transition theory.to post.2015
TRANSCRIPT
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Transition Theory
NU 455
Susan Parker DNP GNP-BC, ACHPN
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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#
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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
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Nursin) $nter!ention
Nurses" Care *or 'atients *a+i%ies &ho are un(er)oin)
transitions# Take are o* the (e+an(s that transitions +ake on 'atients# Pre'are 'atients *or transitions#
9:a+'%es"
0o+en beo+in) +others# 9n)a)e( +otherin)#;teahin) a*ter(e%i!ery#
Patients reo!erin) *ro+ a C
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.ey Cone'ts" Chan)e in
Ciru+stane ? Chan)e in 2o%e
Hea%thy transitions re@uire( +astery o* ne& ro%es, &ith
ne& beha!iors, &ays o* thinkin) an( atin)#
Nursin) inter!entions he%' 'atients take on ne& ro%es#
Nursin) inter!ention suh as teahin), arin),su''ortin), thera'eutis an assist in ne& ro%e
(e!e%o'+ent#
9:a+'%e;Patient
transitionin) *ro+ her
o&n ho+e to %on) ter+
are# Assu+es ro%e o*
ne& resi(ent##
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Co+'onents o* Transitions
Types%e$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
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)#
Nursin) $nter!ention
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Ty'es o* Transitions
De!e%o'+enta%$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#
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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-#
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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
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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#
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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
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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
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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
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Pro'erties o* Transitions
.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
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Pro'erties o* Transitions
/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
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Pro'erties o* Transitions
Tie span1an i(enti*iab%e start1en( 'oint"
Date o* an ai(ent
Ti+e &hen 'atients are a(+itte( to $CU *ro+ the 9D#
Day &hen 'atient is trans*erre( to the +e(ia% unit
)! Tie span-- +o!in) an( *%o&in), start 'oint not %ear no en( 'oint
Gra(ua% onset o* (i**iu%t to (ia)nose hroni (isease" +u%ti'%e
s%erosis, syste+i %u'us erythe+atosus#
Chroni 'ain, un(eter+ine( start 'oint, not assoiate( &ith any
e!ent, u+u%ati!e1resen(o e**et# Patient no& *in(s s1he is
in 'ain a%% the ti+e#
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Pro'erties o* Transitions
Critical points & e$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
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Eai%itators $nhibitors
Facilitators &
Inhibitors
To
Transitions
A# e%eis, A*a*# Transitions Theory" i((%e 2an)e an(
Situation S'ei*i Theories in Nursin) researh an(
Pratie# Ne& 3ork, N3, USA" S'rin)er Pub%ishin)
Co+'any, 6# e%ibrary o%%etions, 65 7une 64
Co'yri)ht86# S'rin)er Pub%ishin)#
"#rsing Inter$ention
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Transition Con(itions" Eai%itators
$nhibitors
Persona%"
hea%th be%ie*s an( 'ere'tions
u%tura% be%ie*s
soioeono+i status
're'aration
kno&%e()e
sy+'to+s
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Case 9:a+'%e
Gary, 6 years o%(, has ha(
D ty'e 6 *or se!era% years
+ana)e( by the 7os%in C%ini &ith
)oo( )%ye+i ontro% an( on)oin) su''ort *ro+ his *a+i%y#
He has '%aye( s'orts, been ati!e in a*ter shoo% ati!ities an( has(is%ose( to his *rien(s that he has (iabetes#
His *rien(s ha!e seen hi+ hek his b%oo( )%uose se%*-a(+inister
insu%in# He *ee%s ae'te( by his *rien(s#
He )ra(uate( *ro+ hi)h shoo% an( is no& o++utin) to o%%e)e an
hour eah &ay 5 (ays a &eek# His (ays are +uh %on)er, he is not
'%ayin) s'orts yet but he is (e*inite%y +ore ati!e#
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Kuestion
Gary o+es to the stu(ent hea%th ser!ie an( you are the 2N assi)ne(to his ase# He 'resents &ith onerns about his b%oo( )%uose &hihis in the Ls in the a*ternoon# He has been takin) his usua% (ose o*insu%in an( eatin) in the a*eteria# He takes a snak &hen here+e+bers it, not the sa+e as ha!in) the kithen at ho+e# 0hih o*
the *o%%o&in) are trueJ A# Eurther assess+ent about his ati!ity, stress %e!e%, (ietary intake
an( routine is nee(e(#
B# This is an e:a+'%e o* a stu(ent &ho &i%% nee( a )oo( (ea% o*su''ort an( you shou%( reo++en( a stu(ent ounse%or &ithe:'eriene in D#
C# His transition to o%%e)e +ay be (i**iu%t beause o* the D#
D# He is kno&%e()eab%e an( (e+onstrates in(e'en(ene in(iabetes are#
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$+'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
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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 $DD# Sy+'to+s;Atten(s to the+ an( in(e'en(ent%y +ana)es#
A(justin) insu%in (ose an( brin)in) a snak Facilitates transition
to new role as 2college st#ent with I%%M30
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The Patients 2es'onse
The patients
response:
Coping to--
Mastery (Takes on
new role
!ole
A# e%eis, A*a*# Transitions Theory" i((%e 2an)e an(
Situation S'ei*i Theories in Nursin) researh an(
Pratie# Ne& 3ork, N3, USA" S'rin)er Pub%ishin)
Co+'any, 6# e%ibrary o%%etions, 65 7une 64
Co'yri)ht86# S'rin)er Pub%ishin)#
"#rsing Inter$ention
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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(
$nteratin)
/oatin) an( bein)
situate(
De!e%o'in) on*i(ene
an( o'in)
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0e%%ness1$%%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
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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
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0e%%ness1$%%ness?Patients Nee(s
Stage---New DiagnosisPatient pro"le#
Concerned about
What does this mean to me? ossible 4ife
ChangeWhat treatments?
Eect on life? ossible5oleChange
Nursing %nter$entioneach to immediate !riorities
atients are often overwhelmed at thisstage
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0e%%ness1$%%ness?Patients Nee(s
Stage---Self-Management
Patient pro"le#Challenges of maing and integrating medical !lan into dail" life#u!!ort critical (e.g. social$ %nancial)
Nursing inter$ention#Wor with !atients to %t it into their life/
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0e%%ness1$%%ness?Patients Nee(s
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$entionddress reason(s) and s"m!tomsEnlist !atient to !lan life changes Support e&orts ofpatient to cope and manage
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0e%%ness1$%%ness?Patients Nee(s
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
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Any Kuestions