Percepção dos enfermeiros sobre a transição do cuidado na alta hospitalar / Nurses' perception about the transition of care at hospital discharge

Existe uma clara lacuna na transição entre Atenção Hospitalar (AH) e Atenção Primária à Saúde (APS). A efetividade da Transição do Cuidado (TC) depende de uma excelente capacidade de comunicação entre profissionais e serviços, sendo a alta hospitalar um momento crítico. O objetivo deste estudo foi investigar as percepções dos enfermeiros da Atenção Hospitalar (AH) e Atenção Primária em Saúde (APS) sobre aspectos da alta hospitalar Trata-se de um estudo transversal e quantitativo realizado com dados de enfermeiros atuantes na AH e na APS no estado de Santa Catarina. Os dados foram coletados entre dezembro de 2020 e janeiro de 2021, por meio de formulário eletrônico. Foi realizada análise descritiva e inferencial. Para comparação entre grupos utilizou-se teste de qui-quadrado de Pearson. Há algumas sobre posições nas percepções dos enfermeiros da AH e APS sobre a temática, sendo que consideram importante o acompanhamento do paciente após a alta hospitalar (54; 91,5%), entende que existe pouca e fraca comunicação entre serviços de saúde (52; 88%). Ainda, são realizadas orientações verbalmente para pacientes e familiares no momento da alta (32; 54,2%), pouca informação é compreendida pelos pacientes (47; 79,7%) e o plano de alta não é individualizado (30; 50,8%), na maioria dos casos. A comunicação é uma grande fragilidade na alta hospitalar, que se expressa nesse estudo, pela percepção dos enfermeiros de uma comunicação fraca entre AH e APS, pela fragilidade do plano de alta e orientações realizadas verbalmente. A melhoria do processo de transição do cuidado, especialmente a alta hospitalar, permite uma assistência à saúde mais integrada, segura e centrada no paciente. O investimento em estratégias que aprimorem esse processo é essencial para a qualidade do cuidado.

There is a clear gap in the transition between Hospital Care (HC) and Primary Health Care (PHC). The effectiveness of the Care Transition (TC) depends on an excellent communication ability between professionals and services, with hospital discharge being a critical moment. The objective of this study was to investigate the perceptions of HC and PHC nurses on aspects of hospital discharge. This is a cross-sectional and quantitative study carried out with data from nurses working in HC and PHC in the state of Santa Catarina. Data was collected between December 2020 and January 2021, using an electronic form. Descriptive and inferential analysis were performed. Pearson's chi-square test was used for comparison between groups. There are some overlapping positions in the perceptions of HC and PHC nurses on the subject, considering that patient follow-up after hospital discharge is important (54; 91.5%), they understand that there is little and weak communication between health services (52; 88%). Also, verbal guidelines are given to patients and family members at discharge (32; 54.2%), little information is understood by patients (47; 79.7%) and the discharge plan is not individualized (30; 50.8%), in most cases. Communication is a major weakness in hospital discharge, which is expressed in this study, by the nurses' perception of poor communication between HC and PHC, by the fragility of the discharge plan and verbally given guidelines. Improving the care transition process, especially hospital discharge, allows for more integrated, safe and patient-centered healthcare. Investment in strategies that improve this process is essential for the quality of care.

Indian Academy of Pediatrics Consensus Guidelines for Adolescent Friendly Health Services

Justification: Adolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice. Process: Indian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021. Objective: To formulate guidelines to enable pediatricians to establish adolescent friendly health services. Recommendations: Pediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services.

