Exploring Mechanisms and Contextual Factors for the Normalised Implementation of Transitional Care for Adult Patients With Enterostomy: A Realist Review.

Abstract

AIM 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. DESIGN Realist review. METHODS 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. DATA SOURCES 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. RESULTS 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. CONCLUSION 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 METHOD Reporting was adhered to the RAMESES publication standards: realist syntheses. PATIENT OR PUBLIC CONTRIBUTION Patients and members of the public were involved in study design. Their contributions were participating in advisory groups, ensuring the research was addressed. IMPACT 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. IMPACT STATEMENT 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.