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Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap)ORCID iD: 0000-0001-6296-0160
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 4, 886-895 p.Article in journal (Refereed) Published
Abstract [en]

Aim:

To investigate registered hospital and nursing home nurses' experiencesof coordination and communication within and between care settings when olderpersons are transferred from nursing homes to hospital and vice versa.

Background:

It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.

Design:

A descriptive study design with a qualitative approach was used.

Methods:

In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.

Results:

Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospitalregistered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursinghome registered nurses suggested increased collaboration to understand each other's work situation better.

Conclusion:

Communication and coordination among hospital andnursing home registered nurses need to be furthered improved. Registered nurses'coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursingcare and unnecessary transfer and admission to hospital.

Place, publisher, year, edition, pages
2013. Vol. 69, no 4, 886-895 p.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-186141DOI: 10.1111/j.1365-2648.2012.06077.xISI: 000316285400014OAI: oai:DiVA.org:uu-186141DiVA: diva2:572704
Available from: 2012-11-28 Created: 2012-11-28 Last updated: 2017-12-07
In thesis
1. Mind the gap: Organizational factors related to transfers of older people between nursing homes and hospital care
Open this publication in new window or tab >>Mind the gap: Organizational factors related to transfers of older people between nursing homes and hospital care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care.

The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners.

Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1120
Keyword
hospitalizations, advance care planning, emergency service, patient admission, nursing homes
National Category
Clinical Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-259342 (URN)978-91-554-9284-7 (ISBN)
Public defence
2015-09-18, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-08-27 Created: 2015-07-31 Last updated: 2016-08-17Bibliographically approved

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Kirsebom, MarieWadensten, BarbroHedström, Mariann

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