Griffin and Pickler Article Critique: "Hospital-to-Home Transition of Mothers of Preterm Infants"

Junyanee Boonmee Griffin, Ph.D., RN and Rita H. Pickler Ph.D., RN, PNP-BC, FAAN, both authors and researchers in "Hospital-to-Home Transition of Mothers of Preterm Infants" seek to recognize the experiences of mothers during the first month following their preterm infant's hospital discharge. Through a series of interviews, apprehension of the cognitive processes of the mothers is revealed through data collection. Griffin and Pickler provide a perspective on the results through a restricted amount of detail in order to give the reader a simplistic understanding of the issues and the need for supplementary resources for patients.

The introduction of the article presents statistical data regarding a rise in preterm birth rates in the United States between 1981 and 2002. The author suggests that "preparation for discharge to home may be more critical than previously thought" (Griffin & Pickler, 2011). To support this provides data on the rising cost of neonatal care for preterm infants in the United States. This is key given the concern for the quality of infant life. Yet, the greatest concern noted in the article is the wellbeing of the parents as it relates to the psychological state, financial burdens, whether it's teen pregnancy and overall support issues that may result from preterm birth. 

Griffin and Picker then move into a discussion on what preterm birth is, by defining it and then stating the research that has been associated with it. "Preterm birth is an unexpected event for a mother. This unexpected event affects the establishment of the maternal role. Several researchers have described the process of becoming a new mother as being associated with profound change, with a strong sense of loss, isolation, and fatigue" (Griffin & Pickler, 2011). There are three different phases of preterm birth: “late preterm, where the baby is born between 34 and 37 weeks of pregnancy; very preterm, where the baby is born at less than 32 weeks of pregnancy and extremely preterm, where the baby is born at less than 25 weeks of pregnancy” (Mayo Clinic, 2013). It would have been a welcoming addition for Griffin and Pickler to state this given their connotation of preterm birth. The most startling aspect that Griffin and Pickler present in the introduction is the effect of maternal proficiency and it potentially being compromised by extended hospitalization following the birth of the baby. It would seem that the challenge comes as a result of the mother's confidence in being motherly. At this point in the article, the reader wants to understand why the mother’s aptitude is challenged by preterm birth. 

Griffin and Pickler move to a discourse on the purpose of the study through several different study design and methods used. The approach used in the study was a descriptive phenomenological approach, "focusing on bracketing the cognitive process to control bias or presumptions and thus enhance the credibility of the findings. Purposive sampling [was also used] to select 10 mothers who lived in Virginia and whose neonatal intensive care unit hospitalized preterm infant had been cleared for discharge to home" (Griffin & Pickler, 2011). The participants willingly agreed to participate in the study. Griffin and Pickler explain here that two specific data collections were used in the study: one for demographics and the other for ascertaining the mental cognitive processes of the mothers 2-4 weeks following discharge. The authors also state that 7 of the participants agreed to be interviewed. An important item of note at this point in the article was the fact that 3 of the 7 participants were not as expressive as the others were in their answers to the questions. To analyze the data, "Colaizzi's (1978) was used" (Griffin & Pickler, 2011). The purpose of this type of method is to provide personal insights so that auditable analysis data can be ascertained (Sanders, 2003). Essentially, the method illustrates the varying processes that can be used to interpret research materials.

One of the more profound parts of the article is the results section. Each theme cluster is expounded upon heavily so the reader can understand how the analysis of the data collected from the interviews was organized. There were five theme clusters in total related to the 19 specific themes that were presented in Table 1. Statistical data is missing from this section. There is more of an explanatory interpretation on the theme clusters rather than specifics of whom out of the 10 participants fell under that particular cluster. The authors do state the various interview responses underneath the designated theme cluster discussion part, but given that demographic data was used in the study, there is no mentioning of the demographics of the mother whose response is listed under the theme cluster area. While this may seem unnecessary given the topic, the author should not have mentioned demographics as a collection point if it wasn't going to be articulated in the results section area. It would seem that enough data was collected in regards to the participants’ responses in accordance with the particular theme, however.

Each of the theme clusters that were attributed to the data is outlined: dealing with an unexpected pregnancy outcome such as an ectopic pregnancy; experiencing the reality of taking care of the baby alone; struggling to adjust to the maternal role; enhancing maternal inner strength and changing the maternal lifestyle. The authors do an exceptional job of honing in on the definitions surrounding the theme clusters; the issue with this is the lack of data to support what is being presupposed. The reader must accept what is being presented without any quantitative data to back up what is being written. What is also absent is a lack of other data from previous studies to provide some meat to the results area. This could have added benefit to the article, by giving the reader a full perspective on the various theme clusters that had been gathered in prior studies on the same subject.

Following the results section, Griffin and Pickler outline the clinical implications of the study as well as the limitations. "Although descriptive phenomenology is an appropriate method for a topic such as this about which there has been little research and although the same size is appropriate, the methods used mean that the findings are only reflective of the participants," (Griffin & Pickler, 2011) the authors add. Griffin and Pickler continue, "the participants in the study were all from a single geographic area and although different in some ways from each other, were mostly urban, young, single and with few resources" (Griffin & Pickler, 2011). The reader must accept this statement, given that the demographic data was not presented in the result section in detail; only scantily mentioned. The author's reason that "despite the limitations, the findings from the study reveal similarities and dissimilarities to findings of other studies that focused on mothers of preterm infants and transition[ed] home from the hospital" (Griffin & Pickler, 2011). It might have been valuable to refer to a study here that had similarities to mothers in this study. 

The authors reaffirm the purpose of this study before writing on the positive and less positive aspects of the mothers' experiences. "Mothers were in agreement that the best day was the day the infant was discharged, at the same time, they described challenges in caring for the infant at home and the associated anxiety and life changes that resulted from having given birth to a preterm infant" (Griffin & Pickler, 2011). This statement is important because it ties the results of the study together with the initial hypothesis. It would seem that Griffin and Pickler were able to prove that mothers do indeed have a competency issue that affects their mental process in raising a preterm infant. The authors continue, "mothers in this study also found social support important" (Griffin & Pickler, 2011). This additional tidbit of information is equally essential to describing the after-effects of the mother following infancy discharge. 

Griffin and Pickler conclude the article by stating what previous studies had not done, and noting what this study did. The study that they performed did satisfy the initial premise regarding the cognition of preterm infant mothers and their ability to handle their child. Griffin and Pickler do admit that the study may not satisfy all who seek to discover all there is to know about the competency of the mother following the discharge of the preterm infant, but that this study was a good starting point. 

References

Griffin, J. B., & Pickler, R. H. (2011, July). Hospital-to-home transition of mothers of preterm infants. The American Journal of Maternal/Child Nursing, 36(4), 252-257.

Mayo Clinic. (2013). Premature birth. Retrieved from http://www.mayoclinic.com/health/premature-birth/DS00137

Sanders, C. (2003). Application of Colaizzi's method: Interpretation of an auditable decision trail by a novice researcher. Contemporary Nurse, 14(3), 292-302.