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Abstract

Background

Sickle-cell disease is a common genetic red blood cell disorder with global concern. Sub-Saharan Africa, including Ghana, is most predominantly affected. Improvement in medicine has enhanced children's survival into adulthood; hence the need to transition them into adult care services. Well-transitioned patients manage the condition without undue disruptions in their quality of life.

Aim

To explore the challenges faced by nurses in transitioning pediatric patients to adult care.

Method

The study adopted a phenomenological descriptive qualitative design to describe and interpret the difficulties nurses encounter when providing transition care to adolescent patients. Purposive sampling and convenience sampling methods were used to select 15 professional nurses from the pediatric department. Thematic content analysis was used to analyze the data. The interview transcripts were read to identify emerging themes and sub-themes and exported into Nvivo 12 software.

Results

Nurses working at the pediatric department of the regional health facility had no education on how to transition children from pediatric to adult care, leading to poor evidence-based transition care. In addition, there was a lack of transitional care protocol, staff training, care collaboration, transition planning, follow-up initiatives to track and monitor progress, difficulty in tracking the transition process, increased workload, and transition resource constraints.

Conclusion

Nurses at the regional health facility have inadequate education on transitional care of adolescent patients, in-service training and workshop on transitional care on the management of patients, and formulating a policy on transitional care to guide nurses at the pediatric unit.

Keywords

Adolescent challenges nurses transition

Introduction

Sickle cell disease (SCD) is the most common genetic red-blood-cell disorder with potentially life-threatening complications, predominantly affecting persons of African descent (Kavanagh et al., 2022). SCD affects approximately 20 million people worldwide and is most prevalent in parts of Africa including Ghana, the Caribbean, the Mediterranean basin, the Middle East, India, and South and Central America (Royal et al., 2021). More than 300,000 babies are born annually with SCD globally, of which at least 75% are in Africa. SCD remains a principal cause of mortality, morbidity, and health disparity, and has been rated as a major worldwide health problem and importance by the World Health Organization (WHO) and the United Nations (UN) (Royal et al., 2021).

Due to the complexity of the impact of this condition on sufferers, this condition is characterized by the inheritance of two abnormal hemoglobin (Hb) types. Hemoglobin is a protein containing iron that facilitates the transport of oxygen in red blood cells. Hemoglobin “S” (HbS) has an irregular structure compared to normal adult hemoglobin (HbA), a genetic condition that can be passed down from parent to child (Kavanagh et al., 2022). The red blood cells of affected individuals assume the shape of a sickle, which interferes with adequate blood flow, resulting in blockage in the blood vessels and dead tissue in the affected organ. Consequently, an inadequate blood supply to an organ or part of the body causes pain, organ/tissue damage, death of body tissue, and chronic breakdown of red blood cells to eventually develop (Inusa et al., 2020). This chronic disorder is associated with severe pain, multiple organ failures, chronic anemia, and even premature death if poorly managed (Beck et al., 2022).

The prime objective of transitioning children with lifelong illnesses such as SCD, from pediatric care to adult health, should focus on imparting the necessary knowledge, attitude, and skills to maximize the quality of life. This is accomplished by delivering developmentally appropriate healthcare services that continue seamlessly through adolescence into adulthood (Morsa et al., 2020; Sousa et al., 2020). A well-planned and coordinated transition process promotes smooth transfer and positive patient outcomes (Saulsberry et al., 2019).

Health experts throughout the world have also affirmed that a well-managed transition process enhances uninterrupted healthcare delivery and reduces psychological problems related to transition (Ibrahim et al., 2020). Fear and anxiety that arise from meeting new healthcare providers, learning new sets of instructions, and mastery of self-management skills among others are part of the problems associated with transition (Nah, 2020). Globally standardized measures for the patient transition from pediatric to adult SCD health care are unlikely to address these challenges due to variations in settings (geographical and resource availability) (Inusa et al., 2020).

Despite this overwhelming disease burden of pediatric SCD on health facilities in Ghana, a formal policy guideline regarding patient-focused education for SCD self-management for a smooth transition from child health into adult care services is unavailable in most health facilities in Ghana (Inusa et al., 2020).

Nurses provide basic clinical care that seeks to meet the biological, psychological, social, emotional, and spiritual needs of patients in transition to adult healthcare. In addition, nurses’ health educates patients on the transition process for a successful adjustment to adulthood. Nurses are the best to coordinate the entire process of transition to adult health care.

