Background or Introduction
Huang et al. (2011) developed a project about the peculiarities of the transition from pediatric to adult health care and the importance of the assessment of adolescents who have chronic illnesses such as inflammatory bowel disease, type I diabetes, and cystic fibrosis. They began their article with the evaluation of health care agencies and the description of the services that could be offered to children and adult patients.
The objective of the article is to examine the transition process and the experiences of patients and to identify the factors that could contribute to the successful development of the process with the help of web-based technologies.
Review of the Literature
Huang et al. (2011) used the reports of the Department of Health/Child Health and Maternity Services Branch and the US Department of Health and Human Services to explain how the issue of health care transition was discussed in relevant societies. Besides, the authors mentioned that the transition process could be traumatic for patients and lead to mobility or even mortality outcomes (Huang et al., 2011).
Therefore, it is important to analyze the qualities of medical practices, the abilities of the medical workers to improve the conditions of health care, and the expectations of patients with chronic illnesses. The evaluation of the literature available for the current transition process showed that there was a lack of interventions that could be used to improve the outcomes. Still, the researchers believed that the use of current technologies and the investigation of the needs of the population could help to change the situation and develop appropriate services. Young-adult patients who have chronic diseases and pediatric and adult health care providers have to be involved in research to clarify the issues of the transition and the improvements that could be offered.
Discussion of Methodology
Much attention is paid to the methods and steps chosen by the authors of the article. The qualitative study was used in the project. It was decided to develop focus-group interviews with the patients who have or had their transition experiences. The number of the participants was identified in the paper. There were six focus groups with 10 young adults with chronic illnesses in each. Three patients had IBD, three patients had CF, and four patients were with diabetes (Huang et al., 2011).
In general, there were four male patients and six female patients. Besides, 24 pediatric and adult health care providers were involved in the study. There were four nurse practitioners and three nurses, six pediatric physicians and three adult physicians, one physician assistant, three social workers, three health educators, and one dietitian (Huang et al., 2011).
The inclusion criterion for the patients was the presence or the current diagnosis of such diseases and IBD, CF, and diabetes (Huang et al., 2011). Health care providers should have experience in nutrition, health education, social work, and visits’ organization. Each focus group had its disease specification and several open-ended questions to be answered.
In addition to the questions, a list of innovation games was offered to the participants so that they could develop their interventions and solutions for the transition process. For example, “Buy a Feature” using distributed money and technology-based elements and “Product Box” games were offered to the patients and practitioners in their focus groups.
Data Analysis
Two members of the research team were focused on the transcripts and analysis of the answers. The data obtained from the interviews were analyzed in two ways: content-based and narrative. The content analysis was divided into three domains such as the transition experience in the context of relations developed between the participants of the study, the differences that could be observed between pediatric and adult health care services, and the identification of the transition services that could be offered to the patients with chronic illnesses (Huang et al., 2011).
Open, axial, and selective coding was used to analyze the narratives. Open coding aimed at the word-by-word analysis and the identification and categorization of the barriers. Axial coding helped to relate the themes and explain the worth of each category and subcategory. Selective coding was used to integrate the relations between the categories and identify the possible facilitators of the transition process.
Researcher’s Conclusion
The analysis of the results achieved by the researchers shows that the majority of young adult patients identified the need for properly developed communication between the representatives of pediatric care and adult health care. A smooth transition was one of the main barriers in the process that led to another crucial challenge, insurance.
The findings of the authors helped to clarify the role of parental involvement in the transitions from pediatric to adult health care and explain that over-involvement was the challenge health care providers had to deal with. Therefore, parents should understand their impact on their children’s lives and make sure that teenagers (aged 14 and above) could take care of their health independently cooperating with health care providers.
Interactive technologies, as well as personal meetings, could be beneficial for patients. Several patients believe that web-based technologies and mobile phones could be used as the main intervention tools to promote quick access to the required portion of information, tailored communication between patients and practitioners, and successful self-management.
Critique of Evidence
Each section of the article has enough evidence to support the conclusions offered by the authors. In the beginning, Huang et al. (2011) explained that the choice of such a qualitative method as an interview could help to identify what people know about the transition process and what kind of information they should ask for. In addition to the literature used to review the current achievements in the health care sphere, the authors used their observations and findings to prove the importance of the transition process among children and adult patients with different chronic illnesses.
Explanation of Human Subjects and Cultural Considerations
The protection of human subjects and the consideration of cultural issues are properly discussed in the study. The authors admitted that the project was approved by a special team of the Institutional Review Board of the University of California at San Diego (Huang et al., 2011). The decision to create focus groups was properly elaborated. A standard protocol was used to explain the peculiar features and their responsibilities to the participants of the study. Each focus group has a certain schedule according to which the work with people was described. First, the participants got a chance to read the description of the consent process. After greetings, the participants learned the proceeding details. So that, before answering the questions, the participants were aware of the research process and their roles in the project.
Strengths and Limitations
The benefits of the project include the possibilities to discover the roles of different participants in the transition process. First, patients themselves should be interested in the successful implementation of the transitions from pediatric to adult health care. Then, it is necessary to make sure that parents have enough information about the health conditions of their children who have chronic illnesses. Finally, the practitioners should clarify their responsibilities regarding their patients. The main disadvantage of the study was its generalizability and the small sample size that was recruited from one particular pediatric health care center (Huang et al., 2011).
However, regarding the shortages of the work done, the authors believed that they introduced a powerful project with several contributions to further research. A qualitative assessment of the patients with chronic diseases and the need for parental involvement in the transition process have to be investigated from time to time because patients, as well as medical practitioners, could benefit from new technological opportunities and current achievements.
Article in Nursing Practice
The chosen article could be used by nursing practitioners in a variety of ways. For example, it informs about the basics of health care services that should be offered to the patients who change their pediatric care to adult health care. In addition, nurses should know about the technology-based activities that could be offered to the patients with special needs to address their disease management issues (Huang et al., 2011). Finally, the article shows that the role of parents remains to be crucial in health care organizations. Therefore, nurses should learn how to develop effective relations with young patients and their parents.
References
Huang, J.S., Gottschalk, M., Pian, M., Dilon, L., Barajas, D., & Bartholomew, L.K. (2011). Transition to adult care: Systematic assessment of adolescents with chronic illnesses and their medical teams. The Journal of Pediatrics, 159(6), 994-998.