Abstract
To analyze the planning and implementation of the care offered by nurses to elders with coronary disease during the hospital-house transition. Qualitative research that used the Transitions Theory as a theoretical reference. The participants were 12 nurses who work in a hospital that specializes in cardiology, in the city of Salvador-BA. A semistructured interview was carried out from January to February 2018, and the data was analyzed using the Content Analysis technique. Transition care takes place on the day of discharge. The presence of the family was found to be a facilitator; low adherence, poor financial situations, the low educational levels inhibited its implementation. The rehospitalization is an indicator of the results of the transition of care. The planning and implementation of transition care is not effective. It must provide safety in the management of self-care in the home of elders with coronary disease and their families.
Highlights
Transitional care is defined as that the care provided for the transition of an individual from one mode of care to another
The transition leads to a better adherence to treatment, and to a lower proportion of mistakes or adverse reactions, reflecting the reduction of hospital readmission rates[1,2]
Through the analysis of the statements, it was found that the transitional care being carried out is based on some elements of the Transitions Theory constructs, which are: nature of transition, transition conditions, and patterns of response to the transition and to the therapeutic nursing intervention
Summary
Transitional care is defined as that the care provided for the transition of an individual from one mode of care to another. The context between hospital and house means that the responsibility of caring for the patient is transferred from the health professionals to the user, the user’s family, and/or other caregivers. Transition is the change between different environments, conditions, or stable states, demanding knowledge from the individual and willingness for internal and external adaptations with regard to the emergent paradigm[3]. These situations are not always desired, transcending the control of the person as in situations that involve death and disease, and can lead to dangerous or noneffective transitions, characterized by instability, vulnerability, stress, insecurity, and even by ruptures in the cycle of life[4]. Interventions from health professionals are necessary to aid in the difficulties found in transpositions, to minimize or avoid risks to the physical and mental health of the person affected, and to that of their relatives and caregivers
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