Transition Experiences Research Articles

Endured and prevailed: a phenomenological study of doctors’ first year of clinical practice

ContextThe challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors’ mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered.MethodsUsing interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year.ResultsThe experience of transition was characterised by overlapping temporal stages. Participants’ initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year.DiscussionFollowing initial anxiety regarding competence and performance, participants’ experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.

Midlife Transition Experiences of South Asian Immigrant Women in Canada: A Qualitative Exploration.

South Asians make up a significant portion of the immigrant population in Canada, and a large portion of them are in their midlife. To improve the midlife transition of South Asian immigrant women, it is necessary to understand their lived experiences. Guided by the transition theory, this study investigates the midlife experiences of South Asian immigrant women in Canada. Twenty-two South Asian midlife, immigrant women were recruited to participate in this study from the Greater Toronto Area, Ontario, Canada. This study consisted of one asynchronous online focus group with 12 participants and ten one-on-one telephone interviews. Qualitative content analysis was guided by transition theory. South Asian immigrant women experienced many different transitions in their midlife in Canada. These transitions included changes in their (a) lifestyle, (b) career, (c) family, (d) physical health, (e) mental health, (f) social, (g) environment, and (h) personal development. Women actively managed their transitions using strategies such as exercise, socialization, counseling, and religion. Women expressed the need for social, community, and governmental support to facilitate their midlife transitions. To promote healthy midlife transition, governments need to create better employment policies to facilitate immigrant women settlement, transferring skills, and re-employment in Canada. In addition, health care and community services to promote physical and mental health should be emphasized.

The contribution of replicated follow-up studies to improving transitional housing programs for youths aging out of care in Israel

Evaluation research on transitional housing programs (THP) for youths aging out of care resulted in recommendations on how to improve the programs to ensure a more effective response to the needs of care leavers. The aim of the present study was to examine whether implementing the recommendations indeed improved the experiences of care leavers during their participation in the THPs, and their outcomes two to three years after discharge from the program. Study participants were young adults from two cohorts of the same national transitional housing program who participated in two follow-up studies conducted after their discharge from the transitional apartment. We harnessed data from two mixed-methods follow-up studies. The first follow-up comprised young adults who had graduated from the program prior to the implementation of the recommendations, while the second consisted of young adults who graduated from the program after said implementation. The questions addressed the participants’ retrospective evaluations of the program, their experiences of transition to independent living, and outcome measures such as life skills, leisure time activities, satisfaction with social relations, self-reported health (SRH), and life satisfaction. Results revealed that participants in the second cohort evaluated both their experience in the program and the outcomes measures more positively than did their counterparts in the first cohort. In addition, a positive association was found between evaluation of the program’s assistance, relationship with an apartment counselor, life skills, and life satisfaction. We conclude that repeated follow-ups of transitional housing program leavers following the implementation of evaluation recommendations can contribute to significantly improving users’ experiences and outcomes.

Understanding Flex-Route Transit Adoption from a Stage of Change Perspective

Given the potential benefits of flex-route transit for the environment and traffic congestion, many cities have goals for diffusing flex-route transit. However, previous studies have focused on practical experience, strategic planning, and operational planning of flex-route transit. Few studies have identified the determinants of flex-route transit adoption. This study aims to address the effect of demographic characteristics and psychological factors on flex-route transit adoption by employing a stage of change framework. First, the transtheoretical model is applied to divide respondents into five ordered stages (i.e., Precontemplation, Contemplation, Preparation, Action, and Maintenance). Second, a survey was conducted in Beijing, China, using an online platform to obtain the demographic characteristics and measurement items of the respondents in the five ordered stages. Then, a structural equation model is applied to quantify psychological factors. In addition, the partial proportional odds (PPO) model is employed to estimate the best model and identify the determinants of flex-route transit adoption. Finally, an elasticity analysis is conducted to uncover the effect of determinants on flex-route transit adoption in the five ordered stages. The results suggest that the PPO model has the best fit and validity. The model reveals the significant implications of psychological factors and demographic characteristics for transport policy in various stages. These findings show that, regardless of the initial stage, interventions concentrating on psychological factors and demographic characteristics appear to have the potential to transfer the stage of individuals from one to another. To make policies as effective as possible for promoting flex-route transit adoption, the targeted interventions should be complemented in the specific stage.

