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. 2018 Oct;86:125-138. doi: 10.1016/j.ijnurstu.2018.06.015. Epub 2018 Jul 1.
Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, necessitating a transition from children's to adult services. Given the lack of evidence on interventions to promote transition, it is important that those creating and evaluating interventions develop a theoretical understanding of how such complex interventions may work.
To develop theory about the interventions, and organisational and human factors that help or hinder a successful transition from children's to adult services, drawing on the experience, knowledge, and insights of young adults with life-limiting conditions, their parents/carers, and service providers.
A realist evaluation using mixed methods with four phases of data collection in the island of Ireland. Phase one: a questionnaire survey of statutory and non-statutory organisations providing health, social and educational services to young adults making the transition from children's to adult services in Northern Ireland and one Health Services Executive area in the Republic of Ireland. Phase two: interviews with eight young adults. Phase three: two focus groups with a total of ten parents/carers. Phase four: interviews with 17 service providers. Data were analysed seeking to explain the impact of services and interventions, and to identify organisational and human factors thought to influence the quality, safety and continuity of care.
Eight interventions were identified as facilitating transition from children's to adult services. The inter-relationships between these interventions supported two complementary models for successful transition. One focused on fostering a sense of confidence among adult service providers to manage the complex care of the young adult, and empowering providers to make the necessary preparations in terms of facilities and staff training. The other focused on the young adults, with service providers collaborating to develop an autonomous young adult, whilst actively involving parents/carers. These models interact in that a knowledgeable, confident young adult who is growing in decision-making abilities is best placed to take advantage of services - but only if those services are properly resourced and run by staff with appropriate skills. No single intervention or stakeholder group can guarantee a successful transition. Rather, service providers could work with young adults and their parents/carers to consider desired outcomes, and the range of interventions, in light of the organisational and human resources available in their context. This would allow them to supplement the organisational context where necessary and select interventions that are more likely to deliver outcomes in that context.
由于护理和治疗水平的提高，越来越多患有危及生命疾病的年轻人能够在儿童期后继续生存，这就需要从儿童服务向成人服务过渡。鉴于缺乏促进过渡的干预措施的证据，对于那些正在创建和评估干预措施的人来说，重要的是要从理论上理解这些复杂的干预措施是如何发挥作用的。
借鉴患有危及生命疾病的年轻人、其父母/照顾者和服务提供者的经验、知识和见解，制定有关干预措施以及有助于或阻碍从儿童服务向成人服务成功过渡的组织和人为因素的理论。
这是一项在爱尔兰岛开展的混合方法的真实评估研究，共分为四个阶段进行数据收集。第一阶段：对北爱尔兰向成人服务过渡的年轻人以及爱尔兰共和国一个卫生服务行政区域的提供卫生、社会和教育服务的法定和非法定组织进行了问卷调查。第二阶段：对 8 名年轻人进行了访谈。第三阶段：举行了两次焦点小组会议，共 10 名父母/照顾者参加。第四阶段：对 17 名服务提供者进行了访谈。分析数据的目的是解释服务和干预措施的影响，并确定被认为会影响护理质量、安全性和连续性的组织和人为因素。
确定了八项有助于从儿童服务向成人服务过渡的干预措施。这些干预措施之间的相互关系支持了两种成功过渡的互补模式。一种模式侧重于培养成人服务提供者管理复杂的年轻人护理的信心，并授权提供者在设施和员工培训方面做出必要的准备。另一种模式侧重于年轻人，服务提供者合作培养一个自主的年轻人，同时积极让父母/照顾者参与。这些模式相互作用，即一个有知识、有信心且决策能力不断增强的年轻人最有可能利用服务——但前提是这些服务得到适当的资源支持，并且由具有适当技能的员工运营。没有单一的干预措施或利益相关者群体可以保证成功过渡。相反，服务提供者可以与年轻人及其父母/照顾者合作，根据他们所处环境中的组织和人力资源，考虑期望的结果和一系列干预措施。这将使他们能够在必要时补充组织背景，并选择在该背景下更有可能实现结果的干预措施。