Perspective of pediatricians and adolescent patients on the transition process in a university hospital / Perspectivas de pediatras e pacientes adolescentes sobre o processo de transição em um serviço terciário

ABSTRACT Objective: To map the transition process from the perspective of pediatricians and their adolescent patients, and to suggest a transition protocol. Methods: This is a descriptive, cross-sectional study conducted in a pediatric outpatient clinic of a public tertiary hospital. Pediatricians answered a questionnaire about the transition process, and that was evaluated in a descriptive manner. The Transition Readiness Assessment Questionnaire (TRAQ) on health autonomy was answered by the adolescents and the analysis was performed using the χ2 and Mann-Whitney tests. p<0.05 were considered significant. Results: 31 pediatricians (16 residents, 15 supervisors) were enrolled, with a mean age of 40.1 (±16.9), 87% women, with years working in Pediatrics ranging from 2 to 45 years (median of 5 years). Most doctors agreed that there was no transition plan, but they stimulated the patient's autonomy and talked to the patient and family members about any existing chronic diseases. A total of 102 adolescent patients participated, with a median age of 15; 56% were female. The TRAQ median was 58, with similar scores between females and males, and higher scores in those older than 16 years of age (Mann-Whitney U test, p=0.01). The patients reported ease in face-to-face communication with their doctors, but great difficulty in talking about health issues over the phone. Conclusions: Even without a transition protocol, adolescents developed several self-care skills as they aged. The lack of a transitional protocol led to conflicting opinions, which reinforces the need for improvement. We suggest a flowchart and transition protocol.

Resumo Objetivo: Mapear o processo de transição na perspectiva de pediatras e de seus pacientes adolescentes bem como sugerir um protocolo de transição. Métodos: Estudo descritivo, transversal, realizado em um Ambulatório de Pediatria de um hospital público terciário. Pediatras responderam a um questionário sobre o processo de transição, que foi avaliado de forma qualitativa. O Questionário de Avaliação do Preparo para a Transição (TRACS) foi respondido pelos adolescentes, e a análise foi feita com testes do qui-quadrado e de Mann-Whitney. Valores p<0,05 foram considerados significantes. Resultados: Participaram do estudo 31 pediatras (16 residentes, 15 supervisores), com média de idade de 40,1 (±16,9) anos, 87% do sexo feminino, tempo de atuação na Pediatria variando de dois a 45 anos, com mediana de cinco anos. A maioria dos médicos concordava que não havia um plano de transição, mas eles estimulavam a autonomia do paciente e conversavam com pacientes e familiares sobre qualquer doença crônica presente. Participaram da pesquisa 102 pacientes adolescentes, com mediana de idade de 15 anos, 56% do sexo feminino. A mediana do TRACS foi de 58, com escores semelhantes entre os sexos feminino e masculino, e escores superiores nos maiores de 16 anos (teste U de Mann-Whitney, p=0,01). Os pacientes relataram facilidade na comunicação presencial com seus médicos, mas grande dificuldade para falar sobre questões de saúde por telefone. Conclusões: Mesmo sem protocolo de transição, os adolescentes desenvolveram várias habilidades de autocuidado com o avanço da idade. A falta de protocolo levou a opiniões conflitantes, reforçando a necessidade de melhor estruturação. Os autores sugerem a criação de um fluxograma e um protocolo de transição.

Transição do cuidado de idosos do hospital para casa / Transition of elderly care from hospital to home

