References
Struggles with infrastructures of information concerning hospital-to-home transitions
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.
Across the globe, policy demands have called for a move of care delivery from secondary to primary care due to demographic changes and an increase in the number of older people with multiple comorbidities (Violan et al, 2014; Martinsen et al, 2018). Accordingly, health systems undergo reorganisation, with a specific focus on short in-patient stay, specialised treatment and very early discharge. However, several studies stress that homecare nurses are facing many challenges due to the increased demand of supporting patients with more complex medical conditions and health needs (Martinsen et al, 2018; Phelan et al, 2018).
Studies have shown that transitional care of older people from hospital to homecare nursing is complex. Often, these individuals have medical, cognitive, physical and social problems that must be taken into account in relation to discharge and follow-up care plans (Greysen et al, 2014; Martinsen et al, 2015). Further, transitional care has been recognised as a high-risk area due to evidence indicating a correlation between patient hand overs and adverse events (Laugaland et al, 2012). Consequently, homecare nurses have a unique role in providing follow-up care after discharge and preventing readmissions (De Vliegher et al, 2014).
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