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Hansen MF, Martinsen B, Galvin K, Norlyk A. Discharging older patients from hospital to homecare: conflicts in collaborative practices among nurses across sectors. Br J Community Nurs 2024; 29:326-334. [PMID: 38963274 DOI: 10.12968/bjcn.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND Collaboration is a key factor influencing the quality and safety in patients transition between sectors. However, specific collaborative practices may give rise to conflict between hospital nurses and community nurses. AIMS To gain a deeper understanding of collaborative practices which have the potential to fuel tension in collaboration between hospital nurses and community nurses during discharge of older patients from hospital to homecare. METHODS A meta-ethnography approach was used in this study and a systematic literature search was conducted in 2022. RESULTS Five themes were identified in the analysis. These themes revealed how uncertainty, limited confidence in information and personal attitude in communication may fuel tension between hospital nurses and community nurses. Tensions arising from a negative loop emerged because of uncertainty, causing a growing rift between hospital nurses and community nurses, leaving them as opponents rather than collaborators. The authors suggest that policy makers and managers can break this loop by underpinning shared policies and awareness of common objectives.
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Affiliation(s)
- Mette Frier Hansen
- Research Assistant, Department of Public Health, Faculty of Health, Aarhus University, Denmark
| | - Bente Martinsen
- Associate professor, Study director, Department of People and Technology, Roskilde University, Denmark
| | - Kathleen Galvin
- Professor, School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Annelise Norlyk
- Professor, Department of Public Health, Faculty of Health, Aarhus University, Denmark and Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Agder University Grimstad, Norway
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Jungdal A, Tousig CG, Christiansen TK, Birkelund L, Sørensen AN, Roskilde J, Birkelund R. Cross-sectoral exchange of nurses: An intervention study. Scand J Caring Sci 2024; 38:378-386. [PMID: 38310602 DOI: 10.1111/scs.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated. AIM The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them. METHODS Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. RESULTS Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. CONCLUSION Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.
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Affiliation(s)
- Anni Jungdal
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Charlotte Gad Tousig
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Lisbeth Birkelund
- Odense University Hospital - University of Southern Denmark, Odense, Denmark
| | - Anette Nissen Sørensen
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jesper Roskilde
- Public Administration and Diploma of Leadership, Senior Healthcare, Vejle, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Kommune, Vejle, Denmark
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Ethier A, Dubois MF, Savaria V, Carrier A. Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography. BMC Health Serv Res 2024; 24:296. [PMID: 38448879 PMCID: PMC10918893 DOI: 10.1186/s12913-024-10709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Case managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work. METHODS An institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used. RESULTS Three main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to "partners" (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the "partners." Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults' file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information. CONCLUSION The results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).
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Affiliation(s)
- Alexandra Ethier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Faculté de médecine et sciences de la santé, Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Virginie Savaria
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Annie Carrier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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Agerholm J, Jensen NK, Liljas A. Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals. BMC Geriatr 2023; 23:32. [PMID: 36658516 PMCID: PMC9854150 DOI: 10.1186/s12877-023-03754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals' views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate. OBJECTIVE This is a comparative study aiming to examine healthcare professionals' perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE). METHOD Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants' contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis. RESULTS Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety. CONCLUSIONS There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.
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Affiliation(s)
- Janne Agerholm
- grid.4714.60000 0004 1937 0626Aging Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Natasja Koitzsch Jensen
- grid.5254.60000 0001 0674 042XSector of Social Medicin, Copenhagen University, Copenhagen, Denmark
| | - Ann Liljas
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Kim Y, Crandall M, Byon HD. Discharge Communications for Older Patients Between Hospital Healthcare Providers and Home Healthcare Providers: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211052031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing volume of our aging population is dramatically affecting the need for home care services. The discharge process from hospital to home can be fraught with communication challenges if critical information is not provided. The transition process can threaten patient safety and incur adverse patient health outcomes. However, little is known about how the communication occurs between hospital and home health providers. Therefore, this integrative literature review was conducted to (1) describe the discharge communication that is occurring for older patients between hospital and home healthcare providers and (2) summarize the limitations of current discharge communication. A systematic search was conducted using CINAHL, PubMed, Web of Science, and PsycINFO databases. Findings were categorized to address each aim. Seven studies were included for full reviews. Healthcare providers used a variety of communication methods, including: written information, phone calls, or in-person meetings to exchange the discharge information of older patients. Limitations in communications included excessive and incomplete discharge documents, lack of provider’s contact information, lack of trust in each other, and lack of bidirectional communications. The quality of discharge communications can improve by utilizing mediators and implementing standardized discharge documentation requirements. Overall, there was a lack of literature that described the methods and limitations of discharge communication for older patients between hospital and home care services. Further studies can be conducted to generate more evidence. Healthcare providers may improve the quality of discharge communication by addressing the suggested areas.
