PATIENTS’ TRANSITION
What is it like in the Intensive Care Unit?
Discover the hidden realities from nurses’
perspective.
SALIZAR MOHAMED LUDIN
Internatioal Islamic University Malaysia
Co-authors: Professor Paul Arbon & Dr. Steve Parker)
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4/13/2015
OVERVIEW
• Conceptualisation of transition
• Problem statement, Research
aims and questions
• Methodology
• Research setting, design &
methods
• Ethical consideration
• Data analysis
• Rigor and trustworthiness
• Findings
• Interpretation & discussion
• Recommendation
• Summary
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Conceptualization of transition
• The term ‘transition’ is derived from the Latin verb
‘transire’, meaning to go across (Chick & Meleis 1986).
• The ‘Macquarie Concise Dictionary (2006, p. 1303)
defines the noun transition as ‘passage from one state,
stage, subject, or a change place to another or a
movement, development, or evolution from one form,
stage, or style to another’.
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Conceptualization of transition
Common definition of transition
in nursing
• Transition occur if an event or
non-event results in a change
in about oneself and the world,
thus requires a corresponding
change in one’s behaviour and
relationship (Schlossberg 1981)
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The individual in Transition Theory
(Schlossberg 1984)
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Helping adults in transition: A content process
model (Schlossberg, Lynch & Chickering 1989)
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• A passage from life phase,
condition, or status to
another…refers to both
process and outcome of
complex personenvironment interaction
(Chick & Meleis 1986).
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• A process that
involves three phases:
ending, neutral, and a
new beginning
(Bridges 2003)
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Characteristics of transition
•
•
•
•
•
•
Critical events
Awareness
Disconnectedness
Time span
Engagement
Change and difference
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Types of transition
•
•
•
•
Health –illness
Developmental
Situational
Organizational
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Transition and Nursing
• The concept of transition is
central to the nursing
discipline because it focuses
on the individual and their
coping with the experience
of clinical care (Meleis et al.
2000; Meleis & Trangenstein
1994).
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Nurse-client encounters that often occur during transitional
periods and the period of instability which may produce
profound alterations in the lives of individuals and their
significant others, have important implications for well-being
and health (Schumacher & Meleis 1994).
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• Consequently, a transition theory framework can
facilitate an understanding of individuals in transition
and their access to the help they need to cope with the
ordinary and extraordinary process of living.
• Such a framework may also be helpful in planning and
providing more appropriate nursing interventions for
patients experiencing transition.
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Critically ill patients context
• Careful conceptualisation of transition and its
consequences in all the bio-psychosocial-cultural
variations will assist nurses in providing therapeutic
nursing to critically ill patients.
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• Critically ill patients recovering from critical illness often
suffer lasting physical and psychological effects and
generally require a ‘package of care’ to support their
complex needs when getting back to good health or a
near normal condition (Foust 2007).
• Adequate preparation of the critically ill patients and
families is an important element of the recovering
process.
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Transition and critical care nurses
• Transitions fall into nursing domain when it pertains to healthillness behaviours or when responses to the transition are
manifested in health-illness behaviours (Chick and Meleis 1986,
pg. 238).
• Nurses’ contribution in patients’ cont’ care during patients’
transition is important as the critically ill patients in the ICU
experience multiple transition as they moves across different
level of care Chaboyer (2005).
• Being transferred to a ‘general’ ward after severe critical illness
or with consequential problems can be distressing and
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challenging.
• This study naturally focus on discharge and change of
the patients’ situation during critical illness, however it
has been recognised that there is increased importance in
awareness of critically ill patients and families transition
experiences including the journey while in C/ICU and
following discharge from the unit.
• As the critical and intensive care nurses are the primary
caregivers in critical care contexts, their understanding
of the critically ill patients’ transition is important to
facilitate better nursing care and prepare the patients
and families.
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Critical care context
Critical illness
Health & illness transition
experiences/journey
Multifaceted treatment/
care
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Problem statement
• Transition of life after health & illness- chronic illness
• Transition (movement) to other care setting- C/ICU
patients
• Discharge and discharge planning in C/ICU
• Patients’ transition experience & nurses engagement in
care
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Research aim
Understanding the critically ill
patients and their families’
transition experience.
This is a vital aspect and it is argued
that nurses should know how to
assist patients and families
during the transitions associated
with hospitalisation and recovery
from critical illness.
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Salizar M Ludin
Research question
What is the awareness of the
critically ill patients’
transitional experience among
the Malaysian C/ICU nurses?
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Methodology
Interpretive Description
approach
Is a qualitative research
approach that requires an
integrity of purpose deriving
from actual practice goal and
an understanding of what
we know and don’t know
from all available sources
(Thorne 2007, p. 35)
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The framework - needs within nursing science and
focuses on developing knowledge that will inform
clinical practice (Hunt 2009)
-experiential questions that are relevant to nursing in clinical
area
Goes beyond description - in-depth conceptual
description stays closer to the data obtained (SullivanBolyai, Bova & Harper 2005).