Family Life During and Beyond COVID-19: The Impact of Relationship Quality on Caregivers’ Management of Paid Work, Caregiving, and Self-Care

This multi-method project examined how Australian caregivers navigated family life during the COVID-19 pandemic in 2020 and subsequent impact on family health behaviours. Participants were invited to complete all three phases. In phase 1, 115 caregivers completed an online survey, focussed on 2020 experiences of COVID-19. In phase 2, 96 of the participants completed a use-of-time recall and 80 completed a dietary recall examining participants’ health behaviours including how they spent their time, their physical activity, and diet quality. Phase 3 involved 24 of the participants completing an online story completion task, focussed on understanding participants’ sense-making of COVID-19. Through triangulating analyses of the three phases, this project identified how poor relationship quality negatively affected families’ experiences of significant disruptions and transitions. This project provides a nuanced picture of how COVID-19 in 2020 impacted family life and highlights the importance of caregiver relationship quality for family health and wellbeing.

Effects of a Childbirth Educational Program on Nulliparous Pregnancy Anxiety: Feasibility and Preliminary Results

Background: Pregnancy is a significant transitional life experience it can also be one of the most stressful experiences in life. The studies demonstrate the importance of educational programs for pregnant women to decrease the anxiety level of the pregnant women. Method: A quasi-experimental design (pretest \ posttest) was utilized to achieve the aim of this study. Results: The total sample size was 122 women. A paired-samples t-test was conducted to compare the level of anxiety pre- and post- the childbirth education program conditions. Anxiety levels were compared pre- and post-intervention conditions. Anxiety levels were higher pre-intervention (M= 31.52, SD= 10.1) than post-intervention (M= 21.39, SD= 8.21). The improvement—9.86, 95% CI [8.25, 12.0]—was statistically significant, t (121) = 10.62, p< .001. The results show that all demographic variables (age, education and employment status) had a non-significant influence on the level of the anxiety of nulliparous pregnant mothers. Conclusion: The study’s conclusions can be used both to enhance the support for nulliparous women with respect to childbirth-related anxiety and also to optimize the care provided to pregnant mothers to support the development of better health as measured by PRAQ-R2.

Immigrant teachers’ experience of professional vulnerability

ABSTRACT The mobility of teachers is a global phenomenon that has affected the education environment worldwide. This study examines the professional transition of immigrant teachers and finds that teacher professional vulnerability is a critical emotion in the complex process of professional transition. Using a qualitative inductive approach, this study reports on the professional transition experiences of ten teachers who migrated from Asia to Australia. Findings revealed that teachers’ perceived teaching competence and interactions with students and colleagues are significant elements contributing to immigrant teachers’ professional vulnerability during their professional transition. I conclude by discussing the resonance between our findings and previous studies, new emerging findings, implications, and recommendations.

Transnational sensemaking narratives of highly skilled Canadian immigrants' career change

PurposeThe authors answer calls for research on the experiences of international professionals' career transitions by investigating how highly skilled immigrants make sense of their career changes in the host country's labor market.Design/methodology/approachThe authors report on a qualitative, inductive and elaborative study, drawing on sensemaking theories and career transitions literature and nine semi-structured reflective interviews with highly skilled Canadian immigrants.FindingsThe authors identified four career change narratives: mourning the past, accepting the present, recreating the past and starting fresh. These narratives are made sense of in a transnational context: participants contended with tensions between past, present and future careers and between relevant home and host country factors affecting their career decisions. Participants who were mourning the past or recreating the past identified more strongly with their home country professions and struggled to find resources in Canada. In accepting the present and starting fresh, participants leveraged host country networks to find career opportunities and establish themselves and their families in the new environment.Originality/valueA transnational ontology emphasizes that immigrants' lives are multifaceted and span multiple national contexts. The authors highlight how the tensions between the home and host country career contexts shape immigrants' sensemaking narratives of their international career change. The authors encourage scholars and practitioners to take a transnational contextual approach (spatial and temporal) to guide immigrants' career transitions and integration into the new social environment.

