transition theory.to post.2015

8/9/2019 Transition Theory.to Post.2015

1/34

Transition Theory

NU 455

Susan Parker DNP GNP-BC, ACHPN


2/34


3/34

De*initions

Transitions Theory is a theory, a +o(e%, or a

*ra+e&ork#

i(ran)e theory nee(in) a''%iation

+o(i*iation as a''%ie( to %inia% 'ratie# .ey one'ts"

/i*e e!ents +ay be transitions or +ay *oster

transitions#

Nursin) are is !ery o*ten *ouse( on assistin)

'atients to transition#

Suess*u% transitions +ay enhane hea%th#


4/34

The 0ho%e Theory1 Con(ense(

Types,Patterns

&

Properties

of

Transitions

Facilitators

&

Inhibitors

To

Transitions

The patients

response:

Coping to--

Mastery (Takes on

new role

!ole

A# e%eis, A*a*# Transitions Theory" i((%e 2an)e an(

Situation S'ei*i Theories in Nursin) researh an(

Pratie# Ne& 3ork, N3, USA" S'rin)er Pub%ishin)

Co+'any, 6# e%ibrary o%%etions, 65 7une 64Co'yri)ht86# S'rin)er Pub%ishin)#

"#rsing Inter$ention


5/34

Nursin) $nter!ention

Nurses" Care *or 'atients *a+i%ies &ho are un(er)oin)

transitions# Take are o* the (e+an(s that transitions +ake on 'atients# Pre'are 'atients *or transitions#

9:a+'%es"

0o+en beo+in) +others# 9n)a)e( +otherin)#;teahin) a*ter(e%i!ery#

Patients reo!erin) *ro+ a C


6/34

.ey Cone'ts" Chan)e in

Ciru+stane ? Chan)e in 2o%e

Hea%thy transitions re@uire( +astery o* ne& ro%es, &ith

ne& beha!iors, &ays o* thinkin) an( atin)#

Nursin) inter!entions he%' 'atients take on ne& ro%es#

Nursin) inter!ention suh as teahin), arin),su''ortin), thera'eutis an assist in ne& ro%e

(e!e%o'+ent#

9:a+'%e;Patient

transitionin) *ro+ her

o&n ho+e to %on) ter+

are# Assu+es ro%e o*

ne& resi(ent##


7/34

Co+'onents o* Transitions

Types%e$elopental

'it#ational

ealth Illness

)rgani*ational

Patterns'ingle

M#ltiple

'e+#ential

'i#ltaneo#s

nrelate

Properties.wareness

/ngageent

Change & ifference

Transition tie span

Critical Points & e$ents




Co+'any, 6# e%ibrary o%%etions, 65 7une 64Co'yri)ht86# S'rin)er Pub%ishin)#

Nursin) $nter!ention


8/34

Ty'es o* Transitions

De!e%o'+enta%$n*ant, to((%er,

'reshoo%, a(o%esene, +enarhe,

're)nany, +eno'ause#

Situationa%A *ire, *%oo(, &ar# Or)aniationa%2e-assi)n+ent o* nursin) sta**#

Hea%th to $%%ness

Transitions *ro+ hea%th to aute i%%ness

Transitions to aute i%%ness hroni i%%ness

Transition *ro+ in(e'en(ene to beo+in) a 'atient

$nstitute o* e(iine#=66># The future of nursing: Leading change,

advancing health. Washington, D#C#"Nationa% Aa(e+ies Press#


9/34

Transition Ty'e" De!e%o'+enta%

Situationa% $++i)rant .orean &o+an stu(ie( to e:a+ine their e:'eriene o*

+eno'ause an( the sy+'to+s they e:'eriene( (urin) +eno'ause#

Ana%ysis (one o* their res'onse to +eno'ause an( assoiate(

sy+'to+s in this situation o* i++i)ration an( ne& job or job searh#

$nter!ie&s o* 6 &o+en sho&e( that" The &o+en ne)%ete( their sy+'to+s, (o&n'%aye( +eno'ause to the

transition o* %oation =i++i)ration> an( ro%e =&ork>#

Stresses o* i++i)ration an( &ork took 'ree(ene o!er +eno'ause

=hea%th>#

Patriarha% u%tura% herita)e +akes &o+ens e:'erienes in!isib%e# /o& ino+e, u%ture (o&n'%aye( the nee( to 'ay attention to

