Municipal healthcare professionals' interprofessional collaboration during older patients' transitions in the municipal health and care services: a qualitative study.

BACKGROUND: Interprofessional collaboration is vital to assist patients towards a healthy transition in the municipal health and care services. However, no study has so far investigated municipal health care providers' inter-professional collaboration during older patients' transition in the municipal health and care services. The aim of this study is therefore to describe and explore what influence health care providers' inter-professional collaboration within and across municipal facilities during older patients' transitions in the municipal health and care services. METHOD: The study has a descriptive, interpretive design. Focus group interviews and individual interviews with municipal health care providers different professions were performed. RESULTS: Municipal health care providers' inter-professional collaboration during older patients transitions in the municipal health and care services was challenging. Two main themes were identified: The patient situation itself and Professional. Personal, and Practical circumstances. The results show that the municipal priority of patients staying at home as long as possible facilitated inter-professional collaboration across the short-term care facility and the home care services. Inter-professional collaboration across facilities with the long-term care facility was downgraded and health care providers in this facility had to cope as best they could. CONCLUSION: Prioritising and facilitating inter-professional collaboration between the short-term care facility and the home care services, contributed to health care providers experiencing doing a proper and safe patient assistance. Yet, this priority was at a cost: Health care providers in the long-term care facility, and in particular registered nurses felt squeezed and of less worth in the municipal health and care services. It was a strain on them to experiencing unplanned and often rushed patient transition into long-term care facility. To focus on municipal inter-professional and inter-facility collaboration during patients in transition to long-term care placement is vital to maintain the patients, and the health care providers working in these facilities.

Nursing staff interactions during the older residents' transition into long-term care facility in a nursing home in rural Norway: an ethnographic study.

BACKGROUND: Future challenges in many countries are the recruitment of competent staff in long-term care facilities, and the use of unlicensed staff. Our study describes and explores staff interactions in a long-term care facility, which may facilitate or impede healthy transition processes for older residents in transition. METHODS: An ethnographic study based on fieldwork following ten older residents admission day and their initial week in the long-term care facility, seventeen individual semi-structured interviews with different nursing staff categories and the leader of the institution, and reading of relevant documents. RESULTS: The interaction among all staff categories influenced the new residents' transition processes in various ways. We identified three main themes: The significance of formal and informal organization; interpersonal relationships and cultures of care; and professional hierarchy and different scopes of practice. CONCLUSIONS: The continuous and spontaneous staff collaborations were key activities in supporting quality care in the transition period. These interactions maintained the inclusion of all staff present, staff flexibility, information flow to some extent, and cognitive diversity, and the new resident's emerging needs appeared met. Organizational structures, staff's formal position, and informal staff alliances were complex and sometimes appeared contradictory. Not all the staff were necessarily included, and the new residents' needs not always noticed and dealt with. Paying attention to the playing out of power in staff interactions appears vital to secure a healthy transition process for the older residents.

Nursing staff's actions during older residents' transition into long-term care facility in a nursing home in rural Norway.

Working in long-term care units poses particular staff challenges as these facilities are expected to provide services for seriously ill residents and give help in a homelike atmosphere. Licensed and unlicensed personnel work together in these surroundings, and their contributions may ease or inhibit a smooth transition for recently admitted residents. The aim of the study was to describe and explore different nursing staff's actions during the initial transition period for older people into a long-term care facility. Participant observation periods were undertaken following staff during 10 new residents' admissions and their first week in the facility. In addition 16 interviews of different staff categories and reading of written documents were carried out. The findings show great variations of the staff's actions during the older residents' initial transition period. Characteristics of their actions were (1) in the preparation period: "actions of sharing, sorting out, and ignoring information"; (2) on admission day: "actions of involvement and ignorance"; and (3) in the initial period: "targeted and random actions," "actions influenced by embedded knowledge," and "actions influenced by local transparency."

Experiences faced by next of kin during their older family members' transition into long-term care in a Norwegian nursing home.

AIMS AND OBJECTIVES: To describe and explore experiences of next of kin during the older persons' transition into long-term care. BACKGROUND: Moving into long-term care is a challenge for both resident and next of kin. Next of kin experience transitions at the same time as they play significant parts in their family members' transition into long-term care placement. DESIGN: Constructivist hermeneutical design. METHODS: Ten next of kin to newly admitted eight residents were recruited by purposeful sampling and interviewed. Periodic participant observation periods following new residents on arrival day and the first week after admission and some written documentation were the backdrops to the interviews. RESULTS: What happened prior to the long-term care placement as well as what happened in the initial period of transition influenced the experiences of next of kin. Characteristics of their experiences were: 'striving to handle the new situation', 'still feeling responsible', and 'maintaining dignity and continuity'. CONCLUSIONS: Next of kin were unprepared for the transition and had little support from staff. Staff lacked awareness about next of kin's transition experiences. Their involvement with next of kin was unpredictable, and this added to the burdens of next of kin in this period. RELEVANCE TO CLINICAL PRACTICE: Knowledge about experiences of next of kin needs to be acknowledged among healthcare professionals. Health professionals need to pay attention to what happens across institutional borders within families as well as between staff and family members. Individual family members need support in this period of change.