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Updated: Jul 5, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
No Place Like Home: Improving the Transition From NICU to Home Through the NICU to Nursery Program
Cheryl Toole1, Michele DeGrazia, Theresa M Andrews
1Neonatal Intensive Care Unit, Boston Children's Hospital, Massachusetts (Mss Toole, Andrews, Bouve, and Pezanowski and Drs DeGrazia and Kourembanas); Harvard Medical School, Boston, Massachusetts (Drs DeGrazia, Kourembanas, and Hickey); and Department of Nursing and Patient Care Operations, Boston Children's Hospital, Massachusetts (Ms Cole and Dr Hickey).
Background:
Boston Children's Hospital's Level IV Neonatal Intensive Care Unit (NICU) discharges about a third of its medically complex infants home. Parental feedback indicated a need for more education and training in discharge preparation.
Purpose:
The NICU to Nursery (N2N) program was created to better prepare parents to care for their medically complex infants following Level IV NICU discharge. The goals were to (1) mitigate safety risks, (2) assess parent satisfaction, (3) assess pediatric primary care providers' (PCPs') satisfaction, (4) assess community visiting nurses' and PCPs' knowledge deficits, and (5) develop educational materials.
Methods:
The N2N program provided parents with pre- and postdischarge assessments with an experienced nurse. Parents completed a survey following assessments to measure satisfaction. To enhance PCPs' knowledge, they were sent summary reports and asked for feedback. PCP feedback, along with a needs assessment of community visiting nurses, guided the development of free Web-based educational videos.
Results:
One hundred and fifty-five parents participated in the N2N program. Parents' educational needs included medication education, safe sleep, and well-infant care, with some requiring significant nursing interventions for safety risk mitigation. Most PCPs found the home visit reports helpful. Knowledge deficits identified among PCPs and community visiting nurses included management of tubes and drains, growth and nutrition, and emergency response. More than 100,000 providers viewed the 3 Web-based educational videos developed.
Implications For Practice And Research:
The N2N program fills a crucial gap in the transition of medically complex infants discharged home. The next steps are developing best practices for virtual in-home assessments.
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