In the transition process, nurses are involved in planning and facilitating holistic care, which is an integral aspect of transition. They facilitate multidisciplinary care interventions by bringing on board other healthcare specialists to improve patient outcomes during the period of transition. Another role nurses play in the transition process is good communication and advocacy for patients with complex health needs. With this revelation, we sought to explore the challenges associated with the transition of SCD adolescents to adults among nurses.

Review of Literature

Health protocols, precisely nursing protocols such as transitional care, are policies that are precise to nursing care practice and are embedded in nursing knowledge (Ortiz, 2019). Researchers have identified that transitional care is a set of multi-disciplinary interventions to improve care coordination when adolescent patients transit between different healthcare settings (Nurjono et al., 2019). Reports indicate that knowledge in transition is a process of organizational innovation and needs to be modeled, structured, and partially formalized by the knowledge-sharing process (Fegran et al., 2023; Sousa et al., 2020). The prime objective of transitioning children with lifelong illnesses such as SCD, from pediatric care to adult health, focuses on imparting the necessary knowledge, attitude, and skills to maximize the quality of life. This is accomplished by delivering developmentally appropriate healthcare services that continue seamlessly through adolescence into adulthood (Sousa et al., 2020). A well-planned and coordinated transition process promotes smooth transfer and positive patient outcomes. With the SCD transition period from pediatric to adult life, continued support is needed to ensure continuity of care. Healthcare transition is the purposeful, planned movement of SCD adolescents from child-centered care to adult-oriented healthcare systems (Saulsberry et al., 2019). Adolescents’ transition from pediatric to adult care is a multidisciplinary enterprise, and nurses play an important role in the transfer team to assist young adolescents to become responsible and independent adults (Fegran et al., 2023).

Scientists have observed that there are several challenges to health care transition. Health system barriers, such as the absence of specialized and interested medical staff, challenges in care coordination across pediatric and adult health systems, and losses in health coverage can all influence adolescent patients’ continuity of care and eventually their management of the disease (Saulsberry et al., 2019). Studies revealed that there is limited evidence on the efficacy of healthcare transition interventions at health facilities and scientists observed that the best practice in the transition process is using care protocols and evidence-based interventions, which should drive the development and implementation of healthcare transition strategies (Saulsberry et al., 2019). Other challenges adolescents with SCD are likely to encounter is that there is a lack of medical staff conversant with their daily management of SCD and there is the poor infrastructure of the health care system limiting coordinated care, which is necessary as patients tend to experience end-organ damage as they get older (Saulsberry et al., 2019). Available studies show that research on nurses’ and physicians’ experiences of the transition of adolescents appear to be scarce, even if their participation and knowledge can both facilitate and hinder the process of transition of an adolescent to adult care (Fegran et al., 2023; Lestishock et al., 2018). Many countries are unprepared for the rapidly increasing numbers of adults now living with SCD and these adolescent patients are often still cared for by pediatric services well into adulthood. Existing practice in Ghana is for the transfer of care to occur by the time the patient is 14–15 years old, with transitioning deliberated from 12 years of age. In South Africa, although the transition usually begins after the age of 12 years, there is local variation from hospital to hospital (Adrienne et al., 2021).

While existing literature has explored the transition of SCD patients to adult care and focused on challenges that patients encounter, there is a notable gap in the transition of SCD pediatric patients to adult care by nurses. Our study addresses this gap by recruiting general nurses at the regional healthcare facility by using a qualitative approach, employing a phenomenological design. Our study addresses the literature gap by providing new insights into general nurses’ challenges when transitioning children with SCD from pediatric care to adult health. Our analysis reveals that general nurses do not receive adequate education on the transition process since they are not pediatric nurses.

Research Question

What are the challenges faced by nurses in transitioning pediatric SCD patients to adult care?

Methods

Study Design and Location

We conducted a hospital-based study, which was carried out at the pediatric department at the regional health facility. The nurses at the regional health facility are made up of general nurses. A qualitative approach was used, employing a phenomenological study design to describe the challenges experienced by the nurses when transitioning SCD adolescents from the pediatric unit to the adult unit. The respondents were recruited from the sickle cell unit of the pediatric department of the regional health facility. The regional health facility is a secondary-level referral health facility serving the entire Eastern Region of Ghana. It also serves as a municipal hospital for the New Juaben Municipality with about 180, 000 people. The 356-bed capacity hospital currently serves as a referral point for about 16 district hospitals in the Eastern Region. The health facility offers services in the following areas: pediatrics, obstetrics and gynecology, internal medicine, surgery, dental care, ophthalmology, physiotherapy, ear, nose and throat, and primary health care.

