Abstract
As a children’s nursing student and a young person who has personally experienced the move from paediatric to adult services, I have become deeply interested in how nurses can best support adolescents and young adults (AYAs) with chronic health conditions during this period of change in their healthcare support. My undergraduate literature review dissertation explored this issue through a systematic review of the literature, and the process, combined with my clinical placements, and personal experience, has transformed how I view the nurse’s role in transitional care. In this piece, I reflect on what I know and have learned about the challenges young people face, the skills nurses require to best support young people transitioning from child to adult care, and how practice, education and service design must evolve to better support this process.
Understanding the complexity of transition
Transition is far more than a simple handover from paediatric to adult healthcare; it is a developmental, emotional, and relational process that shapes how a young person learns to manage their own health. Through personal experience, and my research and practice experiences in the child nursing degree, I have come to appreciate how critical preparation is to this process. Many young people and their parents described transition as sudden and overwhelming (Al-Yateem, 2013; Kirk, 2008). In practice, I observed how this lack of preparation manifests. During my placement on a paediatric ward, I met young people who were approaching the transition age but had limited understanding of what adult services would look like. Some were anxious about losing their familiar paediatric nurses, whereas parents often struggled to step back and allow their child greater independence. These real-world observations mirrored what I found in the research that inadequate communication, inconsistent planning, and emotional unpreparedness can lead to anxiety, loss of trust, and poorer health outcomes (Bomba et al., 2016; Van Staa et al., 2011). I learned that transition cannot be viewed as a single event. It involves preparation, the move itself, and ongoing adjustment. It also involves relationships – between the young person, their family, and their healthcare team. Nurses are often at the centre of this triad, supporting both the young person’s growing autonomy and the parents’ changing role, illustrative of family centred care and supporting the evolving dynamics between parent and child (Casey 1988). In this sense, transitional care requires not only clinical skill but also emotional intelligence, empathy, and continuity.
Developmental understanding and the role of the nurse
My literature review encouraged me to think about transition in the context of adolescent development. Erikson’s (1950) psychosocial theory identifies adolescence and early adulthood as critical stages for developing identity and independence. At the same time, Bronfenbrenner’s (1994) ecological model reminds us that a young person’s development is shaped by multiple layers of influence: family, healthcare systems, and wider society. When these layers shift simultaneously, as they do during transition, young people, and their family, can experience a sense of instability. Emerging neuroscience also deepened my understanding of why transition can be challenging. Arain et al. (2013) highlight that the prefrontal cortex, which governs planning, decision-making, and risk assessment, continues to mature until around age 25. This means that many young people transitioning at 16–18 years are still developing key cognitive and emotional skills required for self-management. This reinforced to me that transition should be flexible and individualised, not dictated by age alone. Whilst I cannot currently change protocol for when children transition to adult care, I can draw on developmental theory in my practice and encourage others to do the same. It helps to tailor communication and support to each young person’s stage of maturity and readiness. It also underlines the importance of continuity and reassurance when preparing young people for independence.
The importance of relationships and trust
One of the most powerful insights from personal, practice, and dissertation experience is that relationships are the foundation of effective transitional care. In paediatric settings, long-term relationships often develop between nurses, young people, and families when supporting children and young people with chronic conditions. When these are suddenly disrupted, it can feel like a loss. That sense of loss is echoed across studies where adolescents and parents express concern about leaving the security of paediatric services for unfamiliar adult environments (Shaw et al., 2004; Van Staa et al., 2011).
As nurses, we can bridge that gap. Continuity of contact, shared visits between paediatric and adult nurses, and structured handovers all help maintain trust. Adult nurses also need to understand the importance of relational care, not just clinical management. Transitional care demands a holistic approach, encompassing emotional well-being and family dynamics as well as physical health (Roper et al., 1989). When adult and paediatric teams collaborate, for example meeting jointly with young people and parents, the young person’s anxiety levels drop significantly. These experiences have convinced me that building and sustaining relationships must remain central to nursing practice, even as care becomes more person-centred and less family-centred with the move from paediatric to adult care (Rogers, 1986).
