Facilitating and Managing Transitions: An Imperative for Quality Care

Abstract

Editorial Being admitted to a hospital, preparing for discharge, receiving a chronic illness diagnosis, transferring from intensive care to regular care, moving to a nursing home, receiving a grave diagnosis, losing a family member, facing an environmental disaster, graduating and starting a new professional position-all of these scenarios may appear different, but ask yourself, what might they all have in common? ey are all changes that trigger a transition process. While change is an event or a situation that is well dened and static in time, transition is a process with a range of responses. During transitions, individuals, families and communities experience unfamiliar environments, sensations and emotions, and confront different levels of uncertainty about what may come next. ey may have expectations, realistic or uninformed, and experience disruptions in their daily lives and routines, all of which are inuenced by and affect their health and wellbeing. How a person perceives the change, its meaning and the availability of support and resources profoundly inuences experiences and responses. People are inuenced by the preparation they receive for anticipated changes, as well as continuity of care throughout the process up until the results of the change are incorporated into their daily lives and identities (1). ese changes require a process of adjustment, recalibration and development of new skills and capacities to meet the new demands imposed by the changes. ey also require mobilization of inner and outer resources and tangible and intangible support for their environment. Nurses are at the center of these changes and the process of transition, and have always supported individuals preparing for and facing changes. For example, when patients are admitted to hospitals, nurses assess their health and illness status and their knowledge of their illness, helping patients navigate the admission process, hospital routines, as well as clarifying the roles of the many team members who visit their beds. ey nd out what patients' expectations are, provide accurate information about what they might expect, teach them new skills to manage their new environments and illness demands and insure access to the needed resources. Nurses also provide similar information, skills and support during discharge, preparing individuals and families to manage their own care. In other words, they facilitate patients' transitions and empower them through clarity, information, skills and resources, continuing the healing and recovery processes and enhancing wellbeing and quality of life (2). Families, signicant others and caregiving institutions, where patients may be referred to upon discharge, require information about patients and about how to continue to provide needed care that leads to recovery or self-care management within the context of a patient's own experiences and responses. Facilitating transitions is a part and parcel of continuity of care. Providing continuity of care requires strategies, resources, skills and knowledge that is congruent with the different stages in recovery and healing, or in the process of acquiring