"It is two worlds" cross-sectoral nurse collaboration related to care transitions: A qualitative study

AIMS AND OBJECTIVES

To explore how the hospital and home care nurses talk about and experience cross-sectoral collaboration related to the transitional care of frail older patients.

BACKGROUND

Effective communication and collaboration between nurses involved in care transition are crucial for a safe patient handover. Organisational systems to support cross-sectoral collaboration have been developed but do not always promote the intended dialogue and precise and useful exchange of information. Other factors may also be of importance to an effective and constructive cross-sectoral nurse collaboration.

DESIGN

A qualitative design using thematic analysis.

METHODS

Data were extracted from 24 focus group interviews conducted with registered nurses from eight hospital wards and six municipalities and a total of 165 hr of observations conducted in three hospital wards and three municipalities. The study was reported according to the COREQ guidelines.

RESULTS

The perception of nursing and care differed across sectors. The nurses expressed having shared goals for the patients-however, these goals derived from different values, the perception of nursing and approach to the patients. The lack of knowledge of each other's working conditions created assumptions and preconceptions, which affected communication and collaboration related to planning and executing care transition negatively.

CONCLUSIONS

The nurses perceived the hospital and home care as" two worlds". The collaboration between the nurses was characterised by insufficient communication and preconceptions rather than concrete knowledge and different cultures and professional identities. It can be questioned whether cross-sectoral collaboration between nurses should be characterised as interprofessional rather than intraprofessional collaboration as the features of the nurses' collaboration.

RELEVANCE TO CLINICAL PRACTICE

Organisational and political systems should recognise that nurses in different sectors are taking care of various aspects of nursing when planning on policies to support cross-sectoral collaboration. More possibilities for nurses across sectors to meet should be made available.

Nurses' perspectives on how an e-message system supports cross-sectoral communication in relation to medication administration: A qualitative study

AIMS AND OBJECTIVES

To describe nurses' perspectives on how an e-message system supports communication between hospital and home care nurses in relation to medication administration.

BACKGROUND

Medication administration is a complex process involving a high risk of error. Unclear communication and lack of updated information about medication have been identified as the leading cause of medication errors during care transitions. E-message systems are progressively being used to improve information exchange across sectors, yet little is known about their usage for exchange of medication information between nurses.

DESIGN

A qualitative design using content analysis.

METHODS

Focus group interviews were conducted with nurses from eight hospital wards and six municipalities (n = 79). Participant observations were conducted in three hospital wards and in three municipalities (165 hr).

RESULTS

The e-message system did not provide the information needed by the home care nurses to ensure safe medication administration after discharge due to (1) limitations of the system, (2) hospital nurses' lack of knowledge about home care nurses' information needs and (3) hospital nurses' lack of access to medication information. Due the home care nurses' perception of responsibility, they bypassed the e-message system to get the information.

CONCLUSIONS

The home care nurses perceived themselves as the last link in the safety chain. As such, access to adequate information was essential for the nurses to ensure safe medication administration; however, the e-message system did not support exchange of the information needed.

RELEVANCE TO CLINICAL PRACTICE

E-message systems must meet home care nurses' need for information to ensure that safe medication administration does not depend on the knowledge of the individual nurse. Moreover, other system factors that influence interprofessional collaboration and nurses' cross-sectoral communication must be addressed.