Operational Definition of Terms

Adolescent: Persons at the age of 12 years. The policy of the regional health facility considers children with SCD at 12 to be able to receive healthcare services in adult health settings.

Adult care: Healthcare provided for persons above the age of 12 years.

Challenge(s): Issues encountered by nurses during the transition process.

Transition: Transfer out of children aged 12 years from pediatric care to adult care.

Transitional care: Nursing care provided for persons aged 12 years moving into adult care.

Study Population and Sampling

The study population consisted of nurses working in the pediatric department at the sickle cell unit. The inclusion criteria were all nurses who have been taking care of SCD patients for at least 1 year and demonstrated a willingness to participate in the study. Purposive and convenience sampling was used to select nurses in the inclusion criteria. Phenomenological study sample sizes are best if they range from 4 to 10 respondents (Smith et al., 2009). A total number of 15 nurses were recruited in this study to gain a deeper understanding of the transition trends in the facility. The researcher continued to interview respondents until subsequent responses yielded no new information. Data collection and data analysis were done concurrently. This was to improve upon subsequent interviews and make necessary corrections where omissions had occurred in previous interviews. Data saturation was attained at the 15th interview. Therefore, the interview was concluded successfully with a total of 15 respondents. As Creswell (1998) suggests, saturation for qualitative study starts at five.

Data Collection Instruments and Tool

Data was collected face-to-face by the use of an interview guide. The interview guide had open-ended questions that addressed the sociodemographic characteristics, knowledge of nurses on transition care, the procedures in transition care, and the challenges when providing transition care. A pilot study was conducted at another healthcare facility, which is the district health facility in the New Juabean South Municipality, using a sample size of five nurses from this facility for the pilot study. The research instrument was pretested for clarification of the tool for freedom from any bias. All ambiguous questions detected were reframed to enable the respondents to have a better understanding of the tool. Responses from the pilot interviews informed the researchers to amend the interview guide before the actual data collection was done to provide high-quality research findings.

Introductory letters were given to the Director of the hospital and the Departmental Head, which provided detailed information about the study, which were communicated to the nurses at the SCD unit. Permission was given to the research team, which enabled the team to recruit available respondents in the inclusion criteria for the study at the time of data collection. Respondents in the inclusion criteria who were available on the days the researcher was at the site were interviewed in an office at the unit.

Interviews were all conducted by the first author, who was a registered and qualified general nurse student in the pediatric specialist program at the time this project was conducted. The two other authors are PhD holders in nursing education and are experienced, who guided the data collection process as well as supervised the project.

Fifteen nurses were interviewed with the help of the interview guide in an office at the unit. The duration of the interview was from a minimum of 60 min to a maximum of 90 min. A nondirective style of interviewing was used, which allowed nurses to control the pacing of the interview. Permission was sought from the nurses to record the interviews and to write field notes. Respondents’ nonverbal communications and body language were all recorded in the field notes. Interviewing continued until saturation of data was evident.

All activities were guided by the observance of the COVID-19 prevention protocol. This included: at least 1 m of social distance from each participant, especially during interview sessions, and face masks were provided and worn. Also, frequent hand hygiene was done when needed. Again, hand sanitizers were provided for use during the interview.

Data Analysis

Thematic content analysis was used to analyze the interview data. The transcribing of the interviews was done by the primary author who was a student nurse under the supervision of the other two authors. The recorded interviews were played and carefully listened to many times. This enabled the interviews to be transcribed verbatim. The transcripts were read several times, one after the other, and repetitive words and phrases identified were recorded in the margins of the transcript. A compilation of all the words and phrases was made and similar phrases were grouped as emerging themes. A thorough and critical look at all the themes that emerged was carried out to identify patterns among them (codes or themes). Following the observed patterns, the themes were grouped in a hierarchical form comprising major themes and their corresponding subthemes. A thorough check was carried out within each transcript and across all the transcripts for consistency. The findings were then presented categorically based on the emerging themes. A compilation of all the words and phrases was made and similar phrases were grouped as emerging themes. These were classified into themes and subthemes to reflect the challenges of respondents in transitioning SCD patients. The themes and subthemes were identified following the data analysis and in line with the objectives of the study. A systematic and critical look at all the themes that emerged was carried out to categorize patterns among them (codes and themes). The data was organized for analysis using the Nvivo 12 version.

