Introduction
In healthcare, efficient transitions can significantly impact patient outcomes. According to Ali (2022), in the United States, 540,000 people die after ICU admission each year. Among many nursing theories, transitional theory proves to be its own because of its comprehensive approach to tackling complex matters in patient transitions. In contrast to the other theories, which can focus solely on the clinical aspects, the transitions theory is more comprehensive as it covers the psychological, social, and organizational aspects and is still preferred for practice in our workplaces. This paper will explore the theory description, the rationale for selecting the theory of implementation, and the barriers to implementing the plan.
Theory Description
Transitions Theory
The Middle-Range Theory of Transitions, created by Dr. Afaf I. Meleis, is a nursing theory that concentrates on the periods of transition experienced by individuals, families, and the general community within the healthcare system (Lindmark et al., 2019). The model aims to ensure an internationally acceptable definition for the healthcare transition and for reasons behind smooth transitions across various life stages, health status, and healthcare settings. The main goal of the transitional theory is to advocate for care that considers the whole person along with his/her circumstances when undergoing a period of transition. Although it impacts health, emotional well-being, and quality of life, it is understood that people are naturally good at passing through the transitional phases. Through grasping transitions and involvement in the process, nurses can offer a helping hand for individuals to adjust to new circumstances and live healthily emotionally.
The transitions theory covers nursing practices in general, including the transitions due to illness, aging, childbirth, rehabilitation, end-of-life, and more (Benbenishty, 2019). At the individual, family, and community levels, the theory deals with transitions and acknowledges the intertwinement of these levels in their influence on health outcomes. Central ideas in the Transitional Theory are Transitional conditions (which include personal attributes, environmental factors, and their effect on transitions), Transitional processes (which involve stages and steps), and the outcomes of transition (Proper adaptation techniques, coping mechanisms, and health benefits). The model is constructed based on the concept of the transition; it is movement from one state to another and usually implies a stressful situation and the need for support. Therefore, it stresses that families and individuals going through a transition require someone to attain support through personal relationships, appropriate communication, continuity of care, and empowerment. The transitions theory has a distinctive element of addressing mood and thought social developments in line with the physical changes. It recognizes that health conditions alter the intricate relationships between physical health, mental well-being, social support, culture, and environmental factors during change, leading to a broader approach to transitional care.
Rationale
The ICU (Intensive Care Unit) is a quick-paced and dynamic environment characterized by patients in a dire situation who have acute and multiple organ illnesses that demand close vigilance and turbocharged care. Patients in the ICU may plunge from the most severe illness to stabilization, then healing phases rapidly (Halter & Scotto, 2021). Thus, care turns out to be dynamic in need, and it is by this aspect, the transitions theory steps in as it is highly relevant during such moments.
The complexity of the care transitions is one of the main factors making practical Transitions Theory implementation in the ICU. ICU patients usually develop their health situation quickly. At the same time, there is a need for expeditious coordination between healthcare workers to offer continuity and receive quality care throughout the ICU journey. Moreover, the approach of transitional theory is focused on interdisciplinary cooperation. In the ICU, where healthcare providers from different departments usually work together to treat patients, communication systems and ways to make decisions should be properly implemented.
Additionally, the patient-centered care of the transitions theory is hugely advantageous for the intensive care unit (ICU) settings (Flores, 2020). ICU patients and their families alike experience the extreme psychological, physical, and psychological aspects of their being in the critical condition that their loved ones are in. Identifying, paying attention to, and responding to their traits, tendencies, and experiences during these moments of transition would lead to care plans and supportive actions, which, in the end, ensure that expectations are met with a client feeling satisfied.
Implementation Plan
The following plan will be put into action.
First, education and training: Undertake a complete simulation exercise for medical staff comprising nurses, physicians, and the supporting team on the how and the whys of the transitions theory. Provide materials such as training classes, seminars, and online modules to make sure everyone is well-informed and has the correct understanding and competencies.
Second, integration into practice: Make the theory of a transition incorporated into care strategies, paperwork frameworks, and interdisciplinary meeting protocols. Provide opportunities for team meetings and put theory into practice decisions to improve care workflow and care delivery communication.
Third, patient and family engagement: Measures should be taken to include patients and their relatives in planning treatment methods, goal setting, and decision-making processes. Leverage transitions theory and align it in different teaching materials and practice communications to make this theory crucial in the patients’ involvement and empowerment.
Continuous improvement: Create a culture of education and improvement by expanding regular quality improvement meetings, peer reviews, and case management reviews to enhance good care transition. Reviewing the effectiveness of the implantation practices and constant acquisition of data as their result will refine the methods and obtain high outcomes.
Barriers to Implementation
One of the challenges is resistance to change. Medical professionals may be reluctant to accept new theories, such as habitual behaviors or the fear of the unknown process. To overcome this barrier, arrange and organize educational and training workshops emphasizing the advantages of the transitions theory, introduce success stories of dissimilar healthcare environments, and encourage staff to participate in decision-making and planning activities.
Resource constraints are another challenge facing the implementation of the plan. The scarcity of resources like time, finance, and workforce may create challenges in implementing the transition theory. The key elements to address this issue are allocating time and resources for training and learning, creating straightforward workflows to avoid waste, and conducting fundraising to support the implementation efforts.
Lastly, communication challenges where lack of communication both in the team, patients, and family can, in turn, lead to disruptions in care transitions. To address this, communication training programs should be implemented, structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) should be used, patients and families should be involved in care discussions, and clear channels for information exchange should be established.
Conclusion
The Transitions Theory for the ICU unit is promising regarding improving patient outcomes, boosting interprofessional collaboration, and putting the patient first. Proactive strategies such as education, resource allocation, and communication training are powerful tools to overcome the barriers of changing attitudes, resource limitations, and communication challenges. Implementing the transitions theory benefits the patients and their relatives. It has a far-reaching influence on the ICU philosophy as it supports the notion of constant improvement and humane patient care.
References
Ali, H., Pamarthy, R., Bolick, N. L., Leland, W., & Lee, T. (2022, November). Inpatient outcomes and racial disparities of palliative care consults in mechanically ventilated patients in the United States. In Baylor University Medical Center Proceedings (Vol. 35, No. 6, pp. 762-767). Taylor & Francis.
Lindmark, U., Bülow, P. H., Mårtensson, J., Rönning, H., & A.D.U.L.T. Research Group (2019). The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review. Nursing open, 6(3), 664–675. https://doi.org/10.1002/nop2.249
Halter, M. J., & Scotto, C. J. (2021). Psychosocial and Spiritual Considerations. Critical Care Nursing-E-Book: Critical Care Nursing-E-Book, 74.
Benbenishty, J. (2019). Life and death in ICU: nursing care to smooth transitions for patients and family (Doctoral dissertation, University of Plymouth).
Flores, L. (2020). Improving Transitions of Care after Critical Illness.
write