Bøje RB, Musaues P, Sørensen D, Ludvigsen MS. Systemic contradictions as causes to challenges in nurses' transitional care: A change laboratory intervention.
NURSE EDUCATION TODAY 2021;
103:104950. [PMID:
34020287 DOI:
10.1016/j.nedt.2021.104950]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND
Transitional care involves coordination of care for patients transitioning between primary care and hospital care. This necessitates collaboration with patients, health professionals and organizations with different goals for patient care. This can result in fragmented patient care pathways. Education of health professionals is a means to improve transitional care. We therefore developed a learning intervention in order to enable nurses to develop transitional care.
OBJECTIVE
The objective was to understand how participants identified needs for development can improve transitional care.
DESIGN
The design was that of a formative intervention design based on Cultural Historical Activity Theory.
SETTING
A regional hospital and a primary care department in a municipality in Denmark.
PARTICIPANTS
Nine health professionals from primary care services and seven health professionals from hospital services.
METHOD
The change laboratory method and the principle of double stimulation guided the facilitation of the learning intervention, which consisted of nine learning sessions (from May to October 2019). A quantitative and qualitative analytical framework was used for data analysis.
RESULTS
The participants identified needs for development, including a wish to involve patients and their next of kin more and to emphasise relational care. Participants developed an appreciation of challenges concerning collaboration between nurses and the formation of nursing practice. Furthermore, participants began to view challenges as caused by a systemic contradiction between nurses' preoccupation with bureaucratic and managerial demands and patients' expectations of coherent care in transitional care.
CONCLUSION
The process of understanding challenges enabled the participants to change their perception from a need to solve problems as they appear on the surface to a need to address underlying systemic contradictions. This possibly has far-reaching consequences for long-term processes underpinning the development of practice and may serve as an alternative to expedient problem solving.
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