A Randomized Trial of Single Home Nursing Visits vs Office-Based Care After Nursery/Maternity Discharge

Abstract

To compare office-based care (OBC) with a care model using a home nursing visit (HNV) as the initial postdischarge encounter for "well" breastfeeding newborns and mothers.Design: Randomized controlled trial.Setting: A single academic hospital.Participants: A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks' gestation.Interventions: Home nursing visits were scheduled no later than 2 days after discharge; OBC timing was physician determined.Outcome Measures: Mothers completed telephone surveys at 2 weeks, 2 months, and 6 months. The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery. Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration. Maternal mental health, parenting competence, and satisfaction with care outcomes were assessed. Analyses followed an intentto-treat paradigm.Results: At 2 weeks, hospital readmissions and emergency department visits were uncommon, and there were no study group differences in these outcomes or with unplanned outpatient visit frequency. Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group (85.9% vs 78.8%) (P =.002) and were more likely to be breastfeeding at 2 weeks (92.3% vs 88.6%) (P=.04) and 2 months (72.1% vs 66.4%) (P =.05) but not 6 months. No group differences were detected for maternal mental health or satisfaction with care, but HNV group mothers had a greater parenting sense of competence (P Ͻ .01 at 2 weeks and 2 months).Conclusions: Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits.

NICU discharge planning and beyond: recommendations for parent psychosocial support

“…24 , 25 HV programs may be funded by community resources, federal or local grants or insurance companies, based on family income criteria and consent to participate. 20 , 47 , 48 , 49 , 50 , 51 , 52 Community-based HV programs may provide financially eligible families with parenting education and support services before delivery.…”

“…49 , 50 Visiting nurses were also identified as a viable means of securing high-quality patient-centered outcomes and found to be as effective and safe for initial patient encounters post-hospital discharge as traditional office visits. 52 …”

A Randomized Controlled Trial of Innovative Postpartum Care Model for Mother-Baby Dyads

“…In jurisdictions such as New Zealand, Australia, Canada and the UK, home-visits done by nurses, midwives and peers are available for mother-baby dyads and have been studied thoroughly in the past decade [ 5 – 8 ]. Home-visits, while recognized for achieving high maternal satisfaction, also produce equivalent clinical outcomes for mothers and newborns as hospital-based follow-up [ 9 – 10 ]. Postpartum home-visits may also decrease newborn hospital admissions [ 11 ].…”

Nurses’ contributions to the promotion of exclusive breastfeeding

“…In the present integrative review, two (22.2%) of the articles (11)(12) were found in the year 2012. It is emphasized that no production was found that responded to the guiding question of the study, between 2000 and 2007.…”

“…To identify and analyze, from the perspective of nurses, the process of axiological evaluation of the promotion, protection and support to breastfeeding. (55.5%) (12)(13)(14)(15) ; one (11.1%) in Portugal (16) ; one (11.1%) developed in Australia (17) ; one (11.1%) in Pennsylvania (18) ; one (11.1%) in the United States of America (11) . Figure 2 summarizes the articles of the final sample, which were presented in chronological order to better explain the evolution of the subject under investigation.…”