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Informasjonsutveksling mellom sykepleiere i hjemmesykepleie og sykehus ved overføring av eldre pasienter
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2013 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Abstract [no]

Darlig samhandling og informasjonsutveksling mellom ulike niva i helsetjenesten har i de senere ar vart gjenstand for bekymring verden over. I Norge ble det gjennom samhandlingsreformen for alvor satt fokus pa behovet for styrking av samarbeidet mellom spesialist‐ og primarhelsetjenesten. Malet med denne avhandlingen var a utvikle kunnskap om sykepleieres informasjonsutveksling knyttet til overforing av eldre pasienter mellom medisinsk sengepost og hjemmesykepleie.

Avhandlingen bestar av fire delstudier. I delstudie I ble det gjennomfort fokusgruppeintervju med sykepleiere ved sykehus og hjemmesykepleie i den hensikt a beskrive deres opplevelse av barrierer som pavirker informasjonsutvekslingen. I delstudie II og III ble det gjort en granskning av pasientjournaldata for eldre pasienter innlagt ved medisinsk sengepost. Pasientene var mottakere av hjemmesykepleie for og etter sykehusinnleggelsen. Hensikten med delstudie II var a undersoke forekomst av sykepleierapporter sendt ved overforing, og a identifisere sammenhengen mellom forekomst av sykepleierapporter og

karakteristika ved pasient og pasientforlop. For delstudie III var hensikten a undersoke innholdet i sykepleierapporter som sendes fra sykehus til hjemmesykepleie ved utskriving, og a identifisere sammenhengen mellom innholdet i sykepleierapportene og karakteristika ved pasient og pasientforlop. Delstudie IV ble gjennomfort som en casestudie knyttet til overforing av ni eldre pasienter. Ved hjelp av observasjon, intervju samt granskning av sykepleiedokumentasjon var hensikten a identifisere og beskrive innholdet i skriftlig og muntlig informasjon som utveksles mellom sykepleiere i hjemmesykepleie og sykehus i forbindelse med eldre hjemmeboende pasienters sykehusinnleggelse, og a identifisere nar og hvordan denne informasjonen utveksles.

I delstudie I ble det funnet en rekke barrierer som pavirker sykepleiernes informasjonsutveksling negativt og kan bidra til at eldre pasienter settes i en sarbar og utsatt situasjon. Barrierene kan beskrives ut fra tre hovedtema med tilhorende undertema. Barrierer assosiert med sykepleier: "mangel pa motivasjon", "mangel pa kontroll", og "mangel pa kunnskap". Barrierer assosiert med mellommenneskelige prosesser: "liten tilgjengelighet", "ulike syn" og "mangel pa tillit". Barrierer assosiert med organisasjonen: "mangel pa ressurser", "uklare ansvarsforhold", "manglende kontinuitet i personalet" og "uhensiktsmessige rutiner og retningslinjer".

Resultater fra delstudie II viste at forekomst av sykepleierapport var 1 % (N= 102) ved innleggelse og 69 % ved utskriving. Forekomst av utskrivingsrapport var assosiert med alder, kjonn, type medisinsk avdeling, samt lengde pa sykehusoppholdet. Delstudie III viste at informasjon relatert til fysisk helse forekom hyppigere enn informasjon relatert til psykisk helse. Utskrivingsrapportene (N=70) var strukturert i henhold til VIPS‐modellen. Forekomsten av psykisk relaterte VIPS‐sokeord var signifikant hoyere for kvinnelige enn for mannlige pasienter, for pasienter i den eldste aldersgruppen enn for pasienter i den yngste aldersgruppen, og for pasienter innlagt ved geriatrisk enhet enn for pasienter innlagt ved generell medisinsk avdeling. Forekomsten av fysisk relaterte sokeord var signifikant hoyere for pasienter innlagt ved generell medisinsk avdeling enn for pasienter innlagt ved geriatrisk enhet. Mens kjonn og type medisinsk avdeling var signifikante prediktorer for psykisk relaterte sokeord i sykepleierapportene, var type medisinsk avdeling en signifikant prediktor for fysisk relaterte sokeord.

Resultater fra delstudie IV viste at utveksling av informasjon mellom sykepleierne i hjemmesykepleien og sykehuset i all hovedsak skjer i forbindelse med utskriving. Det ble ikke gitt informasjon fra hjemmesykepleien til sykehuset ved innleggelse for noen av casene. Informasjon i forhold til fysiske forhold dominerte bade den skriftlige og muntlige kommunikasjonen. Opplysninger om pasientens subjektive opplevelse var sjelden gitt, og forekom bare i den muntlige kommunikasjonen. Det ble funnet forskjeller i den muntlige og den skriftlige informasjonen relatert til psykososiale forhold og sammensatt status. Mal, sykepleietiltak og eventuell effekt ble sjelden rapportert.