Objetivou-se analisar a Transição do Cuidado (TC) de idosos que receberam alta do hospital para casa. Trata-se de um estudo descritivo e transversal, com abordagem quantitativa, realizado com idosos, após internação em hospital público, no interior paulista, no primeiro semestre de 2020. Os dados foram coletados em prontuário eletrônico do paciente e por ligações telefônicas. Foram utilizados um questionário contendo dados sociodemográficos e instrumento Care Transitions Measure (CTM-15 Brasil), versão validada para o Brasil, composto por 15 itens. O CTM-15 segue a escala Likert, com cinco opções de respostas, quanto maior o escore alcançado, melhor é a TC. O CTM-15 Brasil foi aplicado por telefone, aos idosos e/ou cuidadores, em até quatro semanas após alta hospitalar. Foi calculado o escore padronizado, tendo com o valor mínimo 20 e o máximo 100, sendo 70 considerado satisfatório. Realizou-se análises descritivas e inferenciais. Para verificar a relação entre a variável dependente TC e as variáveis independentes foram aplicadas análises bivariadas. Optou-se pelos testes não paramétricos de correlação de Spearman e Kruskal-Walis. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Participaram 156 idosos, familiares e/ou cuidadores sendo 51,92% mulheres; média entre as idades de 74,70 anos; 67,95% residiam em Piracicaba, convivendo com três pessoas e 42,31% eram casados, 84,62% com renda derivada de benefícios do governo, como aposentadoria e/ou pensão e 55,13% tinham ensino fundamental incompleto. Os cuidadores foram a maioria que responderam aos questionários, 88,46%. A duração média da última internação foi de 8,27 dias causada, majoritariamente (72,44 %), por COVID-19 e 75% apresentaram entre 1 e 3 comorbidades, sendo a hipertensão arterial sistêmica (57,7%) a mais frequente. Relacionado ao número de medicamentos em uso, mais de 50% não usavam qualquer medicamento para todas as Classificações Anatômicas Terapêuticas Química, exceto os idosos, com alterações no aparelho cardiovascular. Ao mensurar a TC o escore geral foi 68,6 e os fatores 1 e 2 obtiveram maiores escores 70,5 e 71,2, respectivamente. Houve correlação positiva entre os 4 fatores do CTM-15 Brasil e entre os fatores do CTM-15 Brasil e número de medicamentos utilizados para tratamento dos idosos, de acordo com a Classificação Anatômica Terapêutica Química. O número de medicamentos utilizados para o sistema sangue e órgãos hematopoiéticos apresentaram correlação com o escore geral e com os fatores 1 e 3 do CTM-15 Brasil. O número de medicamentos utilizados para tratamento do sistema cardiovascular teve correlação entre escore geral e fator 3 e, referente aos números de medicamentos para o sistema nervoso houve a correlação entre escore geral e fatores 1 e 2. Os números de medicamentos para o sistema muscular apresentaram correlação apenas com o fator 2. Evidenciou-se a qualidade da TC, neste hospital, próxima do valor considerado satisfatório, sendo dois dos quatro fatores com pontuação maior que 70; entretanto há necessidade de adoção de estratégias para melhorar o processo de alta do hospital para casa, principalmente, no que se refere a Preferências asseguradas e Plano de cuidado dos idosos

The objective was to analyze the Transition of Care (TC) of elderly people who were discharged from hospital to their homes. This is a descriptive and cross-sectional study, with a quantitative approach, carried out with elderly people, after their admission to a public hospital, in the inner cities of São Paulo, in the first semester of 2020. Data were collected from the patient's electronic medical record and by phone calls. A questionnaire containing sociodemographic data and a Care Transitions Measure (CTM-15 Brazil) instrument, with a version validated for Brazil, composed of 15 items, were used. The CTM-15 follows a Likert scale, with five response options, the higher the score achieved, the better the TC. The CTM-15 Brazil was applied via telephone to the elderly and/or caregivers within four weeks after hospital discharge. The standardized score was calculated, with a minimum value of 20 and a maximum of 100, where 70 was considered satisfactory. Descriptive and inferential analyzes were performed. To verify the relationship between the dependent variable TC and the independent variables, bivariate analyses were applied. We opted for the nonparametric Spearman and Kruskal-Walis correlation tests. The study was approved by the Research Ethics Committee. A total of 156 elderly people, family members and/or caregivers participated in the study, 51.92% were women; the mean age was 74.70 years; 67.95% lived in Piracicaba, living with three people and 42.31% were married, 84.62% had income derived from government benefits, such as retirement and/or pension, and 55.13% had incomplete elementary school education. Caregivers were the majority who answered the questionnaires, 88.46%. The average duration of the last hospitalization was 8.27 days caused mostly (72.44%) by COVID-19 and 75% had between 1 and 3 comorbidities, with systemic arterial hypertension (57.7%) as the most frequent. Regarding the number of drugs in use, more than 50% were not using any drugs for all the Anatomical Therapeutic Chemical Classifications, except for the elderly, with changes in the cardiovascular system. When measuring TC, the overall score was 68.6 and factors 1 and 2 had higher scores 70.5 and 71.2, respectively. There was a positive correlation between the 4 factors of the CTM-15 Brazil and between the factors of the CTM-15 Brazil and the number of drugs used to treat the elderly, according to the Anatomical Therapeutic Chemical Classification. The number of drugs used for the blood system and hematopoietic organs correlated with the overall score and with factors 1 and 3 of the CTM-15 Brazil. The number of drugs used for the treatment of the cardiovascular system had a correlation between the general score and factor 3 and, regarding the number of drugs for the nervous system, there was a correlation between the general score and factors 1 and 2. The numbers of medications for the muscular system showed correlation only with factor 2. It was evidenced that the quality of CT, in this hospital, is close to a value considered to be satisfactory, with two of the four factors scoring higher than 70; however, strategies need to be adopted to improve the process of discharge from hospital to home, especially with regard to Assured preferences and Care plan for the elderly