Methodological rigor was ensured by the fact that the persons recruited for the study were nurses in the inclusion criteria. The written notes were read by some of the nurses to confirm what they stated. The coding of the data was also confirmed by a person who majored in qualitative data to identify any disagreement. This ensured credibility. The data were collected from July to August 2021. The same interview guide was used to collect data from all the nurses. All activities that occurred during the data collection were noted and an audit trail was kept to certify dependability. Furthermore, the transcribed and analyzed data were read to a few nurses to confirm and clarify statements said during the interview to affirm the conformability of our data. In addition, our collected data ensured transferability by making sure that we described the setting of the study, the design, and the inclusion and exclusion criteria of the respondents of the study. The sample size, the mode of data collection, and the length of data collection were specified.

Ethical Issues

Ethical clearance was granted by the Ethics Review Committee. The principal investigator received an introductory letter from the director of the hospital and presented it to the Deputy Chief Nursing Officer of the unit.

Participant information sheets were given to all respondents to read and decide if they would like to participate in the study before the commencement of data collection. The respondents were also given written informed consent. We ensured that participation in the study was voluntary and no coercion was applied. The respondents were informed they could withdraw from the study without any persuasion. Respondents were all assured of confidentiality and anonymity that the data collected would be kept private. Access to the data is restricted to the research team alone.

Results

Demographic Profile of the Respondents

The results of the study revealed that the majority of the respondents were 13 (86.7%) females. Only two (13.3%) were males. Almost all the respondents were between 30 and 39 years old 14 (93.3%). In education, bachelor's degree holders were nine (60%) and six (40%) were diploma holders who were trained at the Nursing Training College and passed the general nursing license examination. Only five (33.3%) had working experience of 4–6 years. All these variables are presented in Table 1.

Table 1.

Socio-Demographic Characteristics of Respondents (=15).

Variable	Categories	n (%)
Gender	Male	2 (13.3)
Gender	Female	13 (86.7)
Age (years)	20–29	1 (6.7)
Age (years)	30–39	14 (93.3)
Educational level	Diploma^a	6 (40.0)
Educational level	Bachelor	9 (60.0)
Nursing grade	Staff nurse	3 (20.0)
	Senior staff nurse	4 (26.7)
	Nursing officer	4 (26.7)
	Senior nursing officer	3 (20.0)
	Principal nursing officer	1 (6.6)
	Pediatric specialist	0 (0%)
Work experience years	1–3	10 (66.7)
Work experience years	4–6	5 (33.3)
Ethnicity Marital status	Akans	4 (26.7)
	Ewes	6 (40.0)
	Gas	3 (20.0)
	Dagombas	2 (13.3)
	Married	10 (66.7)
	Single	5 (33.3)

Diploma holders who were trained at the Nursing Training College.

Health personnel are to provide transitional care for adolescent SCD patients to adulthood by collaborating with other health personnel to enhance the continuity of quality care. The study sought to explore the challenges the nurses encounter during transitioning adolescent SCD patients to adult care.

Nurses’ Knowledge of Transition Care

Idea of Transition Care. Most of the nurses claimed they did not understand the technical health terminology and relied solely on English text for their understanding of transition care. Few nurses knew little, while most of the nurses had no understanding of it at all.

I have never heard of transition care before, but based on my understanding of transition as an English word, I think it is about changing from one state to another. (IDIN 1)

Notwithstanding the above response, one respondent from the kids’ ward indicated that she heard about transitional care and read a bit about it online. A quote from the respondent:

I have not heard of transitional care in my practice before, no; but I think I read of it, a bit of it. I heard of it on a TV station while listening to an SCD program; I read a little bit of it online, and that was where I got to know about transitional care, aside from that, in my practice, I have not. The little bit I know is: transitional care is when a child / a Pediatric is being migrated from the childhood to adulthood medicine aspect, that's what I can say about it. (IDIN 4)

Persons Involved in Transition Care. The majority of the respondents’ responses to this question relied on their assumptions or guesswork. The respondents indicated that the attending doctors, nurses, and the child's parents should be involved because they believed it was an interdisciplinary venture, hence, the work of the entire health team.

