Andersons pediatric cardiology 2141
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (62.52 KB, 3 trang )
KeyIssuesinTransition
WhenShouldPatientsBegintheProcessof
TransitionandWhentoTransfer?
Thetimingofentryfromapediatricclinicintoaserviceresponsiblefor
transition,andthesubsequenttransfertoadultclinics,willvaryaccordingtothe
provisionoflocalservicesandtheindividualneedsofthepatient.Itisimportant,
however,thattransitionandtransferoccurinapredictableandplannedmanner.
Referraltotheclinicsorprogramsresponsiblefortransitionshouldideallybegin
by12yearsofage.Comparedtoolderages,attheageof12,individualsare
moresusceptibleforsuggestionsfromadultpeopleandforbuildingupatrusting
relationshipwithnewhealthcareprofessionals.17Attendanceatsuchclinics
involvesachangeinapproachfromthetypicalpediatriccardiacclinic.Parents
shouldcontinuetoattend,butthereshouldbegreateremphasison
communicationwiththeadolescent,includingopportunitiesforconfidentialoneon-onediscussionwithdoctors,nurses,andotherrelevantcounselors.The
approachtocommunicationneedstoevolveastheteenagergrowsolder,with
provisionfordiscussionappropriatetoageandmaturity.
Transfertotheadultclinicmostcommonlyoccursattheageof18yearsoron
completionofschooling.Thetiming,however,shouldbeflexiblesoastomeet
theneedsofthepatient.Forexample,ifapatienthasdevelopmentaldelay,or
multiplemedicalproblemsunderactivefollow-upinthepediatrichospital,
transfermayneedtooccuratanolderage.Patientsshouldunderstandthat
transfertoadultcareisanaturalprocessandpartofgrowingup.Ingeneral,
adolescentsdeemitappropriatetomovetheircaretoadult-focusedfacilities.18
However,parentsareoftenmorehesitantbecausetheystronglyrelyonthe
trustingrelationshipthattheyhavebuiltupwiththepediatriccareproviders.18
Earlydiscussion,andagreementonanageoftransfer,removesthefrequent
anxietyoffamiliesthatexpertcareisbeinglost,andmakestransfertoadultcare
adevelopmenttobeviewedoptimistically.Insomemedicalsystems,provision
ofadultservicesforgrown-uppatientswithcongenitallymalformedheartsisnot
yetavailableatalevelcomparabletothatprovidedduringchildhood.Inthese
cases,delayoftransferisclearlyadvisable.
WhereShouldCareBeUndertaken?
Availabilityofclinicalresourceswilldeterminethelocationofthetransition
clinic.Ideally,thisshouldbewithinthepediatrichospital,asthismakesthefirst
movefromthepediatriccliniclesstraumatictothepatientsandtheirfamilies.
Thosestaffingtheclinichavetheopportunity,duringseveralvisitsoveryears,to
organizethesubsequenttransfertoadultcare,whichmayneedtobetoa
differenthospital.
Facilitiesforin-patientcareshouldbedesignedaroundtheneedsofyoung
people,andideallyshouldbeseparatefrompediatricandadultwards,witha
differentatmosphereandfocus.Adedicatedadolescentenvironmentforpatients
witharangeofmedicalconditionscanworkwellfortheneedsofcardiac
patients.Thispermitsprovisionoffacilities,includingInternetaccess,astudy
area,television,asocialarea,andkitchenfacilities.Theadolescentwardshould
beorganizedbystaffwithspecialawarenessandtrainingintheissuesofthisage
group.
WhoShouldBeInvolvedinTransitionalCare?
Thebalanceofstaffingforthetransitionclinicdependsonlocalresources.Itis,
however,essentialthatmembersoftheteamprovidingpediatriccareandofthe
teamlookingaftertheirfutureneedsasadultswithcardiacproblemsareboth
involved.19Thisprovidesanopportunityfordiscussionbetweenteamsofthe
specificmedicalneedsofthepatient,aswellascreatingavisibleconnectionfor
thepatientandtheirfamilies.
Specialistnursesplayacrucialroleinsuccessfultransitionbytakingupthe
roleoftransitioncoordinator.20–23Theyshouldhaveexperienceintheneedsof
adolescentsandyoungadultswithcongenitallymalformedhearts,andshould
havereceivedtrainingincounseling.Thereshouldbefacilitiesforthespecialist
nurses/transitioncoordinatorstoconsultwiththepatientseparatelyfromthe
doctor,asthisencouragesearlydiscussionofsensitiveproblemsandanxieties.
Thespecialistnurses/transitioncoordinatorsfrequentlyarethemaincontactwith
thepatientandhisorherfamily,developingauniquerelationshipwiththem.
HowShouldTransitionalCareBeProvided?
Transitionalcarecomprisesseveralinteractingcomponents.Thereforeitis
consideredtobeacomplexintervention24andoughttobedevelopedfroma
programmaticpointofview.Thisprogrammaticapproachassuresthat
transitionalcareisprovidedinasystematicandstructuredway.Transition
programsforyoungpersonswithchronicconditionsingeneral,andwith
congenitalcardiacdiseaseinparticular,aredevelopedandtested.Some
transitionprogramsareextensiveandrequirealotoftime,whereasother
transitionprogramscanbeenseenasbriefinterventions.25
CoreComponentsofTransitionPrograms
Todate,sometransitionprogramshavebeendescribedintheliterature.20–23,26,27
Thesetransitionprogramsarecommonpracticeintherespectivehospitals,20–23
orareunderinvestigationaspartofaneffectivenessstudy.26,27Corecomponents
oftransitionprogramshavebeendescribed.27
TransitionCoordinator
Atransitioncoordinatorisanindispensablecomponentofsuccessfultransition
programs.Transitioncoordinatorsisoftenaspecialistnurse,advancedpractice
nurse,clinicalnursespecialist,ornursepractitioner.Thetransitioncoordinator
oftenisthemainpointofaccessforpatientsandtheirfamilieswhenitcomesto
transition,butalsocoordinatesthemultiprofessionalteampertainingto
deliveringtransitionalcare.He/sheassurescontinuityofcare;supportstheyouth
andtheirparentsthroughoutthetransitionprocess;liaisethehospital/clinicwith
thecommunity;servesasapatientadvocate;safe-guardsfamily-andpersoncenteredcare;andprovidesyouthandparenteducation.28
TransitionPlan
Foreachindividualpatientwhoentersthetransitionprocess,awrittentransition
planshouldbedeveloped.Atransitionplandocumentstheneedsoftheyoung
personandhis/herparents;addressesthehealth,psychosocial,andeducational
issues;detailstheobjectivesofthetransition;andcomprisesatimingofthe
plannedmeetingsandtheforeseenmomentoftransfer.Thetransition
coordinator,togetherwiththeadolescent,willbeinchargeofdeterminingwhich
topicsareimportanttodiscussduringthetransitionmeetingsandwhichgoals
relatedtopatientdevelopmentandfunctioningaretobeadvanced.27The
transitionplanisaworkingdocumentthatevolvesoverthecourseofthe
transitionprocess.
