Discharge from the hospital…it's the goal doctors and nurses work tirelessly towards for each patient. Each child and family spends hours, days, weeks or months looking forward to it. Why, then, does the transition from hospital to home not turn out as expected for some children and families? Why do they return to the hospital? What are the barriers to a smooth transition?
New research published in Pediatrics sheds light on the road bumps during the transition home. Through qualitative research, four main concerns for families arose: "(1) “In a fog” (barriers to processing and acting on information), (2) “What I wish I had” (desired information and suggestions for improvement), (3) “Am I ready to go home?” (discharge readiness), and (4) “I’m home, now what?” (confidence and postdischarge care)'". The researchers suggest "the caregiver is key to successful transitions, and the family perspective can inform interventions that support families and facilitate an easier reentry to the home."
How can you help help your patients and families during the transition home in a trauma informed manner? The key is, as this new research suggests, understanding the family's perspective. Some families experience discharge from the hospital as a time when they lose medical support and a sense of safety. They may become anxious, agitated, argumentative, or avoidant as discharge nears. Parents may feel uncertain regarding how they will cope with the medical and treatment issues at home without frequent support. Re-establishing daily routines might cause anxiety and some families might try to rush the normal adjustment process. Trauma triggers, flashbacks, and nightmares may intensify for the child, parents, and other family members. Children who look and feel different may worry about how their friends and peers will react and may avoid interacting with them at first. Siblings may be resentful of their ill or injured brother or sister and at the same time also feel guilty and worry in private.
Doctors, nurses, and other healthcare providers can use trauma informed care to help make the transition from hospital to home easier:
- Remember that as discharge nears, children and families typically experience positive feelings, as well as negative - worry, fear, or loss of a safety net.
- Help the family anticipate the medical, social, and emotional challenges of returning to the home environment.
- Help families identify coping strategies and resources they will use. Explain that feelings of anxiousness are common, and encourage them to gradually let go of unrealistic worries
- Ask parents about what knowledge or skills they need to support caring for their child at home. Help families anticipate the need to adjust after illness or injury and to plan for it.
- Remind parents that siblings can be affected too and to address their worries.
- Encourage ill or injured children to do things on their own, as appropriate, but stress the importance of setting normal behavioral limits.
- Help parents help their child reconnect with friends and plan activities as allowable, as well as prepare answers to common questions that their friends might ask.
Helping children and families transition from hospital to home is a key point in their recovery from injury or illness. Join the conversation on our Facebook page to share how you help your patients and families.