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Affiliation(s)
- Yeonsu Kim
- University of Virginia, Charlottesville, VA, USA
| | - Mary Crandall
- University of Virginia Health System, Charlottesville, VA, USA
| | - Ha Do Byon
- University of Virginia, Charlottesville, VA, USA
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Silverglow A, Johansson L, Lidén E, Wijk H. Perceptions of providing safe care for frail older people at home: A qualitative study based on focus group interviews with home care staff. Scand J Caring Sci 2021; 36:852-862. [PMID: 34423863 DOI: 10.1111/scs.13027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Providing safe care is a core competence in healthcare. The concept usually refers to hospitals but, consistent with the increasing importance of integrated care, the provision of safe care needs to be extended to the context of home care, and more research is needed concerning home healthcare providers' perspectives in this context. AIM The aim of this study was to describe care providers' perceptions of providing safe care for frail older persons living at home. METHOD A qualitative methodology was chosen. In total, 30 care providers agreed to participate. Data were collected through five focus group interviews and analysed using a phenomenographic approach. RESULTS Three themes regarding care providers' perceptions of providing safe care emerged from the data: 'safe care is created in the encounter and interaction with the older person', 'safe care requires responsibility from the caregiver' and 'safe care is threatened by insufficient organisational resources'. The findings show that providing safe care is an endeavour that requires a holistic view among the care providers as well as effective collaboration within the team, but insufficient competence or a lack of time can make it difficult to safeguard the psychological and existential needs of older persons. CONCLUSION Providing safe care in home environments encompasses more than just risk reduction. The findings highlight the importance of establishing and integrating team-based and person-centred care into home care settings. Traditional communication structures for inpatient care also need to be adapted to the cross-disciplinary work in municipalities. Care providers should be given the opportunity to develop and maintain their competences and to prioritise relationship-oriented care.
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Affiliation(s)
- Anastasia Silverglow
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Johansson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden.,The Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
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Holmqvist M, Thor J, Ros A, Johansson L. Evaluation of older persons' medications: a critical incident technique study exploring healthcare professionals' experiences and actions. BMC Health Serv Res 2021; 21:557. [PMID: 34098957 PMCID: PMC8182897 DOI: 10.1186/s12913-021-06518-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Older persons with polypharmacy are at increased risk of harm from medications. Therefore, it is important that physicians and nurses, together with the persons, evaluate medications to avoid hazardous polypharmacy. It remains unclear how healthcare professionals experience such evaluations. This study aimed to explore physicians’ and nurses’ experiences from evaluations of older persons’ medications, and their related actions to manage concerns related to the evaluations. Method Individual interview data from 29 physicians and nurses were collected and analysed according to the critical incident technique. Results The medication evaluation for older persons was influenced by the working conditions (e.g. healthcare professionals’ clinical knowledge, experiences, and situational conditions) and working in partnership (e.g. cooperating around and with the older person). Actions taken to manage these evaluations were related to working with a plan (e.g. performing day-to-day work and planning for continued treatment) and collaborative problem-solving (e.g. finding a solution, involving the older person, and communicating with colleagues). Conclusion Working conditions and cooperation with colleagues, the older persons and their formal or informal caregivers, emerged as important factors related to the medication evaluation. By adjusting their performance to variations in these conditions, healthcare professionals contributed to the resilience of the healthcare system by its capacity to prevent, notice and mitigate medication problems. Based on these findings, we hypothesize that a joint plan for continued treatment could facilitate such resilience, if it articulates what to observe, when to act, who should act and what actions to take in case of deviations from what is expected. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06518-w.
