The Effect of a Home Health Care Program for the

Premature Infant

)Kim, Young Hee, 2)Kim, Hyun Jung, 3)Lee, Eun Jung,

4)Lee, Ji Yoon, 5)Oh, Sun Ja, 6) Lee, Mi Kyoung

1) Home Health Care Nurse Specialist, Samsung Medical Center 2) Director, Department of Home Health Care Nursing, Samsung Medical Center 3) Neonatal Intensive Care Nurse Specialist, Samsung Medical Center 4) Director, Department of Neonatal Intensive Care Unit, Samsung Medical Center 5) Nurse, Neonatal Intensive Care Unit, Samsung Medical Center 6) Clinical Assistant Professor, Department of Clinical Nursing Science, Sungkyunkwan University School of Medicine

* Acknowledgement : This study was financially supported by the fund of nursing department of Samsung Medical Center

Introduction

• Incidence of premature infant increased ( 2% in 1995 -> 5% in 2010 in South Korea)

• Lack of beds for premature infants induced early discharge of premature infants

<Length of stay according to birth weight preterm infants , 2009 in South Korea>

• Readmission to premature infants and mother's

anxiety increased (Rosalyn, 2005; Pudd M, 2010)

Introduction

• Individualized care, Application of family-oriented

discharge process, Enhanced discharge education,

Organized home health care services are required in

order to achieve early discharge of premature infants

(Griffin & Abraham, 2006: T. Allen, 2002: Pudd M,

2010).

Introduction

• Home care services for the premature infants

are not common in South Korea

• Although some communities introduced home

care services for the premature infants, the

services don’t cover special cares for the

premature infants like oxygen therapy, apnea

or bradycardia monitoring, and gavage

feeding

Purpose

• To investigate HHCPPI(Home Health Care

Program for the Premature Infant) effects on

the premature infant’s growth, readmissions,

emergency visits, unplanned hospital visits,

the anxiety of the premature infant’s mother,

and the confidence of maternal role.

Method

• Nonequivalent control pretest-posttest study

• Sample size : A total of 43 premature infants and their mothers

• Control group 22, Experimental group 21

• Single institution study

• Not randomly assigned

• IRB approval

• SPSS & R program stats

Experimental treatment

• HHCPPI(Home health care program for the

premature infant)

• Moderator Training

HHCPPI development

Telephone questionnaire Answer

What kind of difficulties did you have when

you took care of your baby at home after

discharge ?

• The oxygen saturation observation by

using the monitor

• Feeding milk to baby while observing the

oxygen saturation

• Adjustment of Milk feeding amount

Nasogastric tube administration

• Smooting the baby

Among the educational information received,

What was it you couldn’t remember and

what was difficult when you did practice at

home ?

• Baby bathing

• Milk feeding amount adjustment

If a home health care nurse visit your home,

what kind of services do you expect?

• Regular visits to observe the baby state

• Milk feeding education

• telephone counselling

• Baby bathing

• Emergency assistance

HHCPPI development continued

Composition Time Topic Intervention and education Intervention method Used time

1st intervention: family counseling

2-3 days before discharge

Preparing for premature infants discharge

Introduce necessary items for premature infant care at home, preparing home environment, HHCPPI Pamphlet : Premature infant going home

Family and home environment assessment, education, counseling, emotional support

Half-hour

2nd intervention: Home visit

Within 3 days after discharge

Caring for premature infant : feeding the milk safely, Safe use of medical devices

Bottle feeding and nasogastric tube feeding Nasogastric tube management Using oxygen at home

Using the monitor Assess the premature infant Pamphlet : Caring the premature infant

Individual explain, demonstration, practice, counseling, emotional support

Hour

3rd intervention: Home visit

Within 5 days after discharge

Caring for premature infant: Bathing the baby safely

Bathing the baby safely Outpatient appointment guide Pamphlet : Caring the premature infant

Individual explain, demonstration, practice, counseling, emotional support

Hour

4th intervention:

Home visit

2 weeks

after

discharge To get close to the baby

Baby massage Simple sensory development play

Pamphlet : Baby massage guide, To get close to the baby

Individual explain, demonstration, practice, counseling, emotional support

Hour

5th intervention : Telephone counseling

3 weeks

after

discharge Baby health counseling

Premature infant health counseling Check the weight gain, milk increase check the abnormal sign and symptom Pamphlet : Telephone counseling checklist

Individual explanation, counseling, support via telephone counseling

20 minut

es

Moderator Training

• Moderator : Home Health Care Nurse

Specialist 15 people

Educational

content

Teaching methods Training time Evaluation

Caring for

premature infants,

Oxygen therapy,

monitoring,

CPR, baby

massage

Group lecture,

Simulation,

Practice at NICU

7 hours

Moderators were

tested before

treatment.

Moderators with

less than 90 points

were retested.

The Tools

The premature infant`s

mother

The premature infant

• Spielberger, C. D (1970).

Manual for the State-Trait

Anxiety Inventory(Translated

into Korean)

• Parker, S., & Zahr, L. (1980).

