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Parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol

Aagaard, Hanne; Uhrenfeldt, Lisbeth; Spliid, Mette Ludvigsen; Fegran, Liv

Author Information
JBI Database of Systematic Reviews and Implementation Reports: October 2015 - Volume 13 - Issue 10 - p 123-132
doi: 10.11124/jbisrir-2015-2287
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Inclusion criteria

Types of participants

This review will consider studies that include mothers, fathers, step-parents or foster parents of infants who are hospitalized in a neonatal intensive care unit regardless of civil status, ethnicity or country of origin.

Types of intervention(s)/phenomena of interest

This review will include studies that investigate how parents experience the discharge of their infant from the Neonatal Intensive Care Unit. The included studies should describe parents’ experiences of being prepared for the discharge and the event of the discharge.

Transition in this study is defined as: "a passage from one fairly stable state to another fairly stable state and it is a process triggered by a change".28(p11) The focus of this review is infants’ discharge from the NICU.


The context of this review is a Neonatal Intensive Care Unit defined as an intensive care unit of ill or premature and/or newborn infants. This review includes studies from all four classified levels for NICU care: basic care (level I), specialty care (level II), and subspecialty intensive care (level III and, level IV).29

Types of studies

This review will consider studies presenting qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Search strategy

The search strategy aims to identify both published and unpublished studies and a three-step search strategy will be used. An initial limited search in MEDLINE and CINAHL databases will be undertaken followed by an analysis of the words contained in the title and abstract, and of the index terms used to describe the article.

Initial keywords (with truncation):

Population: infant*, premature*, newborn*, very low birth weight*, twins*, premature birth* premature infant*, newborn infant*, baby* AND family*, parents*, single parent*, mothers*, fathers*, foster home care*, relative*, next of kin*, step-parent*

Phenomenon of interest: attitude*, comprehen*, emotions*, experienc*, emotion*, view*, opinion*, percept*, belie*, feel*, know*, understand*, adapt* AND patient discharge*, discharge to home*, going home*, early discharge*, patient discharge*

Context : intensive care units*, neonatal*, neonatal intensive care unit*, NICU* AND patient discharge*, discharge to home*, going home*, early discharge*, patient discharge*

A second search using all identified keywords and index terms will then be undertaken across all included databases as a part of the review. Databases to be searched at this stage will include PubMed, Mednar, CINAHL, The Central Cochrane Database, ProQuest, EMBASE, ISI Web of Science, Scopus and PsycINFO.

Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Finally all identified research reports will be subject to forward citation searches to reach a complete inclusion of studies to the widest extent possible.

Studies in English, Danish, Swedish and Norwegian languages published between January 2000 and 31 December 2014 will be considered for inclusion. To reflect the advances in medical and technical development and changed parental role during the last decade, the present time frame for the literature search is limited to the last 15 years.

Our aim is to include studies focusing on the preparedness for and the event of discharge from the NICU. The event of discharge is understood as issues in connection with discharge influencing parents’ role as caretakers after discharge, such as responsibility, confidence as caretakers or quality of information.

The search for unpublished studies will include Google Scholar, Mednar and ProQuest Dissertations and Theses.

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data extraction

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix VI). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.

Conflicts of interest

The authors declare that there are no conflicts of interest.


The authors would like to thank Kirsten Jensen, Librarian, Aarhus University, Denmark, for her contribution in preparing and conducting the preliminary literature searches.


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          Appendix I: Appraisal instruments

          QARI appraisal instrument

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          Appendix II: Data extraction instruments

          QARI data extraction instrument

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          discharge to home; NICU; parents experiences; preparation; premature; systematic review protocol; transition

          © 2015 by Lippincott williams & Wilkins, Inc.