The analytic procedures - synthesizing, theorizing and
re-contextualizing rather than just simply sorting and
coding (Thorne, Kirkham & O'Flynn-Magee 2004).
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SETTING
Klang Valley (Selangor & K. Lumpur)
HSEL
UMMC
Four (4) public tertiary
Hospitals in Malaysia
HTAR
HKL
DESIGN & METHODS
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SAMPLING & TOOLS
Interview
Focus group and in-depth-individual
• Sampling-Purposive (5 FG and 10 individual
interviews)
• Interview schedule
– Semi-structured questions
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ETHICAL CONSIDERATION
• Flinders University Research Ethic Committee
• Economic planning unit, Prime Minister Dept.
Malaysia
• National Medical Research Ethic Committee of
Malaysia (government hosp)
• Hospital directors(teaching hosp)
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DATA ANALYSIS
Analysis underpinned by the idea of Grounded theory
technique (Strauss & Corbin 1998)
Interview (Group and individual)
– Analysis tool- Nvivo8 software
– Analysis method-GT method of analysis
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RIGOR AND TRUSTWORTHINESS
• Use of framework in data collection and analysis
• Participants’ confirmation of transcript
• Expert opinion-questionnaires
• Reliability test-questionnaire
• Pilot-testing-questionnaire & question guide
• Comparative analysis -GT analysis-back and forward
analysis
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FINDINGS
Coping
Hope, faith and
hopefulness
Complex need
Knowledge
needs
Altered
physiological &
psychological
function
Movement
of location
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Comparison to previous model of transition
Theory of transition (Schlossberg 1981) - Experiencing
transition (middle range theory)(Meleis et al 2000)
Continuous transition process
Patients / families experience
Nurses response
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INTERPRETATION &
DISCUSSION
Hope and
faith
change
Coping
change
Location
change
Skills and
care change
Knowledge
change
Patient’
transition
HealthIllness
change
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Conceptual model: Patients’ transition - What is it like in
ICU from nurses perspectives
ADMISSION
Transition experience
C/ICU
PATIENT
S
PRE-ADMISSION
Therapeutic
use of self
Knowledge
Continuous
Transition
Process
Education
Skills & care
Hope & faith
Coping
FAMILY
Location
change
Family
centred care
TRANSFER/ DISCHARGE
NURSE
Health-illness
RECOMMENDATION
Nursing education
• Broader definition of transition
Clinical practice
• Broader definition of transition
• Develop clear policies
• Practical knowledge
Future research
• Detail exploration of the concept
• Observe the patients’ transition experience
• Test the conceptual model
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Salizar M Ludin
CONCLUSION
Patients’ transition is about continuous
experiences through out their illness
4/13/2015
Co-authors
Professor Paul Arbon
Dean- School of Nursing and Midwifery
Faculty of Health Sciences
Flinders University, South Australia
• Email:
paul.arbon@flinders.edu.au
President -World Association for Disaster and Emergency Medicine (WADEM)
Director- Torrens Resilience Institute
Dr Steve Parker
Associate Dean (Teaching & Learning)- School of Nursing and Midwifery
Faculty of Health Sciences
Flinders University, South Australia
• Email: steve.parker@flinders.edu.au
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REFERENCE
• Chaboyer, W, James, H & Kendall, M 2005, 'Transitional care after the
intensive care unit', Critical care Nurse, vol. 25, no. 3 June, pp. 16-28.
• Boutilier, S 2007, 'Leaving critical care. Facilitating a smooth
transition.', Dimention of Critical Care Nursing, vol. 26, no. 4 JulyAugust.
• Foust, JB 2007, 'Discharge planning as part of daily nursing practice',
Applied Nursing Research, vol. 20, no. 2, pp. 72-7.
• Meleis, AI, Sawyer, L, Im, E-O, Hilfinger, M, DeAnne, K &
Schumacher, K 2000, 'Experiencing transitions: An emerging MiddleRange Theory', Journal of Advanced Nursing, vol. 23, no. 1, pp. 12-28
• Schlossberg, NK 1981, 'A model for analysing human adaptation to
transition', The Counseling Psychologist, vol. 9, no. 2.
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Bridges, W 2003, Managing transitions: Making the most of changes, Nicholas
Brealey Publishing, London.
Kralik, D, Visentin, K & van Loon, A 2006, 'Transition: A literature review.',
Intergrative Literature Reviews and Meta Analyses.
Hunt, MR 2009, 'Strenght and challenges in the use of Interpretive
Description: Reflection arising from a study of the moral experience of health
professionals in humanitatrian work.', Qualitative Health Research, vol. 19, p.
1284.
Thorne, S, Kirkham, SR & MacDonald-Emes, J 1997, 'Focus on Qualitative
Methods. Interpretive description: A Noncategorical qualitative alternative for
developing nursing knowledge.', Research in Nursing and Health, vol. 20, pp.
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