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Affiliation(s)
- Malin Holmqvist
- Department of Hospital Pharmacy, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,The School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, the School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Axel Ros
- Jönköping Academy for Improvement of Health and Welfare, the School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Johansson
- Institute of Gerontology, Aging Research Network-Jönköping, the School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Bjerkan J, Valderaune V, Olsen RM. Patient Safety Through Nursing Documentation: Barriers Identified by Healthcare Professionals and Students. FRONTIERS IN COMPUTER SCIENCE 2021. [DOI: 10.3389/fcomp.2021.624555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although access to accurate patient documentation is recognized as a prerequisite for delivering of safe and continuous municipal elderly care, healthcare professionals often fail to provide comprehensive clinical information in an accurate and timely manner. The aim of this study was to understand the perceptions of healthcare professionals and healthcare students regarding existing barriers to patient safety through the performance of documentation practices.Methods: Using a qualitative, exploratory design, this study conducted six focus group interviews with nurses and social educators (n = 12) involved in primary care practice and nursing and social educator bachelor’s degree students from a University College (n = 11). Data were analyzed using qualitative content analysis.Results: Four themes emerged from the analysis, which described barriers to patient safety and quality in documentation practices: “Individual factors,” “Social factors,” “Organizational factors,” and “Technological factors.” Each theme also included several sub-themes.Conclusion: According to the findings, several barriers negatively influenced documentation practices and information exchange, which may place primary care patients in a vulnerable and exposed situation. To achieve successful documentation, increased awareness and efforts by the individual professional are necessary. However, primary care services must facilitate the achievement of these goals by providing adequate resources, clear mission statements, and understandable policies.
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Moore J, Prentice D, Crawford J. Collaboration among nurses when transitioning older adults between hospital and community settings: a scoping review. J Clin Nurs 2021; 30:2769-2785. [PMID: 33870541 DOI: 10.1111/jocn.15789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transitioning of older patients between healthcare sectors requires the provision of high-quality nursing care. Collaboration among nurses is identified as an essential element of transitional care, yet nurse-nurse collaboration has received little attention. AIM The aim of this study was to examine the extent, range and nature of nurse-nurse collaboration when transitioning older patients between hospital and community settings, and to identify gaps in the literature. METHODS Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) framework was used to undertake a scoping review to answer the research questions: how do nurses collaborate together when transitioning older patients from hospital to community settings and what are the facilitators, barriers and outcomes of nurse-nurse collaboration when transitioning older patients between sectors? The Nurse-Nurse Collaboration Scale (NNCS) subdomains informed the identification of selected studies. RESULTS Twelve papers were included with most coming from Scandinavian countries and the majority using qualitative methodologies. Communication, coordination and professionalism were found to be both facilitators and barriers of nurse-nurse collaboration. Gaps in the literature included conflict management, and the outcomes of collaboration which was only reported in one study. CONCLUSIONS The findings indicate there is limited study of collaboration among nurses when transitioning older patients between hospital and community settings. Future research should address the impact of conflict on nurses working in collaborative practice as well as conducting intervention studies to examine the outcomes of nurse-nurse collaboration.
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Affiliation(s)
- Jane Moore
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Dawn Prentice
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Joanne Crawford
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
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Zimmer MA. Evaluation of the Psychometric Properties of Relational Insights 360 Among Baccalaureate Nursing Students With the Use of Standardized Patients. J Nurs Meas 2020; 28:615-632. [PMID: 33199477 DOI: 10.1891/jnm-d-19-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate reliability and validity of the relational competency assessment instrument, Relational Insights 360 (RI-360) (Koloroutis & Trout, 2012), among 104 baccalaureate nursing students and 10 standardized patients (SPs) upon completion of a communication simulation. METHODS The reliability of the RI-360 was determined by Cronbach's alpha coefficient. Interrater reliability of the RI-360 was measured between the SPs and the primary investigator with percentages. Factor analysis was run to evaluate the construct validity. RESULTS The RI-360 was internally consistent with an alpha coefficient of 0.93. Interrater reliability for all items on the RI-360 was 42% between students' scores and SPs' scores and 38.9% between the Primary Investigator's scores and SPs' scores. Exploratory factor analysis showed that factor loadings ranged from 0.29 to 0.84. CONCLUSIONS The RI-360 appears to be a valid and reliable scale for use in measuring relational competency among nursing students and SPs.