The Maternal Confidence

Questionnaire(Translated

into Korean)

• The physical growth ( weight,

height, head circumference) :

measurements

• The utilization of medical ser

vices (readmission, emergenc

y visit, unplanned hospital vis

it) : chart review, interview

Hypotheses

H1. The anxiety of premature infants’ mother will be lower than the control group

H2. The confidence of maternal role will be higher than the control group

H3. The physical growth of preterm infants(weight, height, head circumference)

will be more increased than the control group

H4. The hospital utilization(readmission, emergency visit,

unplanned hospital visit) will be lower than the control group

Statistical Analysis

Homogeneity Test of Characteristics

: χ²-test, T-test or Mann-Whitney test

Anxiety and the maternal confidence differences : Mann-Whitney test

The premature infant’s growth(Weight, height, head circumference) differences

: Permutational MANOVA test

Readmissions, emergency visits, unplanned hospital visits differences

: Fisher’s exact test

Result

Premature infants

Control group

(n=21)

n(%), M±SD

Experimental

group(n=22)

n(%), M±SD

χ², Z , t p

Gestational ag

e (weeks) 30.48± 2.73 30.00± 3.88 -.232 .816

Length of hosp

ital stay (days) 42.24±32.62 51.59±44.15 -.389 .697

Birth weight 1491.76±368.8

2

1546.36±659.4

8 .333 .741

Sex Boys 14(66.7) 15(68.2) .011 .916

Girls 7(33.3) 7(31.8)

Pregnancy typ

e

Single baby 18(85.7) 15(68.2) 2.251 .363

Twins 3(14.3) 6(27.3)

Triplets 0( 0.0) 1( 4.5)

Birth order First 14(66.7) 14(63.6) 1.263 .747

Second 6(28.6) 8(36.4)

Third 1( 4.8) 0( 0.0)

Special Care None 8(38.1 14(63.6) 3.415 .181

Gavage feedin

g 12(57.1) 8(36.4)

Colostomy car

e 1(4.8) 0(0.0)

Oxygen and m

onitor

Not used 1(4.8) 6(27.3) 3.995 .095

Used 20(95.2) 16(72.7)

Premature infant's mother

Control group

(n=21)

n(%), M±SD

Experimental

group(n=22)

n(%), M±SD

χ², Z , t p

Age(in years) 33.19±3.84 32.64±3.51 -.146 .884

Marriage dura

tion (years) 4.95±3.79 3.86±2.10 -.565 .572

Education Middle School 0( 0.0) 2( 9.1) 2.069 .570

High school 6(28.6) 5(22.7)

College 15(71.4) 15(68.2)

Occupation Housewife 13(61.9) 13(59.1) 2.864 .266

Generalist 5(23.8) 2( 9.1)

Professional 3(14.3) 7(31.8)

Economic sta

tus

High 1( 4.8) 2( 9.1) 1.422 .594

Medium 19(90.5) 17(77.3)

Low 1( 4.8) 3(13.6)

Religion

Yes 15(74.1) 14(66.7) .297 .747

No 6(28.6) 8(36.4)

Marital Satisf

action

Satisfaction 17(81.0) 16(72.7) .407 .721

Usually 4(19.0) 6(27.3)

dissatisfactio

n 0( 0.0) 0( 0.0)

Help her husb

and

Helps a lot 17(81.0) 12(54.5) 3.841 .105

It is usually 3(14.3) 9(40.9)

Does not help 1( 4.8) 1( 4.5)

<Table 1. Homogeneity Test of Characteristics>

Result

H1. The anxiety of premature infants’ mother will be lower than

the control group

Variables The average rank The sum of the aver

age rank Z p

Anxiety difference

s

Experimental 16.81 353

-2.653 .008

Control 26.95 593

< Table 2. Differences for Premature infant`s mother's Anxiety >

Result

H2. The confidence of maternal role will be higher than the

control group

Variables The average rank The sum of the avera

ge rank Z p

Maternal Confidenc

e differences

Experimental 29.86 627

-4.013 .000

Control 14.50 319

< Table 3. Differences for Premature infant`s mother's Maternal Confidence>

Result

H3. The physical growth of preterm infants( weight, height, head circumference) will be more increased than the control group

D Weight D Height D Head circumference

D Weight 1 0.677(0.000) 0.639(0.000)

D Height 0.677(0.000) 1 0.527(0.000)

D Head circumference 0.639(0.000) 0.527(0.000) 1

<Table 4. Correlation for Physical Growth of Premature Infants (n=43)>

* D : Difference , post measure-pre measure

Degrees of fr

eedom Sum of squa

res Mean square R-square F

significant

probability

Group 1 0.010 0.010 0.007 0.292 0.731

Residual 41 1.383 0.034 0.993

Sum 42 1.393 1.000

<Table 5. Differences for Physical Growth of Premature Infants (n=43)>

Result

H4. The hospital utilization(readmission, emergency visit, unplanned hospital visit) will be lower than the control group

<Table 6. Differences for Coeficient of Utilization of Hospital (n=43)>

Experimental

n(%)

Control

n(%) χ² p

Readmission 3(14.3%) 4(18.2%) .120 1.000

Emergency visit 4(19.0%) 3(13.6%) .231 .698

Unplanned hospital visit 0( 0.0%) 1( 4.5%) .977 1.000

Discussion

• Premature infants & their mothers need a support system after they are discharged

• HHCPPI effectively helped the mothers of premature infants

• The hypotheses 3,4 was rejected. This finding was different with a previous study which showed that long term followed up more than 3months(An, 2004;Swanson & Naber,1997)

• We only followed up for one month after discharge, thus the long-term effect of HHCPPI could not be evaluated.

Conclusions

1. The home health care service should be provided to the premature infants with needs for special care and their parents.

2. A more comprehensive design is needed to evaluate the long-term effects of HHCPPI on the physical growth of premature infant & hospital utilization in the future.

3. The participants selected from a certain medical center in Seoul city which limits the generalizability of the results. A larger sample size selected from different hospitals in different areas would help to more accurately understand the effect of HHCPPI on maternal anxiety, confidence, physical growth of premature infants, hospital utilization.

Contact

Nanyhee.Kim @ Samsung.com

THAHK YOU!