Care transtion in hospital discharge for adult patients: integrative literature review / Transición de la atención en el alta hospitalaria para pacientes adultos: revisión integrativa de la literatura / Transição do cuidado na alta hospitalar de pacientes adultos: revisão integrativa de literatura

ABSTRACT Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.

RESUMEN Objetivo: sintetizar y analizar la producción científica sobre la transición de la atención al alta hospitalaria del paciente adulto. Método: una revisión integradora, realizada de mayo a julio de 2020, en cuatro bases de datos relevantes en el área de la salud: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus y Biblioteca Virtual en Salud (BVS). El análisis de los resultados fue descriptivo y organizado en categorías temáticas que surgieron de acuerdo a la similitud de los contenidos extraídos de los artículos. Resultados: 46 artículos de revistas nacionales e internacionales cumplieron los criterios de inclusión, con predominio de estudios descriptivos / no experimentales o con abordaje cualitativo. Se identificaron cinco categorías: Proceso de alta hospitalaria y posterior al alta; Continuidad de la atención posterior al alta; Beneficios de la transición de la atención״; El papel de la enfermera en la transición de la atención y Experiencias de los pacientes en la transición de la atención. El alta hospitalaria y las transiciones de la atención son procesos interconectados, ya que las transiciones califican el proceso de deshospitalización. Se deben adoptar diferentes estrategias para la continuidad de la atención, ya que ofrecen mayor seguridad al paciente. Los estudios han demostrado que los enfermeros juegan un papel fundamental en las transiciones y, en Brasil, esta actividad aún necesita ganar más espacio. La reducción de los reingresos, la mortalidad, los costos hospitalarios y la satisfacción del paciente son beneficios de las transiciones. Conclusión: la transición de la atención surge como una estrategia efectiva para calificar la atención brindada al paciente que se encuentra en proceso de deshospitalización. Señala la necesidad de integración entre la red de atención y ayuda a los servicios a tomar decisiones sobre la continuidad de la atención al alta.

RESUMO Objetivo: sintetizar e analisar a produção científica sobre a transição do cuidado na alta hospitalar de pacientes adultos. Método: revisão integrativa, realizada de maio a julho de 2020, em quatro bases de dados relevantes na área da saúde: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus e Biblioteca Virtual em Saúde (BVS). A análise dos resultados ocorreu de forma descritiva e organizada em categorias temáticas que surgiram conforme a similaridade dos conteúdos extraídos dos artigos. Resultados: atenderam aos critérios de inclusão 46 artigos, de periódicos nacionais e internacionais, com predomínio de estudos descritivos/não experimentais ou com abordagem qualitativa. Foram identificadas cinco categorias: Processo de alta e pós-alta hospitalar; Continuidade do cuidado pós-alta; Benefícios da transição de cuidado; Papel do enfermeiro na transição de cuidado e Vivências de pacientes sobre a transição de cuidado. A alta hospitalar e as transições de cuidados são processos interligados, pois as transições qualificam o processo de desospitalização. Diferentes estratégias para a continuidade do cuidado devem ser adotadas, pois oferecem maior segurança ao paciente. Estudos mostraram que o enfermeiro tem papel fundamental nas transições e, no Brasil, essa atividade ainda precisa ganhar mais espaço. A redução das reinternações, mortalidade, custos hospitalares e a satisfação dos pacientes são benefícios das transições. Conclusão: a transição do cuidado ascende como estratégia eficaz para a qualificação do cuidado prestado ao paciente que está sendo desospitalizado. Aponta a necessidade de integração entre a rede assistencial e auxilia os serviços na tomada de decisão sobre a continuidade do cuidado na alta.