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Affiliation(s)
- Mary Ann Zimmer
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA .,M. Louise Fitzpatrick College of Nursing, Villanova, PA
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Sogstad M, Skinner M. Samhandling og informasjonsflyt når eldre flytter mellom ulike helse- og omsorgstilbud i kommunen. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Lundereng ED, Dihle A, Steindal SA. Nurses' experiences and perspectives on collaborative discharge planning when patients receiving palliative care for cancer are discharged home from hospitals. J Clin Nurs 2020; 29:3382-3391. [PMID: 32533726 DOI: 10.1111/jocn.15371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' experiences and perspectives on discharge collaboration when patients receiving palliative care for cancer are discharged home from hospitals. BACKGROUND Patients receiving palliative care for cancer experience multiple transitions between the hospital and their home. Poor discharge collaboration is a major cause of preventable hospital readmissions. Collaborative discharge planning could improve the care for these patients outside the hospital setting. Previous research has mostly been conducted in noncancer populations. Further research regarding both home care nurses' and hospital nurses' perspectives on care transitions is required. DESIGN A qualitative study with descriptive and explorative design. METHODS Data were collected through 10 individual, semi-structured interviews of nurses working at two oncology wards at a university hospital and home care services in four municipalities within the hospital's catchment area. Data were analysed using systematic text condensation. COREQ guidelines were adhered to in the reporting of this study. RESULTS Three categories emerged from the data analysis: lack of familiarity and different perceptions lead to distrust; inefficient communication creates a need for informal collaboration; and delayed discharge planning challenges collaboration. CONCLUSIONS The nurses lacked an understanding of each other's work situation, which created distrust, misunderstandings and misconceptions regarding each other's abilities to care for the patient. This led to inefficient communication, relying on individual knowledge, informal communication and personal networking. Delays in the discharge planning resulted in poorly prepared discharges often lacking necessary equipment and documentation. RELEVANCE TO CLINICAL PRACTICE To improve the care of patients receiving palliative care for cancer outside the hospital setting, better communication is a key factor to promote confidence and understanding between nurses working in different settings of health care.
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Affiliation(s)
- Elias David Lundereng
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Palliative treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Norlyk A, Deleuran CL, Martinsen B. Struggles with infrastructures of information concerning hospital-to-home transitions. Br J Community Nurs 2020; 25:10-15. [PMID: 31874078 DOI: 10.12968/bjcn.2020.25.1.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Homecare nurses play a unique role in providing care during the follow-up after hospital discharge and in preventing readmission. The aim of this study was to explore the key challenges faced by homecare nurses in relation to caring for discharged patients. Data were collected through five focus group interviews with 29 Danish homecare nurses and subjected to inductive content analyses. The key challenges faced by homecare nurses fell into three themes: struggling to see the bigger picture, caring for patients from a distance, and compromising on professionalism. The findings demonstrated a paradox between the need for information and the struggle to access this information due to complicated infrastructures of information-sharing. Homecare nurses took on a substantial responsibility in providing the best possible care despite having limited information. Ironically, by taking on this responsibility, they implicitly contribute to covering up the problems of organisational and professional information flow.
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Affiliation(s)
- Annelise Norlyk
- Associate Professor, Study Director, Department of Public Health, Research Unit for Nursing and Healthcare, Aarhus University, Denmark
| | - Cecilia Lykke Deleuran
- Senior Lecturer, VIA University College, Bachelor Programme in Nursing, Silkeborg, Denmark
| | - Bente Martinsen
- Associate Professor, Department of Public Health, Research Unit for Nursing and Healthcare, Aarhus University, Denmark
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Engen EJH, Devik SA, Olsen RM. Nurses' Experiences of Documenting the Mental Health of Older Patients in Long-Term Care. Glob Qual Nurs Res 2020; 7:2333393620960076. [PMID: 33134432 PMCID: PMC7576930 DOI: 10.1177/2333393620960076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
Nursing documentation is repeatedly reported to be insufficient and unsatisfactory. Although nurses should apply a holistic approach, they tend to document physical needs more often than other caring dimensions. This study aimed to describe nurses' experiences documenting mental health in older patients receiving long-term care. Individual interviews were conducted with nine nurses and were analyzed by content analysis. One main theme, two categories and seven sub-categories emerged. The findings showed that the nurses perceived mental health as an ambiguous phenomenon that could be difficult to observe, interpret, and agree upon. Thus, the nurses were uncertain about what concepts and words corresponded to their observations. They also struggled with finding the right words to create accurate and complete documentation without breaking confidentiality or diminishing the dignity of the patient. The findings are relevant for nurses in different types of healthcare services and in the educational context to ensure comprehensive nursing documentation.
