Transition describes a process initiated as a result of an expected change or event that has a direction and is influenced by the individual's perception or meaning given to that change or event.1 In the context of high-risk neonates and their families, there are many types of transitions such as developmental, health-illness, situational, and organizational that impact neonates and their families.
A women becomes a mother under difficult circumstances because her infant is in the neonatal intensive care unit.2 Parenthood, a stage in the life cycle, is a form of developmental transition1 that is culture bound.2 In fact, the postpartum period, universally defined as 40 days by different cultures, emphasizes the care of both the mother and the baby. The perceived vulnerability associated with this period has led to the evolution of different customs and traditions intended to promote support for the mother and allow her a period of rest. The effectiveness of these cultural traditions and practices in promoting mother's mental health remains uncertain.3
Health-illness transition(s) influences movement of high-risk infants within or between healthcare system(s) (eg, local community hospital) and finally discharge home with follow-up in the community. Neonatal follow-up clinics screen high-risk infants such as extremely preterm infants for neurodevelopmental issues, whereas medical specialists (eg, cardiologists) attend to the medical issues.4 In contrast, late preterm infants receive “routine postnatal care” despite physiologic and development immaturity. Postpartum care in the community predominantly deals with the health (physical, mental, and social) of the mother and the infant; however, care should be delivered in partnership with the family. Care provided in the first 6 weeks after birth (ie, postpartum period) should be guided by the epidemiologic patterns of health concerns/conditions,5 and interventions should be evidence informed (ie, consider public health resources, community/political preferences, and local context).6 The overall goal is to support the mother in caring for herself and her baby, as well as to ensure a supportive family environment in which the community resources are mobilized.5
The healthcare system has experienced significant strain with technological advancements, change in demographic characteristics of populations, and other forces (eg, ideational/societal and institutional).7,8 These forces have increased demand on the scarce resources.7 In an attempt to improve efficiency7 and contain healthcare costs,8 healthcare systems have changed. Convalescing high-risk infants are often managed in local hospitals nurseries4 or in the home under the care of specialized teams (eg, neonatal transition team). Infants (eg, late preterm) may be discharged early from the hospital, which is defined as less than 48 hours,9 3 days or less in hospital,10 or less than 2 nights hospital stay,11,12 if their medical condition is stable. In most instances, parents do not have an opportunity to be involved in the decision making about the type or model of care. These organizational transitions require families to assume caregiving responsibilities in the home for their infants who may have unresolved and/or complex healthcare needs.8 Community services (including postpartum and other community resources) are essential in supporting these families in the provision of care for their high-risk infant.8
Each of these types of transitions—developmental, health-illness, organizational, and situational—may illicit concerns related to health or illness of the infant. Furthermore, health-related behaviors may manifest as a consequence or response to these transitions. Consequently, the role of the nurse is central in promoting conditions that influence the quality of transition experience in a way that it promotes well-being of the mother, infant, and family relationships, as well role mastery of the mother.1
—Shahirose Sadrudin Premji, PhD
Neonatal Guest Editor
Faculty of Nursing
University of Calgary, Calgary
—Carole Kenner, PhD, RNC, FAAN
Neonatal Guest Editor
Northeastern University School of Nursing Boston, MA
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2. Shin H, White-Traut R. The conceptual structure of transition to motherhood in the neonatal intensive care unit. J Adv Nurs. 2007;58(1):90–98.
3. Eberhard-Gran M, Garthus-Niegel S, Garthus-Niegel K, Eskild A. Postnatal care: a cross-cultural and historical perspective. Arch Womens Ment Health. 2010;13:459–466.
4. Woods S, Riley P. A role for community health care providers in neonatal follow-up [commentary]. Paediatr Child Health. 2006;11(5):301–302.
5. World Health Organization. WHO Technical Consultation on Postpartum and Postnatal Care. Geneva, Switzerland: WHO Document Production Services; 2010.
6. Ciliska D, Thomas H, Buffett C. An Introduction to Evidence-Informed Public Health and a Compendium of Critical Appraisal Tools for Public Health Practice. Hamilton, Ontario, Canada: National Collaborating Centre for Methods and Tools; 2008. http://www.nccmt.ca/pubs/2008_07_IntroEIPH_compendiumENG.pdf
. Accessed November 10, 2011.
7. Schmid C, Cacace C, Götze C, Rothgang C. Explaining Health Care System Change: Problem Pressure and the Emergence of “Hybrid” Health Care Systems. Journal of Health Politics, Policy and Law. 2010;36(5):455–486.
10. McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late preterm and term infants during the first year of life. Pediatrics. 2009;123(2):653–659.
11. Tomashek KM, Shapiro-Mendoza CK, Weiss J, et al. Early discharge among late preterm and term newborn and risk of neonatal morbidity. Semin Perinatol. 2006;30:61–68.
12. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child. 2005;90:125–131.