Date of Award
Spring 6-7-2024
Scholarly Projects
Projects: SPU Access Only
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Faculty Chair
Cindy Dong
Faculty Reader
Bomin Shim
Executive Summary
Background and Significance
Transitioning from pediatric to adult care is an essential part of the continuity of care for patients in healthcare. The disconnection between these parts may lead to negative patient outcomes including medical complications developments, delays in treatment and access to healthcare, frequent emergency department visits, and higher cost of care. In 2017, the American Academy of Pediatrics (AAP) updated its standard for transitioning from pediatric to adult care. The new standard now follows the Six Core Elements of Health Care Transition (HCT) model, which eliminates the age limit standard (Jennison et al, 1972; Healthy Children, 2017). This model was developed to be used by pediatricians and adult providers. It is structured into six components, providing step-by-step anticipatory guidance and a timeline for youth transitioning from pediatric to adult health care. Advancing through these components will also be based on the child’s physical, psychosocial, developmental, and mental health.
Purpose of the Problem
The HCT standard is still poorly recognized and has yet to be widely adopted in healthcare practice. While evidence has shown positive results of using this model and favored the adoption into clinical practice, evidence has also shown that there are barriers that prevent healthcare practices and professionals from confidently initiating the transition conversation with their patients and families and providing the support and resources they may need. This may be the result of the lack of standardized education, organizational infrastructure, and policy in practice. Thus, the project aims to build knowledge of the Six Core Elements of HCT and promote confidence among nurses to initiate a conversation about the transitional process and support patients and families during phone calls, electronic portal messaging, and in-person patient interactions.
Methods
This pilot project measured registered nurses’ (RN) Health Care Transition (HCT) knowledge and confidence skills by implementing a customized educative tool. A convenience sampling approach was used for recruitment targeting RNs who are actively employed, by the start and end of the project, at an exclusive, physician-owned pediatric agency in the state of Washington. The project requires the participants to attend an approximately 1-hour PowerPoint-based educational presentation via Zoom Conference call. The presentation was developed using resources from the Got Transition website. This website is a government resource center for healthcare providers and families that supports them in participating and guiding adolescents and young adults in the HCT process. The knowledge and confidence skills were measured using a five-point Likert pre- and post-survey. The statements in the survey were guided by evidence-based recommendations from Got Transition. The surveys were tested and evaluated for validity by content experts within the field at the agency. The surveys were created and distributed using the Survey Monkey system. Inclusion criteria include participants completing the pre-survey before the start of the presentation and immediately after.
Results/Outcome
Eight qualified pediatric primary care nurses (N=8) were enrolled at the study out of 65 possible candidates (12.3%) at the agency. Before the presentation, most participants’ pre-survey responses for knowledge (78%) and confidence (77.5%) components were concentrated at somewhat to no knowledge and confidence in HCT care. In comparison, the post-survey results showed participants significantly enhanced their knowledge (97%) and confidence (95%) in HCT care. As a result, participants’ responses demonstrated a 75% increase in knowledge and a 72.5% increase in confidence.
Sustainability
The project demonstrated that an HCT educational presentation can provide quality training in enhancing knowledge and building confidence in healthcare professionals. The sustainability of this intervention will require the buy-in of the agency’s administrators and the implementation of a new policy in the agency. The policy may include both existing staff and new hires to participate in the education. Participants will also benefit from obtaining a copy of the PowerPoint and resources after the presentation to refer to in their practice. Due to ongoing updates of HCT care guidelines from AAP, the adopted agency training resources will need to be continually updated and refined. For the agency to keep up with these changes, a designated individual(s) will be required to review the materials and resources and update the available educational tools and materials
Implications
The HCT standard is not widely used in current pediatric practice. The project suggests that implementing HCT educational training is an essential component in increasing the level of knowledge and confidence among nurses. By initiating a standardized HCT policy and/or intervention, the agency may not only see an increase in knowledge and confidence levels among healthcare professionals; this may pave the way for intervention expansion and/or explore alternative avenues to implement new HCT projects to improve HCT practice.
References
Health Children. (2017, August 21). Transitioning to adult care should not be defined by arbitrary age limits. Retrieved July 21, 2022, from https://www.healthychildren.org/English/news/Pages/Transitioning-to-Adult-Care-Should-Not-Be-Defined-by-Arbitrary-Age-Limits.aspx
Jennison, M. H., Coleman, A. B., Feiertag, R. B., Kugel, R. B., Forsyth, W. B., Rinker, A., Hazard, S. W., Ellis, E. O., Knutti, S. H. (1972 March). Age limits of pediatrics. Pediatrics, 49(3), 463. https://doi.org/10.1542/peds.49.3.463
Recommended Citation
Wong Sick Hong, Cindy K., "Bridging the Gap Between Pediatric-to-Adult Primary Care" (2024). Doctor of Nursing Practice (DNP) Scholarly Projects. 73.
https://digitalcommons.spu.edu/shs_dnp/73
Digital Poster