School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, Northern Ireland, United Kingdom.
Faculty of Health, Social Care and Education, Kingston University and St George's, University London, Kingston Hill Campus, Kingston upon Thames, Surrey, United Kingdom.
Int J Nurs Stud. 2017 Nov;76:1-27. doi: 10.1016/j.ijnurstu.2017.06.013. Epub 2017 Jun 23.
Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts.
To explain how intervention processes interact with contextual factors to help transition from children's to adult services for young adults with life-limiting conditions.
Systematic realist review of the literature.
Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers.
Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools.
78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children's service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders.
Early planning, collaboration between children's and adult service providers, and a focus on increasing the young adults' confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents/carers and staff to engage with each other effectively.
护理和治疗的改善使得越来越多患有生命有限疾病的年轻人能够在儿童期后继续生存，这意味着他们必须从儿童服务过渡到成人服务。这对于年轻人和服务提供者来说都是一个具有挑战性的过程，复杂的过渡干预措施以不可预测的方式与当地环境相互作用。
解释干预过程如何与情境因素相互作用，以帮助患有生命有限疾病的年轻人从儿童服务过渡到成人服务。
对文献进行系统的现实主义综述。
文献来源于四个电子数据库：从 1995 年 1 月到 2016 年 4 月的 Embase、MEDLINE、Science Direct 和 Cochrane Library。此外，还在 Google Scholar 中进行了搜索，并从纳入论文的参考文献中获取了文章。
使用经过改编的标准化数据提取工具提取数据，该工具包括与干预措施、机制、情境影响和结果相关的识别信息。两名审查员根据纳入标准评估论文的相关性。使用相关的批判性评估技能计划工具评估方法学严谨性。
综述共纳入 78 篇文章。确定了 6 项与有效过渡到成人服务相关的干预措施。情境因素包括儿童服务提供者与成人服务提供者合作的必要性，以准备一个有知识渊博的员工和充足资源的环境。干预措施引发的机制包括所有利益相关者的赋权感和代理感。
早期规划、儿童服务提供者和成人服务提供者之间的合作，以及重点提高年轻人在决策和参与成人服务方面的信心，对于成功过渡至关重要。干预措施应根据其背景进行定制，并不仅关注组织程序，而且要使年轻人、家长/照顾者和工作人员能够有效地相互配合。
