JCPSLP Vol 17 No 3 2015

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JCPSLP Volume 17, Number 3 2015 117
importance of good planning and communication can be
found in Mel’s report of an incident where she perceived
mixed messages from the nursing staff and Feeding Team
(SLP, dietetics, and occupational therapy). Her baby had
been recommended by the SLP and dietician to have a
nasogastric tube placed but, over the weekend (when
the Feeding Team were not present), he pulled it out. The
nursing staff assured her that he did not need it and it was
not reinserted. While there may have been good reasons
for the clinical decisions made, Mel’s view was that the
situation was unclear: “it does get a bit confusing when
that was the plan, and then the plan’s now changed”.
She suggested: “I think they should all communicate a bit
more together, maybe, which would make it easier on the
parents”.
A second example illustrates the vulnerable position of
parents at discharge. Charlotte felt she had inadequate
information: “It was unfortunate that the SLP was only
able to observe one feed… His feeding is very erratic and
we don’t know why as yet”. She felt underprepared in
managing her baby’s nasogastric tube at discharge. She
wrote:
Things I have not been told include the long term
impact of having a tube, how long they will leave the
tube in, if the tube will affect his speech, if the tube is in
long term are there other options that are not so visual,
how the tube will impact on the introduction of solids. I
have also not been given much information on how to
gravity feed and ways to make tube feeding more easy
in a busy household.
In her second (emailed) interview, Charlotte reported
turning to the internet to get information: “Luckily there
are a lot of online forums and Facebook pages about tube
feeding that I have been able to access for support”. While
such sources of information may be helpful, it is important
that SLPs are aware of parents’ ongoing need for support,
and remain accessible sources of reliable and evidence-
based information both within hospital and after discharge.
Discussion
The aim of this study was to gain an initial understanding of
mothers’ experiences of discharge from hospital to home
with a baby with feeding issues, and the role of SLP in that
discharge and transition. There is little published research
with this group of clients and, following discharge, there are
limited opportunities for them to share their experiences
with their SLPs (Dodrill, McMahon, Donovan, & Cleghorn,
2008). The results of this study confirm VanDahm’s (2010)
position that discharge from hospital does not necessarily
signify the end of the need for SLP support and
involvement, and that a smooth and well communicated
transition to outpatient or community services may be
necessary.
In line with the findings of Fowlie and McHaffie (2004),
while individuals were glad to be home, frustration and
anxiety increased over time if follow-up supports were
not available. The mention of the internet as an important
information and support source is not surprising but it does
show that the SLP has a role in providing ongoing, reliable,
and high-quality information for families following discharge.
The desire for clear and consistent information found in
this study was noted in previous research (e.g., Adams,
Gordon, & Spangler, 1999; Hoddinott & Pill, 2000) which
found that inconsistent advice from health professionals
concerning the management of a baby with feeding issues
is not unusual, especially when tube feeding is involved.
Analysis
Interviews were audio recorded and transcribed verbatim
by the first author and the emailed exchanges were also
collected. Thematic analysis sorted recurring issues and
patterns into themes and subthemes. The first author
recorded feelings to maintain reflexivity, consciously
acknowledging personal biases (Angen, 2000; Liamputtong,
2009; Ryan, Coughlan, & Cronin, 2009). The credibility and
rigour of this study was addressed through the implementation
of member checking, offered to all participants, although
only one participant chose to complete member checking
(Curtin & Fossey, 2007). To achieve consistency and
neutrality, an audit trail was kept which involved the
researcher keeping thorough notes of data, interpretation
and changes to research plans, audio recordings, and
interview transcripts. Rationales for decisions made during
the study were documented to ensure the confirmability of
results and the overall credibility of the research (Lincoln &
Guba, 1985). Both authors reviewed transcripts and
coding, with particular attention to triangulation across
conditions and time (Denzin & Lincoln, 2005).
Results
Through the six points of contact made with participants,
three main themes emerged around the issues of transition
and discharge home. These were maternal emotions, home
and family life, and the role of SLP. These three themes and
their subthemes are shown in Figure 1.
In relation to maternal emotions, there were feelings
of stress and anxiety associated with hospital discharge.
Confidence or erosion of confidence was a recurring
subtheme closely associated with anxiety about managing
the baby’s broader health issues, provision of information,
and coping with unpredictable feeding. For those who saw
positive changes and progress with feeding, going home
was affirming and enhanced a sense of pride, self-worth,
and achievement as well as an increased sense of control
over the environment. The mother with a tube-fed baby
at the time of discharge presented as more stressed and
uncertain at home than the mothers of orally fed babies.
Life at home was also a key theme involving, for example,
responsibilities to other children, the aim for a normal
routine, and having other family members to call on.
Participants felt empowered by being able to educate family
members regarding issues such as tube feeding. Once
home, questions arose, particularly around the baby’s
development, timelines for achieving goals, and how SLP
might help with these issues. In relation to the third theme
of the SLP role, the four mothers in this study appreciated
SLPs’ depth of knowledge on practical issues, for example,
about choices around of bottles or teats, what kind of foods
to try, or how to encourage their child to try something new.
They often had queries or needed help to make sense of
information that they had already been given. They wanted
to discuss issues during regular visits on the ward and they
appreciated getting to know the SLP and seeing the SLP
get to know their child. However, initially, mothers were not
always aware of the role and responsibilities of SLPs with
regard to feeding. Tia was “quite shocked… to find out that
you were under speech [she and her son would receive
support from a speech-language pathologist], ’cause I said to
them that he doesn’t talk yet”. This highlights the importance
of clear introductions in an environment where many
professionals come into contact with parents on the wards.
Stories which emerged from the interviews help illustrate
some of these themes and subthemes. An example of the