Estratégias de transição para alta hospitalar utilizadas por enfermeiros: revisão integrativa / Transition strategies for hospital discharge used by nurses: integrative review / Estrategias de transición para el alta hospitalaria utilizadas por los enfermeros: revisión integradora

Objetivo: identificar estratégias de transição do cuidado na alta hospitalar, utilizadas por enfermeiros para o fortalecimento da continuidade do cuidado, disponíveis na literatura científica. Método: revisão integrativa da literatura, que incluiu estudos completos, tendo como referência as estratégias "care transition" OR "Continuity of Patient Care" OR "care continuity" AND nurse para as bases de dados BVS, PubMed, SCOPUS e WoS e "care transition" OR "care continuity" AND nurse para CINAHL, publicados em inglês, espanhol ou português, entre 2016 e 2020, que responderam à questão de revisão. Resultados: foram selecionados 23 artigos, e as estratégias de transição do cuidado para a alta hospitalar usadas por enfermeiros para o fortalecimento do cuidado foram educação em saúde, reconciliação medicamentosa, telemonitoramento, planejamento da alta, contrarreferência e visita domiciliar. Conclusão: o enfermeiro é responsável pelo desenvolvimento de estratégias de transição interconectadas para o fortalecimento do cuidado, desenvolvendo ações diversificadas que qualificam a atenção.

Objective: to identify strategies for the transition of care at hospital discharge, used by nurses to strengthen the continuity of care, available in the scientific literature. Method: integrative review of the literature, which included complete studies, based on the strategies "care transition" OR "Continuity of Patient Care" OR "care continuity" AND nurse for the databases VHL, PubMed, SCOPUS and WoS and "care transition" OR "care continuity" AND nurse for CINAHL, published in English, Spanish or Portuguese, between 2016 and 2020, which answered the review question. Results: 23 articles were selected, and the strategies for transition from care to hospital discharge used by nurses to strengthen care were health education, drug reconciliation, telemonitoring, discharge planning, counter-referral and home visit. Conclusion: nurses are responsible for developing interconnected transition strategies to strengthen care, developing diversified actions that qualify attention.

Objetivo: identificar estrategias para la transición de la atención al alta hospitalaria, utilizadas por los enfermeros para fortalecer la continuidad de la atención, disponibles en la literatura científica. Método: revisión integradora de la literatura, que incluyó estudios completos, basados en las estrategias "care transition" OR "Continuity of Patient Care" OR "care continuity" AND "nurse" para las bases de datos BVS, PubMed, SCOPUS y WoS y "care transition" OR "care continuity" AND "nurse" para CINAHL, publicada en inglés, español o portugués, entre 2016 y 2020, que respondió a la pregunta de la revisión. Resultados: se seleccionaron 23 artículos, y las estrategias para la transición de la atención al alta hospitalaria utilizadas por los enfermeros para fortalecer la atención fueron la educación para la salud, la conciliación de medicamentos, la telemonitorización, la planificación del alta, la contrarreferencia y la visita domiciliaria. Conclusión: los enfermeros son responsables de desarrollar estrategias de transición interconectadas para fortalecer el cuidado, desarrollando acciones diversificadas que califiquen la atención.