…The people involved in transitional care, from my knowledge, I think the doctors, then the nurses; not all the nurses. I know some hospitals have SCD nurses and units and so they are responsible for that transitional care. Others include I think pharmacists should also be involved because they are on medications for which pharmacists must also be invited…. I think these three people: the pharmacist, the nurses, and the doctors must be involved in the transitional care; and even the child's parents or their relatives…. (IDIN 4)

…the Doctor initiates the process. The whole process is an abrupt thing; once you attain your 12th anniversary, you are informed that on your next visit, that is your next appointment date you need to move to the adult side. The role of the nurse in this transition is not fixed. It depends on the Doctor attending to the patient and sometimes, the Doctor will inform you the nurse to send the patient over to your colleague nurse at the adult side. Sometimes, they just give the patient the next appointment date and tell the patient that from next time, you are going to the adult side because you have reached the adult age. (IDIN 6)

Transitioning Pediatric SCD Patients to Adult Care. The age policy for transitioning a child from the pediatric unit to the adult unit is 12 years old. At age 12, they are automatically transferred to the adult ward for continuation of treatment. The nurses inform the children and their parents on continuing their care at the adult unit. According to most respondents, it is usually a one-day event with no protocol for tracking and monitoring after transitioning. Respondents expressed the following views:

We tell them to attend the adult clinic, we remind them on the food they should eat, the medicine they are supposed to take continuously and perform routine blood level examination as well. (IDIN 2)

Regarding transitional planning, all respondents were of the view that there was no transitional protocol at the unit to facilitate any tracking and monitoring of the children. The following respondents’ responses summarize the views of what most respondents said:

We do not have any protocol on how to transition an adolescent child to the adult unit. The protocol at the pediatric unit is to transfer the child to the adult unit with a referral note. (IDIN 1)

Challenges in Providing Transitional Care

Nurses at the pediatric unit were confronted with some challenges during their transitional care of children with SCD. The problems were a lack of transitional care protocol, lack of follow-up initiatives to track and monitor progress, difficulty in tracking the transition process, lack of collaboration among staff, lack of training, lack of transition planning, increased workload of nurses, and transition resource constraints.

Some quotes from some respondents:

We do not use any protocol to transition any child to the adult unit. The children are given a referral note to go to the adult unit and we do not follow up on them since the staff at the unit are few compared to the number of patients we are taking care of. (IDI 10)

Another said

On collaboration between nurses at the pediatric department and adult SCD unit, … there is no teamwork among us. There is a big gap between those of us at the pediatric unit and those at the adult unit; because we do not have any transition protocol or a model to guide us. (IDIN 3)

Discussion

Knowledge on Transition

The knowledge and skills of the nurses are critical for a successful transition from adolescent care to adult care. As acknowledged by some scientists, knowledge in transitional care is very valuable in the transition process of SCD patients (Hart et al., 2019). The current study recruited nurses who were general nurses since the health facility had general nurses, midwives, and public health nurses. Our findings revealed that nurses working at the pediatric unit of the health facility are not pediatric specialists and as such do not have enough knowledge of the transition process, which is similar to Ibrahim et al. (2020), who argued that knowledge gaps among healthcare staff were one of the key challenges healthcare providers faced during the transitioning process, which may impede effective information for the preparation of the young adolescent of adult care (Ibrahim et al., 2020). The nurses in our study were qualified general registered nurses who had no training in pediatric nursing or specialized training in the transition process. They used their general knowledge to transfer adolescent children to adult care without the knowledge of the transitional process.

Most of the basic nursing training colleges do not have transition care as part of their educational curriculum, thereby making the nurses have limited knowledge on how to transition a patient. These findings in the regional health facility have implications for quality as well as health literacy. Nurses must be taken through workshops to inculcate in them how to transition an adolescent child to an adult care unit. Doucet et al. (2022) argued that a lack of training in transition care among healthcare providers is a barrier to providing transitional care to these patients to adult care. In addition, the transition process is inundated by challenges, which can progress to adverse health consequences owing to the absence of training of nurses on the transition process. Doucet et al. (2022) argued that a significant gap in know ledge and skill exists among nurses in providing transitional care interventions to adolescent and young adult SCD patients. The emphasis made by Doucet et al. (2022) was on the need for adequate knowledge about the disease through the formulation of an interdisciplinary health education strategy to support families. This can only be achieved through healthcare provider empowerment programs such as in-service training and workshops to bridge knowledge gaps in transition care practices. This would reduce the challenges faced when providing care for children being moved to adult care services.