+eno'ausa% transition#

e%eis, A $#, Sa&yer, / , $+, 9, essias,D.E, Shu+aher, .# =># 9:'erienin) transitions" An e+er)in) +i((%e ran)e theory #Adv Nurs SiF=6>"6-#


10/34

Transition Ty'e" Hea%th to $%%ness

in $CU Sur!i!ors De+onstrates the transitions 'atients )o throu)h

*ro+ a(+ission to"

9+er)eny (e'art+ent

$CU

e(ia% unit !enti%ator (e'en(ent 'atients &ere inter!ie&e(

A!era)e (ay stay in $CU

Patients &ent *ro+ bein) in(e'en(ent ='re-ai(ent> to"

$CU--se(ate( !enti%ator (e'en(ent =%earne( he%'%essness>

e(ia% unit;se+i-in(e'en(ent =a&are, !u%nerab%e>

Pre-(ishar)e;(e!e%o'in) in(e'en(ene =takin) on ne& ro%e o*

rehabi%itation>#2a+sey, P#, Huby,G#, Tho+'son , A#, 0a%sh, T# =6> $ntensi!e are sur!i!ors e:'erienes o* &ar(-base( are" e%eis theory o* nursin) transitions

an( ro%e (e!e%o'+ent a+on) ritia% are outreah ser!ies# 7CNF"I5-I65


11/34

Ty'es o* Transitions"

Or)aniationa% Hos'ita% B has been o'en *or o!er 6 years,

)ro&in) an( a(a'tin) to the han)es in the

o++unity, hea%th are nee(s o* the o++unity,

insurers an( re)u%ators# Eisa% han)es has the a(+inistration uttin)

nursin) sta** an( bu()etin) use o* 'er (ie+ sta**#

Nurses &orkin) in +e(ia% sur)ia% units are

re@uire( to &ork o!erti+e to o!er une:'ete(

a%% outs *or the ne:t shi*t#

$+'%iations *or nursin) are are unkno&n#


12/34

Case Stu(y 6

rs# Casey, has been 'ro!i(in) are to

her husban( &ho &as (ia)nose( &ith 'anreati

aner *i!e +onths a)o# $t has been a (i**iu%t *e&

+onths# rs# Casey is beo+in) &orn-out as she is atte+'tin) to &ork

e!ery(ay an( 'ro!i(e are# rs# Casey says to you in 'ri!ate, $ kno&

+y husban( is !ery i%% an( $ &ant to s'en( as +uh ti+e &ith hi+ as $

an# $ a+ )oin) to nee( he%' in arin) *or hi+ an( (o not kno& ho& to

be)in# Do $ nee( to @uit +y jobJ Ho& (o $ ta%k to +y (au)hter about

&hat is )oin) to ha''en to her *atherJ $ just &ant to s'en( @ua%ity ti+e&ith +y husban(#

0hat ty'es o* transitions (o you seeJ

0ho is in transitionJ


13/34

Patterns o* Transitions

Sin)%e

u%ti'%e

Se@uentia%

Si+u%taneous

2e%ate(

Unre%ate(

Mr0 Cs transition to sick role

incl#es #ltiple transitions forhiself an faily ebers

beca#se of the serio#sness

of his illness0


14/34

Pro'erties o* Transitions

A&areness

9n)a)e+ent

Chan)e an( (i**erene

Transition ti+e s'an

Critia% 'oints an( e!ents


15/34


.wareness

Patient +ay not be a&are that s1he is in a

transition 'roess#

Prob%e+s assoiate( &ith this are o*ten beause"

The han)e &as not initiate( by the 'atient# They are not 're'are(#

9:a+'%e" Patient ne&%y (ia)nose( &ith (iabetes is not a&are o* the

%i*esty%e han)es she &i%% nee( to +ake =A(a'ti!e ro%e>#

9:a+'%e" Dau)hter &hose 'arent has a C


16/34


/ngageent

Patient +ay be a&are or una&are

Se(ate( 'atients in $CU

A&are 'atients +ay intentiona%%y (isen)a)e in

their transition--(enia%#

9:a+'%e" .orean &o+en &ho &ere i++i)rants

*in(in) an( &orkin) in ne& jobs (e%iberate%yi)nore( their +eno'ausa% sy+'to+s#

0hat ha''ens &hen these sy+'to+s are i)nore(J


17/34


Tie span1an i(enti*iab%e start1en( 'oint"

