Care transitions — whether they involve transfer from inpatient to outpatient care, from the hospital to home, between healthcare specialties, or to palliative care and beyond — represent a high-risk period for patients. Nurses play a critical multifaceted role in helping patients and their families navigate the complexities of care transitions.

The ATS 2026 International Conference scientific symposium, “Nursing Year in Review – Navigating Care Transitions in Pulmonary, Critical Care, and Sleep,” from 2:15–3:45 p.m. ET, Monday, May 18, in the Orange County Convention Center, Room W204 (Level II, OCCC West Concourse), will spotlight recent evidence on care transitions within pulmonary, critical care, and sleep medicine, including patient-oriented and family-centric tools and the role of nurses as transitional care liaisons.

Deena Kelly Costa, PhD, RN, FAAN, Helen Porter Jayne & Martha Prosser Jayne Associate Professor at the Yale School of Nursing, explained that the session will focus on various transitions of care, including transfers of patients between providers, clinicians, and settings; for instance, transitioning the patient from the ICU or a skilled nursing facility to home, or across different levels of care. The session will also cover support for families of patients who are navigating end-of-life transitions.

“The reason we focus on transitions is because it is a high-priority topic for nurses that spans the clinical areas of pulmonary, critical care, and sleep,” Dr. Costa explained. “Care transitions usually involve coordination of resources and services. When care transitions do not occur effectively, it can lead to fragmented care, unmet needs, and potentially poor outcomes, both for patients as well as for their family members.”

Dr. Costa is co-chairing the session with Tammy L. Eaton, PhD, MSc, RN, FNP-BC, ACHPN, FCCM, FAAN, research assistant professor of medicine at the University of Michigan, and Crystal T. Stephens, PhD, MSN, assistant professor at the University of Alabama at Birmingham, Heersink School of Medicine.

The session will begin with a presentation on the state of science in post-ICU care transitions, given by Kelly M. Toth (Potter), PhD, RN, assistant professor of critical care medicine at the University of Pittsburgh.

“The first presentation will explore the varying trajectories of ICU survivors over time, how that might look or might be different for veterans who are discharged from community hospitals, compared to VA hospitals, and how the coordination of those services can be impacted,” Dr. Costa said. Research on a patient-oriented tool to support the ICU ward transition during the “window of vulnerability” for families and a qualitative study on post-discharge rehabilitation services will also be discussed.

The session will then examine how nurse-led family-centric interventions can be translated from evidence into practice, including how nurses can act as transitional navigators to coordinate services for patients and families. Dr. Costa said that evidence from systematic and narrative reviews on the post-ICU psychological burden for ICU families and the impact of family interventions on patient and family outcomes will be reviewed.

Lynn F. Reinke, PhD, APRN, BC, ATSF, clinical professor at the University of Utah College of Nursing, will then discuss palliative care and end-of-life transitions.

“This is an exciting topic,” Dr. Costa said, adding that Dr. Reinke is a co-author on an ATS workshop report focused on a new palliative care pulmonary framework — PalliPulm. Dr. Reinke will also speak about compassionate extubation in the ICU and co-designing interventions, “which is a process by which clinicians and/or researchers partner with stakeholders, typically family members, to design an intervention that is then implemented in the clinical setting.”

The last presentation, on smoking and vaping cessation across the lifespan, will be given by Tierney A. Keeton-Tucker, DNP, APN, clinical program coordinator of the Comprehensive Smoking Treatment Program at the University of Pennsylvania Health System.

Dr. Keeton-Tucker’s talk will include an examination of a study integrating smoking cessation interventions in standard lung cancer screenings and a clinical decision support tool that alerts clinicians to provide tobacco or vaping cessation materials to patients. She will also discuss cessation strategies for adolescents, especially for vaping cessation.

For the full list of sessions organized by the ATS Assembly on Nursing, visit ATSConference365.