Challenges in Transition

This study showed that there was no protocol on the transition to guide the nurses on how to transition the SCD patient from the pediatric unit to the adult unit. What the nurses do at the unit is educate the patient and family to continue with the routine medical activities. Ortiz (2019) debated that policy must guide the nursing actions in the transition process of a child. Transition readiness of the SCD patients in the current study was given to them as one-time education to prepare them for transition to adult care. Discussions concerning transfer to an adult healthcare provider should be included in transition planning. Regrettably, the respondents of this study stated that the practice was absent in the regional health facility. Before patients reach the age of 12, healthcare providers should engage with parents, or caregivers, and their children to prepare them for transition. SCD patients residing in the U.S. state that they had the privilege to be transitioned within 6 months (p = .0023; Travis et al., 2020). Unfortunately in this current study, nurses inform the patients on the very day of transition to the adult unit. The outcome of the transitional planning of these children in this study cannot be compared to the outcome of SCD patients in the United States. The U.S. SCD patients are more at an advantage than the SCD patients in this setting. Health care providers, particularly nurses, should engage with SCD patients and their families to learn more about what transition entails. Scientists argued that communication and thorough documentation may help to ensure that patients receive consistent transition care (Hart et al., 2019). This situation will aid the adolescent children adapt to their new setting. A study conducted in Accra, Ghana observed that 29 SCD patients could recall pretransition preparation; Seventy-one SCD patients did not recall preparation. It was observed that SCD patients who recall pre-preparation had positive feelings about the need to transition care compared with those who could not recollect preparation (55% vs 32%, p = .004) (Kwarteng-Siaw et al., 2022).

Lack of Transition Protocol

Respondents stated that the interventions they carried out were merely based on general nursing knowledge of what they deemed was right to do. This is due to the absence of a standard protocol for the unit. Such revelations are a source of worry, in that, such situations breed inconsistency in the work of nurses providing transitional care to pediatric SCD adolescents. Hart et al. (2019) noted that most young adult patients are not monitored to track the effectiveness of the transition interventions rendered to them. Respondents in this study do not follow up with pediatric SCD adolescents because the number of staff on duty is low and do not also collaborate with the other staff at the adult unit. This finding is again consistent with the key issues in Disabato et al. (2019), which shows that nurses performed selected transition interventions rather than approaching them holistically. Hart et al. (2019) further argued that tracking the transition process was typically complex because adolescent SCD patients may be seen in pediatric, adult, or specialist clinics, depending on the health needs of the patient and clinic protocol, so that attendance in one setting or the other may not fully capture a patient's clinic attendance.

Lack of Collaboration among Staff and Follow-Ups

Transition services for adolescents with SCD are an emerging clinical specialty that requires that nurses in this area acquire special knowledge and skills to function effectively. This upcoming specialty demands that transition care nurse coordinators provide a blend of both pediatric and adult healthcare services geared towards successful adult care integration while ensuring that the adolescent attains adulthood ambitions. SCD patients need an integral approach to health care including pharmacological strategies, lifestyle involvements, and coordinated management. These patients need a multidisciplinary approach that addresses their unique conditions and minimizes the risk of complications (Obeagu & Obeagu, 2024). One issue influencing respondents’ ability to cope with the transition was the nonavailability of transition nurse coordinators to foster collaboration among nurses who take care of pediatric SCD adolescents. For collaboration to be effective in the transition process, there should be a coordinator of care, a consultant, an educator, an agent of change, a leader, and a researcher, which can be applied to promote effective transition care coordination (Doucet et al., 2022). A surprising finding of this research was that none of the nurses who participated in this study had received transition care training to enable them to collaborate with the other staff to provide quality health care for the transition adolescent children.