Date o* an ai(ent

Ti+e &hen 'atients are a(+itte( to $CU *ro+ the 9D#

Day &hen 'atient is trans*erre( to the +e(ia% unit

)! Tie span-- +o!in) an( *%o&in), start 'oint not %ear no en( 'oint

Gra(ua% onset o* (i**iu%t to (ia)nose hroni (isease" +u%ti'%e

s%erosis, syste+i %u'us erythe+atosus#

Chroni 'ain, un(eter+ine( start 'oint, not assoiate( &ith any

e!ent, u+u%ati!e1resen(o e**et# Patient no& *in(s s1he is

in 'ain a%% the ti+e#


18/34


Critical points & e$ents:

De*initi!e +arkers o!er &hih no one has any

ontro%#

Birth

De!e%o'+enta% +i%estones

Situationa% han)es

Onset o* i%%ness


19/34

Eai%itators $nhibitors

Facilitators &

Inhibitors

To

Transitions




Co+'any, 6# e%ibrary o%%etions, 65 7une 64

Co'yri)ht86# S'rin)er Pub%ishin)#



20/34

Transition Con(itions" Eai%itators

$nhibitors

Persona%"

hea%th be%ie*s an( 'ere'tions

u%tura% be%ie*s

soioeono+i status

're'aration

kno&%e()e

sy+'to+s


21/34

Case 9:a+'%e

Gary, 6 years o%(, has ha(

D ty'e 6 *or se!era% years

+ana)e( by the 7os%in C%ini &ith

)oo( )%ye+i ontro% an( on)oin) su''ort *ro+ his *a+i%y#

He has '%aye( s'orts, been ati!e in a*ter shoo% ati!ities an( has(is%ose( to his *rien(s that he has (iabetes#

His *rien(s ha!e seen hi+ hek his b%oo( )%uose se%*-a(+inister

insu%in# He *ee%s ae'te( by his *rien(s#

He )ra(uate( *ro+ hi)h shoo% an( is no& o++utin) to o%%e)e an

hour eah &ay 5 (ays a &eek# His (ays are +uh %on)er, he is not

'%ayin) s'orts yet but he is (e*inite%y +ore ati!e#


22/34


23/34

Kuestion

Gary o+es to the stu(ent hea%th ser!ie an( you are the 2N assi)ne(to his ase# He 'resents &ith onerns about his b%oo( )%uose &hihis in the Ls in the a*ternoon# He has been takin) his usua% (ose o*insu%in an( eatin) in the a*eteria# He takes a snak &hen here+e+bers it, not the sa+e as ha!in) the kithen at ho+e# 0hih o*

the *o%%o&in) are trueJ A# Eurther assess+ent about his ati!ity, stress %e!e%, (ietary intake

an( routine is nee(e(#

B# This is an e:a+'%e o* a stu(ent &ho &i%% nee( a )oo( (ea% o*su''ort an( you shou%( reo++en( a stu(ent ounse%or &ithe:'eriene in D#

C# His transition to o%%e)e +ay be (i**iu%t beause o* the D#

D# He is kno&%e()eab%e an( (e+onstrates in(e'en(ene in(iabetes are#


24/34

$+'atin) Eators" Nursin) Thera'ies

9:a+'%e

"#rsing therapies

Assess+ent o*"

4 hour (ietary intake

Ati!ities in a (ay S%ee' at ni)ht

2a''ort &ith ne& *rien(s

Soia% ati!ities J9TOH

"#rsing Therapies

Teahin) 1 assess+ent

2ein*ore+ent or ne&

in*or+ation

Content

0hat to 'ik at the

a*eteria

0hat to arry (urin)

o++ute

Su''ort

astery in(e'en(ene


25/34

Case 9:a+'%e =Continue(>

Pre'aration;Gary un(erstan(s (iabeti se%*-are as a hi)h

shoo% stu(ent %i!in) at ho+e# Su''ort at ho+e ontinues an( there is no on*%it &ith

si)ni*iant others o!er D# Facilitates transition

Gary has &a%ke( +i%es the *irst (ay, *or)ot to brin) a snak, an(&as %ate to %ass so he ou%( not )et to the *oo( ourt# /ak o*

