LAUSR

PURPOSE Patient trust is strongly related to adherence, but has not been tested in transitional care. Low adherence post-transitions of young adults from pediatrics to adult renal care jeopardizes transplanted kidneys and quality of life. We aimed at identifying barriers to trust of young adults in nurses and trust-building elements upon and post transition. DESIGN AND METHODS Following IRB approval, we recruited 21 young adults who underwent kidney transplants before the transition to adult renal care and eleven nurses from adult care in two Israeli tertiary hospitals that perform kidney transplants. We conducted 42 in-depth narrative interviews with young adults and one interview with each nurse. We used thematic analysis guided by Meleis's framework of effective transitions. RESULTS Most young adults' attributed negative meanings to the transition to adult care which did not enhance their well-being. Young adults were not provided with resources to promote their autonomy and role-sufficiency; despite preparation processes pre-transition, they were not aware of expectations from them. Their own unmet expectations of clinicians made them feel unsafe, objectified, and helpless and resulted in distrust in professionals, low adherence, and in some cases, dropping out of care and lower quality of life. CONCLUSIONS Nurses who focused on building a relationship with young adults rather than on operational tasks established trust and led young adults towards role-sufficiency, satisfaction with care, adherence, and optimized quality of life. PRACTICE IMPLICATIONS The proposed recommendations for nurses and clinicians structure the trust-building process using elements to improve transitional care.