Career Choices and Experiences in Role Transition: A Multistate Survey of Pediatric-Focused Hospital-Based Nurse Practitioners

We examined factors influencing pediatric hospital-based APPs' career decisions and described the transition to practice experiences. We conducted a cross-sectional, descriptive electronic survey using a novel instrument to examine APP career decisions and transition to practice experiences among APPs in four Southeastern children's hospitals. There were 158 respondents composed of family nurse practitioners (NPs) (30%), primary care pediatric NPs (24%), and acute care pediatric NPs (18%). APPs chose their career to further their education (46%) and because of interest in pediatrics (18%). Most APPs had experience in pediatrics on APP graduation and were well prepared for the role (47%) and to care for pediatric patients (56%). Nearly two-thirds of APPs had an orientation. Early exposure to pediatrics influenced APP career choices and increased career preparedness. Although most APPs had an orientation, future studies should assess the impact of orientation on patient, professional, and organizational outcomes.

Interventions to support adolescents and young adults with the healthcare transition from paediatric to adult nephrology health services: A scoping review protocol

Background: Due to technological advancements and improved medical management of adolescents and young adults (AYAs) living with renal disease, there has been an exponential increase noted in the number of patients advancing from the paediatric to adult nephrology healthcare setting. Subsequently, more AYAs are required to undergo the process of healthcare transition from paediatric to adult healthcare services. This process is often a challenging period for young people and families and is often associated with a decline in physical and psychosocial health outcomes of AYAs with renal disorders. To ensure a successful transition, AYAs must develop the ability to manage their renal condition, including the medical and psychosocial aspects of their condition, independently. Despite significant research into the transition from paediatric to adult healthcare for this unique patient cohort, the transition period remains a challenge. The scoping review will aim to map, explore, and understand the interventions that are currently available to offer positive perceptions and experiences of transition for both AYAs living with renal disorders and their families. Methods: A systematic literature search will be conducted of PubMed, PsycInfo, CINAHL, ASSIA, EMBASE and Web of Science databases from the year 2000 to present. Two independent reviewers will screen the title and abstracts of peer-reviewed literature obtained and assess them against the inclusion criteria to determine their inclusion eligibility. Data will be extracted and synthesised using a template refined by the authors. The scoping review will be undertaken in accordance with PRISMA-ScR guidelines. Data will undergo a formal critical appraisal using recognised appraisal tools. Conclusions: Through mapping this knowledge, the scoping review will aim to identify interventions that are currently available and identify gaps within the literature. This evidence may support the development of transitional care interventions in the future, promote patient satisfaction, and improve patient outcome measures and experiences.

‘If I play I won’t learn’: Children’s perceptions and experiences of transition and school readiness from Maternelle to Year 1

How children experience the major transition from pre-school to compulsory schooling influences their immediate and future success and wellbeing. This complex process of change and adaptation is impacted by school readiness policy drivers, which prioritise children’s performance and achievement. Pedagogic and curriculum progression shifts from play to work, with structured and adult-led activities. These factors contribute to the schoolification of early childhood education, and construct school readiness as an attribute of the child. This paper reports findings on how six children experienced transition and school readiness as they move from Maternelle to Year 1 in an International school in Belgium. Multimodal and multivocal methods of data collection were used to provide child participants with accessible ways of expressing their perspectives of the lived experience of transition. The children perceived the major transition being from play to work and understood that they were expected to be ready for this change. From a socio-cultural perspective, this paper argues that school readiness cannot be assessed at a specific point in time, but should instead be viewed as the lived experience of children that begins before, and continues well beyond the transition. Children are expected to adapt to multiple changes in curriculum and pedagogical practices, as well as changes in cultural, temporal and material contexts. It is recommended that critical questions about how school readiness is constructed should take account of children’s perspectives and experiences of transitions.