're'aration Inhibits transition0

.no&%e()e;Gary )ets use( to the routine o* +ore e:erise,

)i!es hi+se%* %ess insu%in in the a+# Facilitates

astery o* ne& ro%e in(e'en(ent%y as 'erson &ith $DD# Sy+'to+s;Atten(s to the+ an( in(e'en(ent%y +ana)es#

A(justin) insu%in (ose an( brin)in) a snak Facilitates transition

to new role as 2college st#ent with I%%M30


26/34

The Patients 2es'onse

The patients

response:

Coping to--

Mastery (Takes on

new role

!ole




Co+'any, 6# e%ibrary o%%etions, 65 7une 64

Co'yri)ht86# S'rin)er Pub%ishin)#



27/34

Transition Outo+es 1 Patterns o*

2es'onse

Outo+e in(iators

astery

E%ui( $nte)rati!e

$(entities =takes on ne&

ro%e, a(a'ts

Gary the stu(ent 'iks a

ba%ane( +ea% in the

a*eteria, has *ruit bars in

his bak'ak, an( a(justsinsu%in (ose beause he

&a%ks M 6 +i%e a (ay

no

Proess $n(iators

Eee%in) onnete(

$nteratin)

/oatin) an( bein)

situate(

De!e%o'in) on*i(ene

an( o'in)


28/34

0e%%ness1$%%ness Transitions"

Patients Nee(s a%on) a Trajetory

28

Pre-Diagnosis

NewDiagnosis

Self-Management

Exacerbation

End-of-Life

Needreassuranc

e

Watchfulofcliniciansbehavior

(e.g. non-verbal) andchoice ofwords

Concernedabout

What doesthis meanto me?Whattreatments?

Eect onlife?

Challengesof maing

andintegratingmedical!lan intodail" life#u!!ort

critical (e.g.social$%nancial)

Concernedabout what

ha!!ened &Wh" didthes"m!tomsget worse?'ow long

did the"have thes"m!toms

Concernsabout self

and lovedonesreferences (e.g.dvanced*irectives$

living wills )

+e calm$

focused,ollow-u!

each toimmediate

!riorities

Wor with

!atients to%t it into/

ddress

reason(s)and

0a1or

focus ons"m!toms

Nursing interventions

From Dr Janice Foust


29/34

0e%%ness1$%%ness?Patients Nee(s

Stage---Pre-DiagnosisPatient newly admitted to hospitalVulnerable sic! in pain

Patient pro"le#

Need reassuranceWatchful of clinicians behavior (e.g. non-verbal) and choice ofwords

2ncertaint"$ a health !roblem e3ists thatbrought them to the hos!ital$ tests will be

ordered.Nursing inter$ention+e calm$ focused,ollow-u! on an" !romises

atients are often ver" concerned or frightened

at this stage


30/34


Stage---New DiagnosisPatient pro"le#

Concerned about

What does this mean to me? ossible 4ife

ChangeWhat treatments?

Eect on life? ossible5oleChange

Nursing %nter$entioneach to immediate !riorities

atients are often overwhelmed at thisstage


31/34


Stage---Self-Management

Patient pro"le#Challenges of maing and integrating medical !lan into dail" life#u!!ort critical (e.g. social$ %nancial)

Nursing inter$ention#Wor with !atients to %t it into their life/


32/34


Stage---ExacerbationPatient pro"le#

Concerned about what ha!!enedWh" did the s"m!toms get worse?

'ow long did the" have the s"m!toms

Patients are often discouraged

Nursing %nter$entionddress reason(s) and s"m!tomsEnlist !atient to !lan life changes Support e&orts ofpatient to cope and manage


33/34


End-of-Life

atient !ro%le6Concerns about self and loved onesreferences (e.g. dvanced *irectives$ living wills )

atients want to be cared for or cared about7concerns aboutabondonment

Nursing 8ntervention60a1or focus on s"m!toms (e.g. $!ain$ s!iritual needs


34/34

Any Kuestions

transition theory.to post.2015

Documents