feedback, guidance, and continual focus. I am pretty sure I challenged his
patience, however he was steadfast, and stayed determined to help see me through to complete
this process.
I appreciate the entire graduate faculty at East Tennessee State University School of
Nursing who guided me, provided feedback, and helped expand my performance to a scholarly
level. My completion would not be possible without the support and direction from
administrative and support staff at the School of Nursing.
I also want to thank Austin Peay State University, specifically Dr. David Denton and the
School of Nursing Faculty for supporting me throughout this endeavor. The value and respect
you placed on my work helped me to complete this enormous task.

7
TABLE OF CONTENTS
Page
ABSTRACT .................................................................................................................................. 2
DEDICATION .............................................................................................................................. 5
ACKNOWLEDGEMENTS .......................................................................................................... 7
LIST OF TABLES ...................................................................................................................... 15
LIST OF FIGURES .................................................................................................................... 16
Chapter
1: INTRODUCTION .................................................................................................................. 17
Statement of the Problem .............................................................................................. 18
Purpose of the Study ...................................................................................................... 21
Significance of the Study .............................................................................................. 22
Philosophical Perspectives ............................................................................................ 23
Specific Aim of the Study ............................................................................................. 23
Research Questions ....................................................................................................... 23
Summary ....................................................................................................................... 24
2: REVIEW OF THE LITERATURE ........................................................................................ 25
Premature Birth ............................................................................................................... 25
Health Disparities ............................................................................................................ 27
Rural .................................................................................................................... 27
Appalachia .......................................................................................................... 29
Vulnerable Populations ....................................................................................... 31
Transition ........................................................................................................................ 31
8
Role Adaptation .............................................................................................................. 33
Coping ............................................................................................................................. 35
Stress, Anxiety, and Depression ..................................................................................... 36
Grief ...................................................................................................................... 36
Vulnerable Child Syndrome ........................................................................................... 37
Discharge Readiness ....................................................................................................... 38
Measuring Discharge Readiness ......................................................................... 44
Discharge Planning ............................................................................................. 47
Parental Support and Resources .......................................................................... 49
Medication Safety ............................................................................................... 53
Interdisciplinary Support .................................................................................... 54
Outcomes ........................................................................................................................ 55
Community Providers ..................................................................................................... 56
Outpatient Utilization .......................................................................................... 58
Follow Up Clinics ................................................................................... 59
Medical Resources .............................................................................................. 61
Readmission ........................................................................................................ 62
Education and Staff Training .............................................................................. 63
Summary ............................................................................................................. 64
3: METHOD ............................................................................................................................... 66
Theory ............................................................................................................................. 67
Philosophical Underpinnings .......................................................................................... 68
Research Design .............................................................................................................. 70
9