Author Affiliations: Science of Life Department, Northwestern Regional University of the State of Rio Grande do Sul (Ms Rodrigues and Dr Kolankiewicz); and Nursing Department, Federal University of Santa Catarina (Dr Lorenzini and Ms Malkiewiez), Florianópolis, Brazil; Faculty of Education, University of Cambridge (Dr Onwuegbuzie), United Kingdom; School of Nursing, University of British Columbia, Okanagan Campus (Dr Oelke), Kelowna, Canada; and Serviço de Educação Continuada, Associação Hospital de Caridade Ijuí (Ms Garcia), Ijuí, Brazil.
Cancer Nurs. 2024;47(1):E47-E56. doi: 10.1097/NCC.0000000000001160. Epub 2022 Dec 11.
Integration into the health system is essential for safe care and efficient use of resources.
The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.
The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.
The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.
The low score for the care plan factor indicates weakness in the care transition.
The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.
融入医疗体系对于安全护理和资源的有效利用至关重要。
本研究旨在从患有消化道肿瘤的成年患者和多专业护理团队的角度分析护理交接情况，确定影响护理交接的因素，并与专业人员共同制定改善研究点护理交接的措施。
采用混合方法研究，采用 QUAN→QUAL 序贯解释方法进行 Care Transitions Measure-15 评估。作为知识转化策略，采用审议对话原则，并进行数据整合。
Care Transitions Measure-15 的平均得分被认为是令人满意的 74.3 分。护理计划因素的得分不理想，为 66 分。焦点小组参与者列出了改善护理交接的策略，例如为消化道肿瘤患者制定补充护理方案，并提供一份包含与治疗和患者护理连续性相关的所有信息的单一出院计划。
护理计划因素的低得分表明护理交接存在薄弱环节。
综合分析结果表明，可以通过出院计划制定过程中的教育、为消化道肿瘤患者实施方案以及确定参考护理人员来帮助患者了解医疗保健系统，从而改善护理交接。