Transição do paciente da Unidade de Terapia Intensiva para a enfermaria na perspectiva da continuidade do cuidado: o olhar da enfermagem / Transition of the patient from the Intensive Care Unit to the infirmary from the perspective of continuity of care: the view of nursing

Resumo: Uma adequada transição do cuidado é uma estratégia para assegurar a continuidade dos cuidados para o paciente e sua família após a alta, contribuindo na prevenção das readmissões hospitalares, complicações preveníveis, e consequentemente na redução dos custos relacionados à assistência em saúde. Uma transição de qualidade impacta na segurança do paciente que está em uma situação de mudança na sua condição de saúde, como no caso de estar em uma UTI. Faz parte da responsabilidade do enfermeiro garantir elementos que resultem em uma boa transição para o paciente, tornando-se um elo para a continuidade. O objetivo geral deste estudo é analisar o processo de transição dos pacientes da UTI para a Enfermaria de Trauma na perspectiva da continuidade do cuidado sob a ótica dos enfermeiros. Os objetivos específicos são: identificar as fases da transição e, propor os elementos para um plano de transição dos pacientes. Trata-se de um estudo qualitativo, de natureza exploratória, desenvolvido na UTI e na enfermaria de trauma de um hospital de grande porte no município de Curitiba. Os dados foram coletados por meio de entrevistas semiestruturadas, após a explicação dos objetivos do estudo aos participantes, e tiveram os áudios gravados e posteriormente transcritos, nos meses de maio a junho de 2017. Foi aplicada a técnica da vinheta antes das entrevistas e, a análise aconteceu por meio da Análise de Conteúdo Temático Categorial, com o uso do software MAXQDA® como recurso para organização dos dados. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital do Trabalhador da SESA/ PR, CAEE N° 60950516.7.0000.5225. Os participantes foram selecionados por amostragem não probabilística, e após a aplicação dos critérios de inclusão e exclusão, totalizaram 22 participantes. O estudo foi submetido a dois testes piloto para adequação dos instrumentos do trabalho. Os resultados foram organizados em quatro categorias: Determinantes para os contextos de saída e entrada do paciente em transição da UTI para a enfermaria; Planejamento do processo de transição e continuidade do cuidado do paciente da UTI para a enfermaria; Efetivação do processo de continuidade de cuidados da UTI para a enfermaria e; Elementos facilitadores do processo de continuidade de cuidados do paciente em transição da UTI para a enfermaria. A criação de práticas profissionais que fomentem o entendimento de transição, como o planejamento de alta é elemento crucial na continuidade de cuidados, e os dados permitiram a construção de um modelo com os elementos necessários para o processo de transição do paciente e continuidade de cuidados da UTI para a enfermaria.

Abstract: A proper transition of care is a strategy to ensure continuity of care for patients and their families after discharging from the hospital. Such strategy contributes to avoid hospital readmissions, preventable complications and, therefore, reduction of costs related to health assistance. An effective transition impacts on the safety of the patient who is going through changes in health conditions, such as in the case of those being in an intensive care unit. Part of the nurse's responsibility is to ensure elements which result in a good transition for the patient, what makes such role a point of connection for continuity of care. The general aim of this study is to analyze the transition process of patients from intensive care unit to trauma ward from the continuity of care-based approach and from nurses' perspective. Its specific aims are: to identify patient's transition phases and to propose elements for patient's transition plan. This is an exploratory qualitative study, carried out in an intensive care unit and trauma ward of a large hospital in the city of Curitiba, Paraná, Brazil. Data was collected from May to July, 2017, through semi-structured interviews which were recorded and transcribed after the aims of this study had been explained to participants. The vignette technique was applied before the interviews and the analysis was carried out through Theme/Category-Based Content Analysis and as a means of organizing data was used MAXQDA® software. This research was approved by the Ethics Committee for Research from the Hospital do Trabalhador of SESA/ PR, CAEE N° 60950516.7.0000.5225. Participants were selected by nonprobability sampling, totalizing 22 participants after criteria of inclusion-exclusion had been applied. This study underwent two pilot tests in order adapt work instruments. The results were organized in four categories: determinants of admission and discharge of the patient in transition from intensive care unit to ward; planning transition process and continuity of care of patient from intensive care unit to ward; implementing the continuity care process from the intensive care unit to ward and, facilitating elements of the continuity care process of patient in transition from intensive care unit to ward. Results indicate that creating professional development practices which raise the understanding of transition, such as discharge planning, is paramount for continuity of care. Moreover, data allowed to build a model with required elements for the process of transition and continuity of care of patient from the intensive care unit to ward.