Avhandlingen viser at informasjonsutvekslingen mellom sykepleiere i hjemmesykepleie og sykehus ved overforing av eldre pasienter er mangelfull bade nar det gjelder forekomst og innhold. Nar det ikke utveksles adekvat informasjon om pasientens helsestatus ved overforing, blir det vanskelig for sykepleier pa neste niva a yte hensiktsmessig omsorg rettet mot pasientens spesifikke behov. Studien avdekket mange barrierer for informasjonsutveksling, og beskrivelsen av disse vil kunne hjelpe bade sykepleiere i praksis og deres ledere til a vare mer oppmerksomme pa de forutsetninger som trengs for a oppna en tilfredsstillende informasjonsutveksling og styrking av kontinuiteten.

Abstract [en]

Lack of communication and coordination between health care organizations is a

subject of worldwide concern. In Norway, the Coordination Reform has focused on

the need for increased cooperation between the primary and secondary health care.

The aim of this thesis was to develop knowledge in regard to home care and

hospital nurses' information exchange during transfer of older patients between

home care and hospital medical department.

This thesis includes four studies (I‐IV). In study I, focus group interviews were

used to explore nurses' experiences of barriers that influence their information

exchange during the transfer of older patients between hospital and home care. In

study II and III, transfer documents and background data of older hospitalized

home care patients was analysed. The objectives of study II were to evaluate the

prevalence of nursing transfer documents, and identify patient and transfer

characteristics associated with the presence of nursing transfer documents. In

study III, the objectives were to examine the content of nurses' discharge notes,

and investigate the association between the content of discharge notes and

characteristics of patient and transfer. Study IV was a multiple case study

including nine patient transfers. Using observations, qualitative interviews, and

document reviews, the objective 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.

In study I, there were found several barriers that negatively influence the

information exchange and may put the older patients in a vulnerable and exposed

situation. The barriers could be described by three main themes and several subthemes.

The first theme, Barriers associated with the nurse, consisted of three subthemes:

"lack of motivation," "lack of control," and "lack of knowledge." The

second theme, Barriers associated with interpersonal processes, consisted of three subthemes:

"lack of accessibility," "different views," and "lack of confidence." The

third theme, Barriers associated with the organization, consisted of four sub‐themes:

"lack of resources," "unclear responsibilities," "lack of staff continuity," and

"inappropriate routines and policies."

Results from study II showed that nursing admission notes were present in 1%

of the patient transfers from home care to the hospital, while discharge notes were

present in 69% of the transfers from the hospital to home care. Patient and transfer

characteristics associated with the presence of a nursing discharge note were age,

gender, medical department facility, and length of hospital stay.

Results from study III showed that information relating to physical health was

more frequently reported than information relating to mental health. The discharge

notes (N=70) were structured in accordance with the VIPS model. Significant

differences for mean scores on used VIPS keywords in the discharge note were

found for gender, age, and medical department facility. While gender and medical

department facility were significant predictors of mental related keywords in the

discharge note, medical department facility was a significant predictor of physical

related keywords.

Results from study IV showed that the information exchange between hospital

and home care nurses mainly occurred at discharge. In none of the cases was there

information provided from the home care nurses to the hospital nurses.

Information regarding physical care was more frequently reported than other

caring dimensions in both the verbal and written communication. Descriptions of

the patients' subjective experiences were almost absent, and occurred only in the

verbal communication. Differences were found in the written and verbal

communication related to psychosocial status and composite assessment. Nursing

interventions and evaluations were rarely described.

The studies show a gap in the information flow, as well as inaccuracy and

incompleteness in the content of information exchanged between home care and

hospital nurses during transfer of older patients. When adequate information

regarding the patient's health status during transfer is lacking, it constitutes a

challenge to nurses at the next level to provide appropriate care to the patient's

specific needs. The study revealed several barriers to information exchange, and

the description of these barriers will help both nurses in practice and their leaders

to be more attentive to the prerequisites needed to achieve a satisfactory nursing

information exchange and enhance continuity of care.

Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2013. , 58 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 155
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-19241ISBN: 978-91-87103-86-5OAI: oai:DiVA.org:miun-19241DiVA: diva2:628706
Opponent
Supervisors
Available from: 2013-06-14 Created: 2013-06-14 Last updated: 2013-07-09Bibliographically approved
List of papers
1. Barriers to information exchange during older patients' transfer: nurses' experiences
Open this publication in new window or tab >>Barriers to information exchange during older patients' transfer: nurses' experiences
2013 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 19-20, 2964-2973 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives To describe nurses' experiences of barriers that influence their information exchange during the transfer of older patients between hospital and home care. Background The successful transfer of an older patient across health organisations requires good communication and coordination between providers. Despite an increased focus on the need for cooperation among providers across healthcare organisations, researchers still report problems in the exchange of information between the hospitals and the healthcare systems in the municipalities. Design A qualitative study using focus group methodology. Methods Three focus group interviews using topic guides were conducted and interpreted. The study included registered nurses (n = 14) from hospital and home care. The data were analysed through content analysis. Results Three main themes were identified: barriers associated with the nurse, barriers associated with interpersonal processes and barriers associated with the organisation. These themes included several subthemes. Conclusions The findings highlight the challenges that nurses encounter in ensuring a successful information exchange during older patients' transfer through the healthcare system. The barriers negatively influence the nurses' information exchange and may put the patients in a vulnerable and exposed situation. In order for nurses to conduct a successful exchange of information, it is critical that hospital and home care systems facilitate this through adequate resources, clear missions and responsibilities, and understandable policies. Relevance to clinical practice Recognition of the barriers that affect nurses' exchange of information is important to ensure patient safety and successful transitions. The barriers described here should help both nurses in practice and their leaders to be more attentive to the prerequisites needed to achieve a satisfactory nursing information exchange and enhance informational continuity.

Keyword
content analysis, home care nurses, hospital nurses, information exchange, older people, patient transfer
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-19239 (URN)10.1111/jocn.12246 (DOI)23742093 (PubMedID)
Note

Published online (early view) 7 juni 2013

Available from: 2013-06-14 Created: 2013-06-14 Last updated: 2014-08-15Bibliographically approved
2. Nurses' information exchange during older patient transfer: prevalence and associations with patient and transfer characteristics.
Open this publication in new window or tab >>Nurses' information exchange during older patient transfer: prevalence and associations with patient and transfer characteristics.
2013 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 13, e005- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: To ensure continuity of care, it is important to effectively communicate the health status of older patients who are transferred between health care organizations. The objectives of this study were to: (1) evaluate the prevalence of nursing transfer documents, and (2) identify patient and transfer characteristics associated with the presence of nursing transfer documents for older patients transferred from home care to hospital and back to home care again after hospitalization.

METHODS: Nursing documents were reviewed from a total of 102 records of older inpatients admitted from home care to medical wards at a local hospital in central Norway and later discharged home. Frequencies were used to describe patient and transfer characteristics, and the prevalence of transfer documents. Pearson's χ(2) test and logistic regression were used to identify possible associations between patient and transfer characteristics and the presence of nursing transfer documents.

RESULTS: While nursing admission notes were present in 1% of the patient transfers from home care to the hospital, 69% of patient discharges from the hospital to home care were accompanied by nursing discharge notes. Patient and transfer characteristics associated with the presence of a nursing discharge note were age, gender, medical department facility, and length of hospital stay.

CONCLUSIONS: The low prevalence of nursing transfer documents constitutes a challenge to the continuity of care for hospitalized home care patients. Patient and transfer characteristics may impact the nurses' propensity to exchange patient information. These findings emphasize the need for nurses and managers to improve the exchange of written information. While nurses must strive to transfer accurate patient information at the right place and at the right time, the managers must facilitate this by providing appropriate guidelines and standards, as well as adequate personnel and resources.

Keyword
older people, transfer, nursing documentation, hospitalization, home care
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-19237 (URN)10.5334/ijic.879 (DOI)000319804300005 ()23687477 (PubMedID)2-s2.0-84882958971 (ScopusID)
Available from: 2013-06-14 Created: 2013-06-14 Last updated: 2016-10-18
3. Content of nursing discharge notes: Associations with patient and transfer characteristics
Open this publication in new window or tab >>Content of nursing discharge notes: Associations with patient and transfer characteristics
2012 (English)In: Open Journal of Nursing, ISSN 2162-5336, Vol. 2, no 3, 277-287 p.Article in journal (Refereed) Published
Abstract [en]

Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2012
Keyword
Older People; Transfer; Nursing Documentation; Hospitalization; Home Care
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:miun:diva-17468 (URN)10.4236/ojn.2012.23042 (DOI)
Available from: 2012-11-28 Created: 2012-11-28 Last updated: 2015-07-01Bibliographically approved
4. Breakdown in informational continuity of care during hospitalization of older home-living patients - a case study
Open this publication in new window or tab >>Breakdown in informational continuity of care during hospitalization of older home-living patients - a case study
2014 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 14, no Apr-Jun, Art. no. e012- p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
home care, hospitalization, nursing information exchange, older people, transfer
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-19240 (URN)10.5334/ijic.1525 (DOI)000343390200007 ()24868195 (PubMedID)2-s2.0-84902105411 (ScopusID)
Available from: 2013-06-14 Created: 2013-06-14 Last updated: 2016-10-20Bibliographically approved

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