Facilitating holistic continuity of care for older patients: Home care nurses’ experiences using checklists

Abstract

Aims and objectives To explore home care nurses’ experiences of implementation and use of checklists developed for improving continuity of care for older patients (65+ years). Background The Norwegian Coordination Reform was implemented to improve coordination between hospitals and communities and facilitate a quicker return to home community after hospital discharge. To follow‐up, national learning networks were initialised to improve pathways for chronically ill older patients, including the development and use of standardised checklists. Design An explorative qualitative design was chosen. Methods Three focus group interviews were conducted, including 18 registered nurses from eight municipalities in southern Norway. Systematic text condensation was used to analyse the interview texts. The COREQ checklist was followed. Results Three categories emerged from the analysis. (a) “The implementation process” included the experiences of a chaotic beginning, the importance of involvement, the leaders’ role and resource allocation. (b) “Pros and cons of checklists in use” included the informants’ experiences of checklists’ usefulness for nurses and the patients. (c) “Competence needed” included the need for a comprehensive set of formal, experiential and social competences. Conclusion and relevance to clinical practice The leaders’ role, support and engagement are decisive for a successful implementation. To succeed and establish solid routines, allocating resources when implementing new laborious routines, such as checklists, is important. To improve holistic continuity of care to chronically ill older patients, checklists should be customisable to each patient's needs, be comprehensive enough to grasp the essence in what to be done at several time points, but at the same time brief enough to be operational. Checklists can be a useful tool for home care nurses, if customised to the individual municipality and the staffs’ working routines. It is important that the staff have versatile and extensive competencies enabling them to use the checklists appropriately.

Crossing Knowledge Boundaries: Health Care Providers’ Perceptions and Experiences of What is Important to Achieve More Person-Centered Patient Pathways For Older People

“…However, previous research has shown that CPs in general and the PaTH in particular are challenging to implement, often because of the very boundaries they are supposed to cross [8,27,41,83]. The participants' skepticism toward the checklists is supported by previous research that shows that when checklists meet the complex and messy realities of practice contexts, they are often abandoned [8,41,83].…”

“…Furthermore, recent reviews on safety and quality in care transitions [15,83] have highlighted the need to consider patient-centered knowledge sharing interventions that emphasize relationships and interaction to overcome boundaries, which is also reiterated by our ndings. Checklists may be useful for the systematization of work and as a reminder for keeping a person-centered focus across settings [27], but they should be regarded as only one aspect of a more holistic approach.…”

“…to asking, "What matters to you?" (WMTY) [22,24] and 2) local tailoring of "The Patient Trajectory in Home care" (PaTH), a patient-centered and checklist-based CP that was developed in Norway for the care of older people in need of follow-up by primary care after hospital discharge [25][26][27]. Based on this, a bottom-up approach where the HCPs were encouraged to come up with local improvement measures in their respective municipality was employed.…”

Evaluating an integrated care pathway for frail elderly patients in Norway using multi-criteria decision analysis

“…To our knowledge, no thorough scientific evaluation of patient outcomes related to introducing HCPC has so far been completed. Within the HCPC context, a qualitative exploration was conducted by Nilsen et al [ 31 ]. They studied home care nurses’ experiences with implementation and systematic use of functional and wellbeing checklists developed for improving continuity of care and quality of care in the pathways provided to old and chronically ill patients in the communities.…”

Nurses’ experiences of continuity of care for patients with heart failure: A thematic analysis

“…Continuity of care has mainly been studied from the perspective of the patient–physician relationship, where the number of contacts with the same physician over time is considered a measure of continuity (Hussey et al, 2014; Van Walraven et al, 2010). Previous studies that have focused on nurse–patient relationships in municipal home health care or neurological healthcare settings have reported that nurses can contribute to continuity of care for both patients and their next of kin (Aspinal et al, 2012; Close et al, 2013; Nilsen et al, 2019). In an ongoing project, patients and their next of kin describe nursing care as important in promoting continuity of life for patients with HF (Östman et al, 2015a, 2015b, 2019).…”