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Lemetti T, Voutilainen P, Stolt M, Eloranta S, Suhonen R. Older patients’ experiences of nurse‐to‐nurse collaboration between hospital and primary health care in the care chain for older people. Scand J Caring Sci 2019; 33:600-608. [DOI: 10.1111/scs.12653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Terhi Lemetti
- Department of Nursing Science University of Turku Turku Finland
- Helsinki University Hospital Helsinki Finland
| | | | - Minna Stolt
- Department of Nursing Science University of Turku Turku Finland
| | - Sini Eloranta
- Department of Nursing Science University of Turku Turku Finland
- Turku University of Applied Sciences Turku Finland
| | - Riitta Suhonen
- Department of Nursing Science University of Turku Turku Finland
- Turku University Hospital and City of Turku Welfare Division (Riitta Suhonen) Turku Finland
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Melby L, Obstfelder A, Hellesø R. "We Tie Up the Loose Ends": Homecare Nursing in a Changing Health Care Landscape. Glob Qual Nurs Res 2018; 5:2333393618816780. [PMID: 30574532 PMCID: PMC6295756 DOI: 10.1177/2333393618816780] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022] Open
Abstract
During the last decades, the work of homecare nurses has been affected by several changes, including an aging population, the decentralization of health care, nursing recruitment crises and the scarcity of public resources. Few scholars have analyzed how these changes have impacted homecare nursing. In this article, we describe and discuss aspects of homecare nurses’ work, with specific focus on nurses “organising work.” We outline three phenomena that are increasingly occurring: (a) homecare nurses are frequently involved in negotiating care level and, consequently, what kind of care the patient will receive; (b) homecare nurses’ clinical practice has become increasingly advanced; and (c) and homecare nurses play an important role in coordinating care among interdependent actors. The article draws on material from participant observation and interviews with homecare nurses in two Norwegian studies. Changes in work practice increase the demand for nurses to be competent and have excellent organizational and collaborative skills.
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Affiliation(s)
- Line Melby
- SINTEF, Trondheim, Norway.,Norwegian University of Science and Technology, Gjøvik, Norway
| | - Aud Obstfelder
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Ragnhild Hellesø
- Norwegian University of Science and Technology, Gjøvik, Norway.,University of Oslo, Oslo, Norway
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17
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Johnsson A, Boman Å, Wagman P, Pennbrant S. Voices used by nurses when communicating with patients and relatives in a department of medicine for older people-An ethnographic study. J Clin Nurs 2018; 27:e1640-e1650. [PMID: 29493834 DOI: 10.1111/jocn.14316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden. BACKGROUND Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome. DESIGN An ethnographic design informed by the sociocultural perspective was applied. METHODS Forty participatory observations were conducted and analysed during the period October 2015-September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow-up interviews were conducted with five nurses. RESULTS In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation. CONCLUSION The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved. RELEVANCE TO CLINICAL PRACTICE Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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18
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Johnsson A, Wagman P, Boman Å, Pennbrant S. What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people-An ethnographic study. J Clin Nurs 2018; 27:e1651-e1659. [PMID: 29493840 DOI: 10.1111/jocn.14315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Anette Johnsson
- Department of Health Sciences; University West; Trollhättan Sweden
- School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Petra Wagman
- Department of Rehabilitation; School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Åse Boman
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Sandra Pennbrant
- Department of Health Sciences; University West; Trollhättan Sweden
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19
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20
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Johannessen AK, Tveiten S, Werner A. User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions. Scand J Caring Sci 2017; 32:815-823. [PMID: 28833351 DOI: 10.1111/scs.12512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/05/2017] [Indexed: 12/01/2022]
Abstract
User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.
