1Chaboyer W, James H,Kendall M. The transitional care after ICU[J]. Crieical Care Nurse, 2005,25 :16 - 28.
2Beattie RM, Symposium 6: Young people,artificial nutrition andtransitional care : Nutrition, growth and puberty in children and ad-olescents with Crohn,s disease[J]. Proc Nutr Soc, 2010, 69(1):174 - 177.
3Wendy C, Lukman T. Adverse events in patients after dischargefrom the Intensive Care Unit[J], AmJ Crit Care, 2008,17(3) : 255 -263.
4Carpenito LJ. Nursing diagnosis: Application to clinical practice[M]. 5th ed. Philadelphia, Pa: Lippincott Williams &. Wilkins,2006:978.
5Beard H. Does intermediate care minimize relocation stress for pa-tient leaving the ICU. [J]. Nurs Crit Care, 2005, 10 (6): 272 -278.
3Schenker M,Burstedt MK,Wiberg M,et al.Precision grip function after hand replantation and digital nerve injury[J].J Plast Reconstr Aesthet Surg,2006,59(7):706-716.
4Naylor M,Brooten D,Jones R,et al.Comprehensive discharge planning for the hospitalized elderly:a random clinical trial[J].Ann Im Med,1994,120(12):999-1006.
5Parry C,Mahoney E,Chalmers SA,et al.Assessing the quality of transitional care:further applications of the care transitions measure[J].Med Care,2008,46(3):317-322.
6Peikes D,Chen A,Schore J,et al.Effects of care coordination on hospitalization,quality of care,and health care expenditures among medicare beneficiaries:15 randomized trials[J].JAMA,2009,301(6):603-618.
7Smeenk FW,Witte LP,van HJC,et al.Transmural care,a new approach in the care for terminal cancer patients:Its effects on re-hospitalization and quality of life[J].Patient Educ Couns,1998,35(3):189-199.
8Gillette VA.Elderly patients and family members satisfaction with discharge planning[M].USA:Dissertation Com,2002:1.
9Naylor M,Bowles K,Campbell RL,et al.Discharge planning:Design and implementation[M]//Fulmer TT,Foreman MD,Walker M,et al.Critical care nursing of the elderly.New York:Springer Publishing Company,2001:197-121.
10ACT Health Policy Division.Discharge planning policy[EB/OL].[2006-10-13].www.health.act.gov.au/c/health?a=dlpubpoldoc&document.
2Barr J,Fraser GL,Puntillo K^et al. Clinical practice guidelines forthe management of pain,agitation,and delirium in adult patientsin the intensive care unit[J]. Critical Care Medicine, 2013 ,41(1):263 - 306.
3Bose M,Shah P. Analysing Post Stroke Depression (PSD) levelsin stroke patients using Zung self - rating depression scale[J]. In-dian Jounral of Physiotherapy and Occupational Therapy, 2012 , 6?4):187 - 190.
4Caroline E, Jones M D, Robert H, et al.Transitional Care In- terventions and Hospital Readmissions in Surgical Popula- tions: A Systematic Review[ J ].Surgery, 2016, 212(2):329- 335.
5Naylor M D. Advancing High Value Transitional Care: The Central Role of Nursing and Its Leadership[ J ]. Nurs Crit Care,2012,36(2): 115-126.
6Niel S L, Panier A M, Kindig D A. Health Literacy:Apre- scription to End Confusion[M]. Washing(DC): National A- cademies Press (VS),2004:1-3.