A Unique Transition From Child Mental Health Services (Cmhs) To Adult Services: An Audit Of The Clinical Profile Of Patients Progressing From Cmhs To The First Specialised, Multidisciplinary Adult Neurodevelopmental Service In Singapore

The transition from child mental health services to adult mental health services can be challenging for patients. Transition is a critical aspect of continuity of care but little is known of the profile of the patients who makes such transitions and their unique characteristics, which could place special demands on subsequent mental health services. The Adult Neurodevelopmental Service at the Institute of Mental Health, Singapore is the first integrated service for adults with neurodevelopmental disorders and psychiatric co-morbidities in Southeast Asia. This audit aims to analyse the profile and characteristics of patients who have made this transition to ensure that the service addresses their specific needs. Methods: The electronic records of 50 patients who were seen in 2015 were analysed in relation to socio-demographics, diagnosis and psychiatric co morbidities, pharmacotherapy, functioning and illness severity scores. Results: All patients except 3(6%) were seen as outpatients. 41(82%) of whom were male and 9(18%) female with the mean age of 21.1 years (SD±2.68). 32(64%) had autistic spectrum disorder, 28(56%) had intellectual disability and 8(16%) had attention deficit/hyperactivity disorder. Co morbid psychiatric disorders included anxiety disorders (16%), mood disorders (14%), psychotic disorders(8%), and obsessive-compulsive disorders(8%). Risperidone and fluoxetine were the most commonly used antipsychotics and antidepressants respectively. The mean initial clinical global impression score was 4.05(SD±0.87) ± 0.87), and the mean global assessment scale was 53.78(SD±9.42) in patients who were scored. Conclusion: Patients in transition from a child to adult mental health services are a complex and vulnerable group which requires services adapted to their unique needs. Analysing the profile of these patients is critical in evolving the service to meet the needs of this group of young patients to achieve an ideal level of care. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care

Abstract The main objective of this work is to describe the formation of the Transition Adolescent Clinic (TAC) and understand the process of transitioning adolescents with HIV/AIDS from pediatric to adult care, from the vantage point of individuals subjected to this process. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in São Paulo, Brazil. An in-depth semi-structured interview was conducted with sixteen HIV-infected adolescents who had been part of a transitioning protocol. Adolescents expressed the need for more time to become adapted in the transition process. Having grown up under the care of a team of health care providers made many participants have reluctance toward transitioning. Concerns in moving away from their pediatricians and feelings of disruption, abandonment, or rejection were mentioned. Participants also expressed confidence in the pediatric team. At the same time they showed interest in the new team and expected to have close relationships with them. They also ask to have previous contacts with the adult health care team before the transition. Their talks suggest that they require slightly more time, not the time measured in days or months, but the time measured by constitutive experiences capable of building an expectation of future. This study examines the way in which the adolescents feel, and help to transform the health care transition model used at a public university. Listening to the adolescents’ voices is crucial to a better understanding of their needs. They are those who can help the professionals reaching alternatives for a smooth and successful health care transition.

Application of Chinese version of Care Transitions Measure in patients with chronic diseases Li / 中国实用护理杂志

Objective To apply the Chinese version of Care Transition Measure (C-CTM) in patients with chronic diseases to assess the quality of transitional care and its influencing elements in order to provide reference for improving the quality of transitional care. Methods A total of 210 patients with chronic diseases were telephoned 2 to 4 weeks after discharge using C- CTM. Results The C- CTM score of the 210 study participants was 52.37±15.45. The general self- care preparation scored the highest which was 65.48±15.07, written plan was the lowest with a median score of 16.67. Multiple regression analysis showed that education level, hospital class and Activity of Daily Living (ADL) scores upon admission were significantly positively associated with the C- CTM scores. Conclusions The overall quality of transitional care was poor, especially in written plan. Quality of transitional care was poorer in patients with lower education level, being admitted to lower class hospitals and with lower ADL scores upon admission.