Jones et al. (2019) argued that important duties, such as attending to patients’ emotional and psychological needs during the transition into adult care settings, are neglected as a result of poor workload management, which is similar to this current study due to poor staffing; nurses are not able to follow-up on the children at the adult unit. Respondents mentioned that they were unable to follow patients through the transition process to ensure successful completion and integration into adult SCD settings due to overwhelming workloads as a result of poor staffing at the unit. This phenomenon is similar to the findings of Hart et al. (2019), which suggest that there is a high risk of losing adolescent SCD patients to follow-up care, possibly due to the extra responsibilities associated with it. Inferring from the above observation, general nurses have limited knowledge of the transition process and this evidence can assist and inform nurses on the transition development of programs, policies, and interventions to improve transition care for SCD patients. Also, this current study contributes to the literature by revealing the challenges nurses with pediatric experience encounter during the transition process of an adolescent child to adult care at a primary healthcare facility.

Study Limitation

We identified significant findings in our study, but we explored the transition process at the regional health facility and not the tertiary health facility, which is affiliated with an academic institution. Also, the current study used only one health institution. The respondents of this study were general registered nurses with no knowledge of pediatric nursing, which may affect the findings of the study. The convenience sampling method for this study gives room to bias and the sample size of 15 respondents may not be representative of the larger population. The findings of this study may be less generalizable to other topographical settings. Nevertheless, these limitations did not affect the overall findings of the study.

Directions for Future Study

Future studies may employ mixed-methods research to unveil the challenges the nurses encounter in transitioning SCD patients and reveal the rationale for the data collected to assist policymakers. Also, a study may be conducted at tertiary health institutions with specialized nurses and doctors to unveil the challenges encountered during the transition process.

Conclusion

Nurses working at the pediatric unit of the regional health facility do not have adequate education on how to transition children from pediatric care to adult care. Also, transitional care protocol was not in existence at the unit to guide their practice. In addition, they lack follow-up initiatives to track and monitor progress, and there was poor collaboration among the staff.

Informing Practice or Policy

The current study revealed that general nurses who are not specialists in pediatric nursing encounter diverse challenges, which hinder them from providing appropriate transitional care to children as they move to adult care. These findings will provide information to the policymakers concerning the transition of SCD pediatric patients to adult care. Nurses at the pediatric unit should have pediatric education or have periodic workshops. Health facilities should have protocols for transitioning pediatric patients to adult care. Additionally, the findings of this current study will inform nursing education curriculum developers to include transitional care in the management of chronic pediatric conditions such as SCD in nursing training schools to enhance awareness creation about transitions.

Implications for Pediatric Nursing Practice on the Transitional Care Process

In-service training and sponsoring nurses to specialize in pediatric nursing. Provision of a model for the transitional care process to aid the nurses in providing quality transitional care from adolescence to adulthood.

Supplemental Material

sj-doc-1-son-10.1177_23779608251318234 - Supplemental material for Challenges Faced by Nurses in Transitioning Pediatric Sickle Cell Disease Patients to Adult Care

Supplemental material, sj-doc-1-son-10.1177_23779608251318234 for Challenges Faced by Nurses in Transitioning Pediatric Sickle Cell Disease Patients to Adult Care by Gifty Enyonam Amoaku, Delali Adwoa Wuaku and Vivian Efua Senoo-Dogbey in SAGE Open Nursing

Supplemental Material

sj-doc-2-son-10.1177_23779608251318234 - Supplemental material for Challenges Faced by Nurses in Transitioning Pediatric Sickle Cell Disease Patients to Adult Care

Supplemental material, sj-doc-2-son-10.1177_23779608251318234 for Challenges Faced by Nurses in Transitioning Pediatric Sickle Cell Disease Patients to Adult Care by Gifty Enyonam Amoaku, Delali Adwoa Wuaku and Vivian Efua Senoo-Dogbey in SAGE Open Nursing

Footnotes

Acknowledgments

The authors wish to acknowledge the nurses who voluntarily participated in this study.

Author Contributions

Gifty Enyonam Amoaku: conceptualization, investigation, and writing—original draft. Delali Adwoa Wuaku: methodology, writing—original draft, and writing—reviewing and editing. Vivian Efua Senoo-Dogbey: formal analysis and writing—reviewing and editing.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Ethical clearance was granted by the Ghana Health Service Ethics Review Committee. The study's identification number is GHS-ERC025/04/21.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Delali Adwoa Wuaku

Supplemental Material

Supplemental material for this article is available online.

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