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To explore how, why and under what circumstances transitional care can be normalised as a routine care practice for adult patients with enterostomy after discharge from hospitals.
Realist review.
This review was conducted in three iterative phases: (1) constructing an initial programme theory to identify the scope of the study; (2) retrieving and evaluating the evidence, extracting data and integrating the evidence; and (3) analysing and integrating the evidence to refine the programme theory.
Five bibliographic databases and the grey literature were searched from 1947 to 2024 to identify the studies of two core concepts: enterostomy and transitional care.
A total of 36 papers were included, identifying nine context-mechanism-outcome configurations that explain how, why and under what circumstances transitional care can be normalised as routine care for adult patients with enterostomy after discharge: (1) Responsibilities of individual roles; (2) Interdisciplinary team collaboration; (3) Support from upper management; (4) Communication and interaction; (5) Multiple linkage; (6) Professional training; (7) External support and policy formulation; (8) Personalised measures; and (9) Evaluation and feedback.
The normalised implementation of transitional care is essential to help enterostomal patients better adapt to stoma life and improve their quality of life. An effective transitional care model not only relies on the support of professional caregivers, but requires the close cooperation of patients, family members, communities and healthcare organisations.
Reporting was adhered to the RAMESES publication standards: realist syntheses.
Patients and members of the public were involved in study design. Their contributions were participating in advisory groups, ensuring the research was addressed.
This study provides theoretical guidance for clinical stoma transitional care, translating the research findings into routine healthcare practices, constantly optimising and improving the stoma care system, and offering patients higher-quality and more efficient services.
This research, through the realist review approach in combination with the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR), systematically elucidates for the first time how, why and under what circumstances transitional care can be regularised as a routine post-discharge care measure for adult enterostomy patients. The research findings will: Improve the quality of life of patients: Through personalised care plans and multidisciplinary team cooperation, help patients better adapt to life with an ostomy, reduce complications and improve self-management ability. Optimise clinical practice: Provide theoretical guidance for medical staff, promote the regular implementation of transitional care and improve the quality and efficiency of care. Promote education and training: Emphasise the importance of professional training and communication skills, and provide new ideas for nursing education. Support policy formulation: Call on the government and medical institutions to improve relevant policies, provide more resources and support and promote the rational allocation of medical resources.
This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure-process-outcome’ model.
A Delphi survey.
The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.
The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.
The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.
This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.
Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.
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