NUS Singapore University, Singapore
Title: Patient centered transitional care for patients transferred from Intensive Care Unit (ICU) to step-down care unit: A mixed method study
Zhou Wentao, an advanced Practice Nurse, she is a PhD Candidate at National University of Singapore (NUS). She is the Assistant programme coordinator for the master of nursing program, which is training competent advanced practice nurses for Singapore. Her research interest focuses on care transition in situation, diseases process and role development, as well as inter-professional education. She has conducted studies together with her team to explore the outcome of inter-profession education by using simulation, and explored the collaboration among the juror nurses and junior physicians. Her PhD study is on patient entered transitional care for patients transferred form Intensive Care units to step-down care setting.
Background: Transfer from critical care to step-down care is a difficult time for patients, their relatives, as well as, healthcare providers. Patients often experience anxiety, depression, cognitive and physical impairment after being transferred out from intensive care unit (ICU), and these have known to delay their recovery. Other factors known to affect patient's transition experiences are poor discharge planning, inadequate handover, and suboptimal follow up care. Effective transitional care has the potential to improve the patients’ continuity of care after ICU discharge, patient's satisfaction, reduce depression and anxiety related to relocation, and improve healthcare provider's job satisfaction and multidisciplinary collaboration. Studies suggested that interventions for patients who experience ICU relocation distress need to address patient's physical, psychosocial, and cognitive need, as well as other factors that affect the patient's continuity care from ICU to step- down care.
Objectives/aims: This study aims to explore patient's transition experience and ways healthcare providers can help their transition from ICU to step-down care. The outcome of this research will subsequently assist in developing and evaluating a Patient Centered Transitional Care (PCTC) protocol. This PCTC protocol aims to improve patient's satisfaction towards continuity of care from ICU to Step-down care, reduce patient's ICU readmission after ICU transfer, decrease patients’ relocation depression and anxiety level, improve communication among healthcare providers, and improve nurse’ decision making ability.
Method/design: This mixed methods study has two phases. Phase 1 qualitative study will explore both patients’ transition experience, and healthcare provider's perception of patient's transition experience and transitional care provided during the ICU transfer to step-down care unit. The qualitative data will be collected through face-to face interview with patients and focus group interview with healthcare providers. The content analysis of this phase will use a constant comparative data analysis method. The themes derived from this phase will help to develop a PCTC Protocol supported by up-to-date literatures and clinical expert contributions from industry stakeholders. Transitional midrange theory will be used to guide the study and the PCTC protocol within the paradigmatic perspective of transitional care. Phase 2 quantitative study will examine and evaluate the effectiveness of PCTC protocol by adopting validate measurements, and pre and post-test comparison design will be used.
Significance of the study: The PCTC protocol will direct a goal orientated transitional care process for healthcare providers as well as patients who transferred from ICU to step-down care. PCTC protocol will enable healthcare providers to be more aware of patient's transitional needs and facilitate patient's continuity of care defectively, therefore patients can have their maximize recovery.
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