Liminality as a Framework to Understand Parents’ Experiences of Going Home After Their Infants Complex Cardiac Surgery: A Conceptual Model

Background: Liminality, as a concept explores the ‘rite of passage’ through a transition (Turner 1967, Van Gennep 1960), in this case parents’ experiences of the transition from hospital to home for the first time with an infant following cardiac surgery for complex Congenital Heart Disease
Aim: To present a conceptual framework arising from empirical findings, as an interpretative approach to the phenomenon of liminality for a group of parents
Design This was a longitudinal qualitative feasibility study, within a constructivist paradigm. Parents were asked to participate in self-report tools and semi-structured interviews at four timepoints: before discharge [T0]; two weeks after discharge [T1], eight weeks after discharge [T2] and after stage two surgery [T3]. Interviews were transcribed verbatim and thematically analysed.
Setting One tertiary children’s cardiac centre in the UK
Subjects Eighty infants were screened during the 15month recruitment period, of whom 47 parents were eligible for participation; parents of 13 infants were recruited; parents of 8 infants took part in interviews (8 mothers, 4 fathers), between August 2013 and February 2015
Results: A betwixt and between time existed for parents, enabling them to develop, maintain and restore a sense of self and control, such that they were ready to face the hurdle of the transition from hospital to home with their fragile infant. Transition across the liminal space was a constraint for some and enabling for others. Parents were bounded by physical, emotional and social constraints in terms of their preparedness to go home.
Conclusion: The model represents the parents’ experiences of transition through a pre-liminal phase (pivotal events), liminal phase (crossing the threshold of the ward into the outside world) to the post-liminal phase (mastery, developing confidence over time). Simplification of the model for practice will enable assessment of each family’s needs before discharge planning commences.