Abstract TP42: Door To Thrombolysis Administration Times Before And After Tenecteplase Implementation Across Different Hospital Types

Background: The switch from alteplase to tenecteplase as a thrombolytic in acute ischemic stroke has been reported to be associated with faster door-to-needle (DTN) times. We aimed to study the effect of the early transitional experience after tenecteplase switch on DTN across different hospital types. Methods: We retrospectively analyzed prospectively collected data of patients that underwent thrombolysis at 7 free-standing emergency departments (FSEDs), 8 primary stroke centers (PSC), 3 thrombectomy-capable stroke centers (TSC), and a comprehensive stroke center (CSC) in a large healthcare system. The distributions of DTN time before (January 2021-January 2022) and after (January 2022-June 2022) tenecteplase implementation were compared. The Mann-Whitney test was used to compare door-to-needle time differences between alteplase and tenecteplase treatment groups. Results: Alteplase was given to 318 patients with a median DTN of 40 minutes (interquartile range [IQR]: 27;57) and 154 received tenecteplase with a median DTN of 46 minutes (IQR: 33;63). Patients in the two groups had similar demographic characteristics, NIH Stroke Scale scores, and patient distribution across hospital types. Among tenecteplase-treated patients, 68 (44%) were from FSEDs and PSCs, 67 (44%) were from TSCs, and 19 (12%) were from CSCs. The median DTN time at FSEDs and PSCs increased from 39 (IQR: 27;55) to 56 minutes (IQR: 41;72) after tenecteplase implementation (P<0.0001). At the TSCs the median DTN was 40 minutes (IQR: 29;55) and did not change after the switch to tenecteplase (P=0.31). The median DTN at CSC in the alteplase group was 41 minutes (IQR: 26;72) and 33 minutes (IQR:20;45) in the tenecteplase group (P=0.06). Conclusion: For the first 6 months of tenecteplase implementation the DTN time increased at FSEDs and PSCs but remained unchanged in higher volume centers.

Navigating liminal spaces together: a qualitative metasynthesis of youth and parent experiences of healthcare transition

Abstract Transition from pediatric to adult care for adolescents and young adults (AYAs) with chronic illness affects the entire family. However, little research has compared AYA and parent experiences of transition. Using Sandelowski and Barroso’s method, the aim of this metasynthesis was to summarize findings of qualitative studies focusing on the transition experiences of AYAs and their parents across different chronic physical illnesses. PubMed, EMBASE and CINAHL were searched followed by forward and backward citation searching. Two authors completed a two-step screening process. Quality was appraised using Guba’s criteria for qualitative rigor. Study characteristics and second order constructs were extracted by two authors and an iterative codebook guided coding and data synthesis. Of 1,644 records identified, 63 studies met inclusion criteria and reflect data from 1,106 AYAs and 397 parents across 18 diagnoses. Three themes were synthesized: transition is dynamic and experienced differently (differing perceptions of role change and growth during emerging adulthood), need for a supported and gradual transition (transition preparation and the factors which influence it) and liminal space (feeling stuck between pediatric and adult care). While AYAs and parents experience some aspects of transition differently, themes were similar across chronic illnesses which supports the development of disease agnostic transition preparation interventions. Transition preparation should support shifting family roles and responsibilities and offer interventions which align with AYA and family preferences.

The effects of traumatic experiences during transit and pushback on the mental health of refugees, asylum seekers, and migrants

ABSTRACT Background: There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit – time after they leave their country of origin and before they reach the receiving country. Transit brings numerous protection and mental health risks refugees are exposed to. Objective: The aim of this study was to assess the stressful and traumatic experiences refugees are exposed to during transit, with a special focus on the experience of pushback – the denial of access to the territory to foreign nationals and forcible return to countries of origin or neighbouring countries without an assessment of their rights to international protection, as well as the impact of these experiences on refugees’ mental health and well-being. Method: 201 refugees currently residing in Serbia completed the Stressful and Traumatic Experiences in Transit questionnaire – short version (SET-SF), questionnaire for assessing stressful and traumatic experiences during pushback (SET-SF PB), Refugee Health Screener (RHS-15), and Well-being index (WHO-5). Results: The results showed that refugees experience a large number of stressful and traumatic events (M = 10.27, SD = 4.85). In addition, half of the participants experience severe symptoms of depression (50.7%), while about a third of the participants experience severe symptoms of anxiety (37.8%) and post-traumatic stress disorder (PTSD) (32.3%). Refugees who experienced pushback showed overall higher levels of depression, anxiety, and PTSD. Traumatic experiences during transit and pushback were positively related to the severity of depression, anxiety, and PTSD. In addition, traumatic experiences during pushback showed an incremental contribution in predicting refugees’ mental health difficulties over and above traumatic experiences in transit. Conclusions: This study provides valuable insights into the multiple risks refugees are exposed to and emphasise the need for the provision of adequate protection and support.