Mental health and emotional well-being
Transition is a time of vulnerability. Many young people in the studies I reviewed described uncertainty and fear about the adult system (Amajjar et al., 2021). Chronic illness itself can already isolate young people from their peers, and transition can intensify that sense of difference, moving away from familiar support systems. Mental health support should therefore be integral to transitional care. Nurses can play a key role by recognising distress early, offering reassurance, and referring to specialist psychological services when needed. This consideration specifically has shaped how I want to practise as a nurse. I have learned the value of simply asking, ‘How are you feeling about the move?’ and creating space for young people to express their worries. Listening, validating their emotions and empowering them with knowledge are fundamental nursing interventions that can make the process less daunting.
Implications for nursing education
Reflecting on both research and experience, I believe transitional care needs greater emphasis within nurse education. Despite being a common and predictable process, it is not always taught in depth. I propose that universities integrate transitional care throughout the nursing curriculum, linking it to child development, communication, and chronic illness management modules. Simulation-based learning could help students practise difficult conversations with young people and families around transition planning.
Hearing directly from service users would be especially powerful. Their voices can bring to life the emotional realities behind the policies. Similarly, placements with transition specialist nurses or joint paediatric–adult clinics would offer invaluable experiential learning. By embedding transition throughout training, we can prepare future nurses to manage these complex emotional and developmental challenges with confidence and compassion.
Implications for nursing practice
In practice, nurses play a central role in coordinating and delivering effective transitional care. I have learned that preparation is key: young people and families need clear information, consistent communication and structured opportunities to meet their new teams. Orientation sessions, joint clinics, and ward tours can make an enormous difference to how prepared young people feel. Named ‘transition nurses’ within each ward or specialty could take responsibility for coordinating these activities and ensuring communication across teams. Supporting parents is also critical. They often experience their own emotional adjustment as their child becomes more independent. Nurses can help by acknowledging their changing role, providing reassurance and involving them appropriately while still empowering the young person to lead their own care. Equally important is recognising that transition does not end once the young person enters adult services. Follow-up support is needed to ensure they are coping, attending appointments, and managing medication independently. Also adult nurses should be supported and educated to understand the specific needs of young adults with chronic conditions. As a nurse, I hope to advocate for stronger partnerships between paediatric and adult teams to make this continuity possible.
Implications for healthcare services
From a service perspective, I learned that effective transition requires organisational commitment. Structured transition timelines starting around age 13 could help young people and families understand what to expect each year, reducing the sense of sudden change. I was also struck by the idea of dedicated ‘young adult wards’ or clinics for those aged 18–25, which could bridge the gap between paediatric and adult services and reflect recent new understandings of the adolescent period. This model could offer a more developmentally appropriate environment and foster peer support among young people with chronic illnesses. Transition workshops tailored to specific conditions also have great potential. They could combine peer connection and self-management training in a supportive setting. Such initiatives align with National Institute of Clinical Excellence (2016) guidance advocating person-centred, developmentally appropriate transition planning. To ensure quality and accountability, transition services should be regularly audited and evaluated through feedback from young people, families, and staff. Young peoples’ voices must shape ongoing improvements, as they are the true experts in their own experience.
Personal learning and future practice
Engaging in this research, and reflecting on my placement experiences and personal experience, has profoundly influenced how I see my role as a nurse. I have learned that supporting transition is not simply about logistics or policies, it is about relationships, building and maintaining trust, and empowerment. It requires nurses to combine developmental understanding with empathy and advocacy. I now feel better equipped to recognise when young people need more preparation or emotional support in the transition process and to involve families in a way that promotes independence rather than dependence. Going forward, I aim to champion transitional care within my practice. I will encourage open conversations about transition early in the care journey, collaborate closely with multidisciplinary teams, and advocate for the inclusion of mental health and peer support initiatives. I also intend to pursue further training in adolescent health to deepen my understanding of developmental needs.
Most importantly, I have learned that small actions, listening, explaining, checking understanding, and arranging introductions, can have a huge impact on how young people experience transition. As a nurse, I want to be that consistent, reassuring presence that helps make a daunting process feel manageable and empowering.
Conclusion
Transition from paediatric to adult healthcare is a critical period that shapes young people’s future engagement with health services and ultimately their health and well-being. Nurses play a pivotal role in ensuring that young people and their families are well prepared, emotionally supported in this process. By embedding transitional care in education, strengthening paediatric and adult health service collaboration, and prioritising relationships and mental well-being, we can create a system that truly supports adolescents and young adults to thrive. For me, this learning will continue to shape my nursing identity and commitment to holistic, family-centred and person-centred care.