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Affiliation(s)
- Anne-Kari Johannessen
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Sidsel Tveiten
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Jeffs L, Saragosa M, Law M, Kuluski K, Espin S, Merkley J, Bell CM. Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study. BMJ Open 2017; 7:e015400. [PMID: 28706095 PMCID: PMC5734419 DOI: 10.1136/bmjopen-2016-015400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.
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Affiliation(s)
- Lianne Jeffs
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Marianne Saragosa
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Madelyn Law
- Department of Health Science, Brock University, St Michael's, Toronto, Canada
| | - Kerry Kuluski
- Community Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada
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Lemetti T, Voutilainen P, Stolt M, Eloranta S, Suhonen R. An Enquiry into Nurse-to-Nurse Collaboration Within the Older People Care Chain as Part of the Integrated Care: A Qualitative Study. Int J Integr Care 2017; 17:5. [PMID: 29042847 PMCID: PMC5630076 DOI: 10.5334/ijic.2418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/07/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. THEORY AND METHODS Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. FINDINGS Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. DISCUSSION AND CONCLUSION Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.
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Affiliation(s)
- Terhi Lemetti
- Department of Nursing Science, University of Turku, Helsinki University Hospital, Helsinki, FI
| | | | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, FI
| | | | - Riitta Suhonen
- Department of Nursing Science, University of Turku/Turku University Hospital, City of Turku, Welfare Division, Turku, FI
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23
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Rustad EC, Cronfalk BS, Furnes B, Dysvik E. Continuity of Care during Care Transition: Nurses’ Experiences and Challenges. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.72023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Rustad EC, Seiger Cronfalk B, Furnes B, Dysvik E. Next of kin's experiences of information and responsibility during their older relatives’ care transitions from hospital to municipal health care. J Clin Nurs 2016; 26:964-974. [DOI: 10.1111/jocn.13511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Faculty of Health and Caring sciences; Stord Haugesund University College; Stord Norway
- Department of Clinical Medicine; Helse Fonna Local Health Authority; Haugesund Norway
| | - Berit Seiger Cronfalk
- Palliative Research Center; Ersta Sklöndal University College; Stockholm Sweden
- Faculty of Health and Caring Sciences; Stord Haugesund University College; Haugesund Norway
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Bodil Furnes
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
| | - Elin Dysvik
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
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25
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26
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Nordmark S, Zingmark K, Lindberg I. Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC Med Inform Decis Mak 2016; 16:48. [PMID: 27121500 PMCID: PMC4847180 DOI: 10.1186/s12911-016-0285-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/19/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers. METHODS The study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff. RESULTS Using the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice. CONCLUSION The result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.
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Affiliation(s)
- Sofi Nordmark
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden. .,Department of Healthcare Administration, Norrbotten County Council, Luleå, Sweden.
| | - Karin Zingmark
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Department of Research and Development, Norrbotten County Council, Luleå, Sweden
| | - Inger Lindberg
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Department of Healthcare Administration, Norrbotten County Council, Luleå, Sweden
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27
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28
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Melby L, Brattheim BJ, Hellesø R. Patients in transition--improving hospital-home care collaboration through electronic messaging: providers' perspectives. J Clin Nurs 2015; 24:3389-99. [PMID: 26374139 DOI: 10.1111/jocn.12991] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how the use of electronic messages support hospital and community care nurses' collaboration and communication concerning patients' admittance to and discharges from hospitals. BACKGROUND Nurses in hospitals and in community care play a crucial role in the transfer of patients between the home and the hospital. Several studies have shown that transition situations are challenging due to a lack of communication and information exchange. Information and communication technologies may support nurses' work in these transition situations. An electronic message system was introduced in Norway to support patient transitions across the health care sector. DESIGN A descriptive, qualitative interview study was conducted. METHODS One hospital and three adjacent communities were included in the study. We conducted semi-structured interviews with hospital nurses and community care nurses. In total, 41 persons were included in the study. The analysis stemmed from three main topics related to the aims of e-messaging: efficiency, quality and safety. These were further divided into sub-themes. RESULTS All informants agreed that electronic messaging is more efficient, i.e. less time-consuming than previous means of communication. The shift from predominantly oral communication to writing electronic messages has brought attention to the content of the information exchanged, thereby leading to more conscious communication. Electronic messaging enables improved information security, thereby enhancing patient safety, but this depends on nurses using the system as intended. CONCLUSION Nurses consider electronic messaging to be a useful tool for communication and collaboration in patient transitions. RELEVANCE TO CLINICAL PRACTICE Patient transitions are demanding situations both for patients and for the nurses who facilitate the transitions. The introduction of information and communication technologies can support nurses' work in the transition situations, and this is likely to benefit the patients.
