School of Behavioural Sciences and Psychology, College of Management Academic Studies, Rishon-Letzion, Israel.
Faculty of Nursing Sciences, Tel Aviv-Jaffa Academic College, Jaffa, Israel.
J Pediatr Nurs. 2020 Jul-Aug;53:e41-e48. doi: 10.1016/j.pedn.2020.02.004. Epub 2020 Mar 3.
Patient trust is strongly related to adherence, but has not been tested in transitional care. Low adherence post-transitions of young adults from pediatrics to adult renal care jeopardizes transplanted kidneys and quality of life. We aimed at identifying barriers to trust of young adults in nurses and trust-building elements upon and post transition.
Following IRB approval, we recruited 21 young adults who underwent kidney transplants before the transition to adult renal care and eleven nurses from adult care in two Israeli tertiary hospitals that perform kidney transplants. We conducted 42 in-depth narrative interviews with young adults and one interview with each nurse. We used thematic analysis guided by Meleis's framework of effective transitions.
Most young adults' attributed negative meanings to the transition to adult care which did not enhance their well-being. Young adults were not provided with resources to promote their autonomy and role-sufficiency; despite preparation processes pre-transition, they were not aware of expectations from them. Their own unmet expectations of clinicians made them feel unsafe, objectified, and helpless and resulted in distrust in professionals, low adherence, and in some cases, dropping out of care and lower quality of life.
Nurses who focused on building a relationship with young adults rather than on operational tasks established trust and led young adults towards role-sufficiency, satisfaction with care, adherence, and optimized quality of life.
The proposed recommendations for nurses and clinicians structure the trust-building process using elements to improve transitional care.
患者信任与依从性密切相关，但在过渡护理中尚未得到检验。年轻成年人从儿科过渡到成人肾脏护理后依从性低，会危及移植肾脏和生活质量。我们旨在确定年轻成年人对护士的信任障碍，并确定过渡前后建立信任的要素。
在获得机构审查委员会批准后，我们招募了 21 名在过渡到成人肾脏护理之前接受过肾脏移植的年轻成年人和来自以色列两家进行肾脏移植的三级医院的 11 名成人护理护士。我们对年轻成年人进行了 42 次深入的叙事访谈，对每位护士进行了一次访谈。我们使用 Meleis 的有效过渡框架指导的主题分析。
大多数年轻成年人将过渡到成人护理赋予负面意义，这并没有提高他们的幸福感。年轻成年人没有获得促进其自主性和角色能力的资源；尽管在过渡前进行了准备过程，但他们不知道自己的期望。他们对临床医生的期望未得到满足，使他们感到不安全、被客体化和无助，从而导致对专业人员的不信任、依从性低，在某些情况下，他们会放弃护理，生活质量下降。
与专注于操作任务的护士相比，关注与年轻成年人建立关系的护士建立了信任，并使年轻成年人实现角色能力、对护理的满意度、依从性和优化的生活质量。
为护士和临床医生提出的建议使用改善过渡护理的要素来构建信任建立过程。
