This issue of the Journal of Perinatal and Neonatal Nursing has the topic of Transitions as its feature. "Transitions" is a bridge word that implies passage from one state to another. In the Perinatal section of this issue, 4 manuscripts reflect the transitions seen in recent practice, in patient safety, in establishing a new nursing practice model, and in transitioning to a new level of care.
Krening et al describe the transition in recent clinical practice relative to the use/misuse of oxytocin. The use of oxytocin can lead to uterine tachysystole, and this has been one of the leading causes of obstetric liability claims. Their article presents a collaborative approach to increasing safety measures for pregnant women receiving oxytocin in labor. The focus is on the quality improvement effort in a multihospital system. Standardization, guidelines, and safety checklists were used to improve outcomes.
Hiner et al discuss the transition to an improved approach to patient safety relative to infant security. Ensuring infant safety is a top priority for hospitals today. The authors present an interdisciplinary approach to the problem of newborn safety within the hospital. In collaboration with the security department, a new program was developed utilizing the components of Six Sigma. They demonstrate improved outcomes and the strengthening of abduction preventative measures.
Hedges et al speak about the transitional undertaking needed in order to develop a new nursing practice model. They describe the relationship-based nursing practice model used to transition to a new care delivery model in maternity units. This relationship-based nursing practice is a care delivery model designed to transition nursing care from task-focused care to relationship-based care. There are 3 relationships that are critical in this paradigm: the nurse with the patient; the nurse with colleagues; and the nurse with self. These are the guiding principles that actualize the role of professional nursing and improve patient safety outcomes in the process.
Transitioning to Baby-Friendly care is developed by Vasquez and Berg. They document the first Baby-Friendly certified hospital in San Francisco. This quality improvement program had its beginning way back in 1999 and took 8 years to complete. Challenges and barriers to the process are noted. Resetting patient care goals and getting buy-in from all involved are discussed. Changes in patient outcomes, especially with breast-feeding rates, are noted.
High-risk neonatal care presents many transitions for neonates and their families. The neonatal section of this issue is intended to elucidate several types of transitions in the context of high-risk neonates and their families.
Premji addresses health-illness transition of late preterm infants both in hospital and postdischarge. The impact of organizational transitions on health-illness transitions is considered along with implications of postpartum care of late preterm infants in the community. Premji also emphasizes the importance of evidence-informed decision making when considering models of postpartum care in the community.
Ballantyne, Stevens, Guttmann, Willan, and Rosenbaum explain the importance of the neonatal follow-up program and provide details of the negative consequences of attrition to follow-up to the children, families, and healthcare system cost. The authors indicate that attendance rates at neonatal follow-up programs are dated (ie, based on studies done over 10-20 years); hence, they convey the significance of their research aims to examine current patterns of attendance and identify time points at which families end contact with the neonatal follow-up program. Implications of the patterns identified are considered in relation to different types of transitions (eg, situational/organization, developmental).
Letourneau, Tryphonopoulos, Duffett-Leger, Stewart, Benzies, and Dennis, and Joschko as well as Stewart and Doucet challenge community-based programs to consider developmental transition of the father, particularly because it relates to the impact of mother's postpartum depression on the father. Fathers require support, both formal and informal, to manage their own depressive symptoms as well as to support their depressed partners. The findings of Letourneau et al, which represent the voice of the fathers, indicate that intervention programs for postpartum depression need to be responsive to families in that they need to be individualized and multifaceted.
Boykova and Kenner review neonatal transition research, specifically related to neonates, over the last 30 years. They conclude that while more is known about the transition from hospital to home following neonatal intensive care, little is known about transition back to the hospital, although readmissions are common in the preterm infant population. The research also illustrates that little progress has been made on infant/family engagement to ease the transition from initial hospital admission to home.
-Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC
Perinatal Editor
-Shahirose Sadrudin Premji, PhD
Neonatal Guest Editor
Faculty of Nursing
University of Calgary, Calgary
Alberta, Canada
-Carole Kenner, PhD, RNC, FAAN
Neonatal Guest Editor
Dean/Professor
Northeastern University School of Nursing
Boston, MA