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Affiliation(s)
- Line Melby
- Department of Health, SINTEF Technology and Society, Trondheim, Norway
| | - Berit J Brattheim
- Department of Radiography, Sør-Trøndelag University College (HiST), Trondheim, Norway
| | - Ragnhild Hellesø
- Department of Nursing Sciences, University of Oslo, Institute of Health and Society, Oslo, Norway
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29
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Callinan SM, Brandt NJ. Tackling Communication Barriers Between Long-Term Care Facility and Emergency Department Transfers to Improve Medication Safety in Older Adults. J Gerontol Nurs 2015; 41:8-13. [DOI: 10.3928/00989134-20150616-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Nordmark S, Zingmark K, Lindberg I. Experiences and Views of the Discharge Planning Process Among Swedish District Nurses and Home Care Organizers. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822315569279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Discharge planning is an important care process, but deficits in planning are common. The aim of this study was to explore district nurses’ (DNs) and home care organizers’ (HCOs) experiences and views of the workflow during the discharge planning process (DPP). Demands, workload, time, collaboration, and engagement, together with knowledge and professional confidence, are factors that influence workflow and outcome of the DPP for DNs and HCOs. Strengths and obstacles at the organization, group, and individual levels affect the workflow during the discharge planning. Knowledge of these strengths and obstacles should help care providers in their practice as well as help management and politicians become more aware of prerequisites needed to achieve a safe and efficient workflow for securing the patient’s discharge.
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Affiliation(s)
| | - Karin Zingmark
- Luleå University of Technology, Sweden
- Norrbotten County Council, Luleå, Sweden
| | - Inger Lindberg
- Luleå University of Technology, Sweden
- Norrbotten County Council, Luleå, Sweden
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Richardson JE, Malhotra S, Kaushal R. A case report in health information exchange for inter-organizational patient transfers. Appl Clin Inform 2014; 5:642-50. [PMID: 25298805 DOI: 10.4338/aci-2014-02-cr-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/02/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities. METHODS A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant. RESULTS Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers. CONCLUSIONS Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.
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Affiliation(s)
- J E Richardson
- Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York , USA Health Information Technology Evaluation Collaborative (HITEC) , New York, USA
| | - S Malhotra
- Weill Cornell Physicians Organization , New York, NY
| | - R Kaushal
- Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York , USA Health Information Technology Evaluation Collaborative (HITEC) , New York, USA
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Breakdown in informational continuity of care during hospitalization of older home-living patients: a case study. Int J Integr Care 2014; 14:e012. [PMID: 24868195 PMCID: PMC4027933 DOI: 10.5334/ijic.1525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 02/04/2014] [Accepted: 02/07/2014] [Indexed: 12/21/2022] Open
Abstract
Introduction The successful transfer of an older patient between health care organizations requires open communication between them that details relevant and necessary information about the patient's health status and individual needs. The objective of this study was to identify and describe the process and content of the patient information exchange between nurses in home care and hospital during hospitalization of older home-living patients. Methods A multiple case study design was used. Using observations, qualitative interviews and document reviews, the total patient information exchange during each patient's episode of hospitalization (n = 9), from day of admission to return home, was captured. Results Information exchange mainly occurred at discharge, including a discharge note sent from hospital to home care, and telephone reports from hospital nurse to home care nurse, and meetings between hospital nurse and patient coordinator from the municipal purchaser unit. No information was provided from the home care nurses to the hospital nurses at admission. Incompleteness in the content of both written and verbal information was found. Information regarding physical care was more frequently reported than other caring dimensions. Descriptions of the patients’ subjective experiences were almost absent and occurred only in the verbal communication. Conclusions The gap in the information flow, as well as incompleteness in the content of written and verbal information exchanged, constitutes a challenge to the continuity of care for hospitalized home-living patients. In order to ensure appropriate nursing follow-up care, we emphasize the need for nurses to improve the information flow, as well as to use a more comprehensive approach to older patients, and that this must be reflected in the verbal and written information exchange.
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