The psychological impact of the secondary school transition on families of autistic children

The transition from primary to secondary school is a stressful period for autistic individuals. However, less is known about parental experiences of the school transition, and its impact on the family. This study explored mothers’ perspectives on the psychological impact of the transition to secondary school for their autistic children and their families. Using Interpretative Phenomenological Analysis, semi-structured interviews were analysed to explore the experiences of eight mothers of autistic children at the end of their child’s first year in secondary school. The analysis revealed two superordinate themes: lack of available support and detrimental psychological impact on the family. Mothers reported the negative impact the transition had on themselves, their child, and the wider family. The importance of pre- and ongoing transition support was highlighted to reduce the concerns of children and their parents throughout the transition process. The findings highlighted the need for autism-specific individualized guidance, as well as considering the potential for transition issues to impact on siblings.

New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic

The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic. To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession. Thorne's interpretive description method was utilized. All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession. Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.

Transitional Experiences of STEM Students in Learning General Physics at Notre Dame of Marbel University – Integrated Basic Education Department

Transitional Experiences of STEM Students in Learning General Physics at Notre Dame of Marbel University – Integrated Basic Education Department

‘My disability was my own responsibility’: An institutional ethnography of the transitional experiences of disabled young people leaving care

Across child welfare and disability policy, the intersectionality of being a young person with experiences with both child welfare and disability services is not well addressed. In line with this, a growing body of international evidence shows a gap in the level of transitional and post-care support provided to meet the needs of this group of young people leaving care. The present article draws on data from a qualitative interview study with eight disabled young people leaving care in Norway. However, rather than giving an account of their individual experiences of aftercare, it uses these experiences as a starting point to a broader investigation of how the institutional setting of aftercare shapes these experiences. The study is inspired by institutional ethnography (IE), a method of inquiry developed by Canadian sociologist Dorothy E. Smith, which attempts to describe the interface between individual experiences and institutional relations. Our findings showed that the study participants experienced insufficient support from child welfare services related to their disability during the transition to adulthood. The institutional forces behind these findings are explored and discussed.

An impaired learning environment: Resident physicians' experience of the transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden.

Extensive studies regarding the COVID-19 pandemic have shown negative effects on physicians-in-training. Besides a high workload, their learning environment has been affected. A quality learning environment is vital for residents' physician's clinical development and also their health. Nevertheless, few studies have explored this. The aim of this study was to explore resident physicians' experiences of transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden. In this qualitative study, 12 Swedish resident physicians were interviewed using a semi-structured interview guide. They were interviewed between June and October of 2020 and asked to reflect on the pandemic and, more specifically, the first wave. The empirical material was analysed using qualitative content analysis. The analysis resulted in one theme and four categories. The theme identified was An impaired learning environment which signifies the disruptions the resident physicians experienced during the first wave of the pandemic. The four categories, Professional role insecurity, High expectations but little influence, Stagnant clinical development, and Professional growth through experience, describe in what way the learning environment was impacted.

Sustaining newcomers' career adaptability: The roles of socialization tactics, job embeddedness and career variety

AbstractIn this study, we aim to examine how socialization practices predict newcomers' career adaptability during their organizational transitions. Drawing on career construction theory and conservation of resources theory, we argue that newcomers' job embeddedness, as predicted by their perceived organizational socialization tactics, positively predicts their career adaptability during career transitions. We investigate the role of past transition experiences (i.e., career variety) in moderating the relationship between job embeddedness and career adaptability. Data were collected at three time points from 492 newcomers in an information technology company in China. The newcomers' perceived organizational socialization tactics (i.e., training, future prospects and coworker support) positively predicted their job embeddedness, which was positively associated with their career adaptability. Additionally, career variety weakened the positive effect of job embeddedness on career adaptability. Furthermore, career variety moderated the indirect effects of future prospects and coworker support on career adaptability via job embeddedness, but not that of training. We conclude the article with discussions of our theoretical and practical contributions.