Practices of Hospital Nurses for Continuity of Care in Primary Care: An Exploratory Study

Abstract

Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.

Encuesta hispanoamericana de terapia nutricional en servicios de asistencia domiciliaria

“…Essa importância foi avaliada neste inquérito e, apesar de mais da metade informar a presença desta rotina, 77% referiram uma prática de orientação em até um dia antes da alta, bem diferente da recomendação da literatura. O ideal é que o processo se inicie desde a admissão, envolvendo toda equipe multiprofissional, a família ou cuidador responsável e o paciente, facilitando a compreensão das necessidades terapêuticas indicadas para a pós-alta hospitalar (42)(43)(44) .…”