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Nurses' and physicians' perspectives on implementation barriers and facilitators in a transfer program for parents of
Ena Lindhart Thomsen1, Johanne Cecilie Koppelhus1, Kirsten Arntz Boisen1
1Department of Paediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Insights
Implementing a parental transfer program requires understanding barriers and facilitators. Key factors include healthcare professionals
Area of Science:
- Adolescent Health
- Chronic Illness Management
- Healthcare Transition
Background:
- Adolescents with chronic illnesses require comprehensive transfer programs to ensure continuity of care.
- Effective transfer programs involve parents as key stakeholders in managing the transition from pediatric to adult healthcare.
Purpose of the Study:
- To identify barriers and facilitators impacting the implementation of a parental transfer program for adolescents with chronic illness.
- To inform strategies for successful integration of such programs into clinical practice.
Main Methods:
- A qualitative process evaluation using individual interviews with 10 nurses and 7 physicians.
- Data were collected from outpatient clinics across Nephrology, Hepatology, Neurology, and Rheumatology.
- Analysis employed Normalization Process Theory to understand implementation dynamics.
Main Results:
- Barriers included healthcare professionals' unclear understanding of the parental role, hierarchical decision-making, and role ambiguity in joint consultations.
- Facilitators involved clear program understanding, the crucial role of a named nurse keyworker, and inter-departmental collaboration.
- Participants noted the program aided parents but questioned its universal necessity.
Conclusions:
- Successful implementation hinges on addressing identified barriers and leveraging facilitators at personal, professional, and organizational levels.
- Appointing a nurse as a named keyworker and providing clear training on program purpose are vital.
- Findings can guide the implementation of similar transfer programs in diverse clinical settings.
Aim:
To identify barriers and facilitators impacting the implementation of a comprehensive transfer program aimed at parents of adolescents with chronic illness in clinical practice.
Design:
A real-time, qualitative process evaluation.
Methods:
Individual interviews were conducted with 10 nurses and seven physicians from paediatric and adult outpatient clinics: Nephrology, hepatology, neurology, and rheumatology. Data were analysed through the lens of normalization process theory.
Results:
Themes were framed within the theory's four components. (1) Coherence: Healthcare professionals' views on their core tasks and on the parents' role influenced their perception of the program. (2) Cognitive participation: A named key worker, autonomy, and collaboration impacted healthcare professionals' involvement in the program. (3) Collective action: Department prioritization and understanding of the program's aim were key factors in its successful delivery. (4) Reflective monitoring: Participants experienced that the program helped parents during transfer but questioned if the program was needed by all families.
Conclusion:
We identified three barriers: Healthcare professionals' lack of understanding of the parental role during transfer, top-down decisions among nurses, and physicians' uncertainty about their role in joint consultations. Facilitators: Healthcare professionals' understanding of the program's purpose and expected effect, the nurses' significant role as named keyworkers, and good collaboration across paediatric and adult departments.
Implications For The Profession And/Or Patient Care:
Implementation strategies should be developed before implementing a transfer program in clinical practice.
Impact:
Implementing a parental transfer program in clinical practice can be challenging. Therefore, for successful implementation, it is crucial to identify barriers and facilitators. Barriers and facilitators exist at the personal, professional, and organizational levels, and it is important to understand them. The results of this qualitative study could support the implementation of transfer programs in other settings.
Reporting Method:
Consolidated criteria for reporting qualitative studies (COREQ).
Patient Or Public Contribution:
No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Nurses' and physicians' experiences of ownership of the transfer program is essential for successful implementation. Clinics should appoint a named keyworker, preferably a nurse, as the driving force during the implementation of a transfer program. Nurses and physicians should receive training about the purpose, justification, and expected effect of a transfer program before implementation.
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