Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions

Nasrabadi, Alireza Nikbakht; Dehkordi, Leila Mardanian; Taleghani, Fariba

doi:10.1177/10848223211002166

Cited by 4 publications

(4 citation statements)

References 38 publications

(49 reference statements)

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“…Of all studies in the review, thirty-one (75.6%) reported findings relating to processes of interprofessional communication and service integration in specialist care settings. Interestingly, findings from all three participant groups identified similar issues, such as the siloed nature of specialties leading to fragmented care [ 42 , 48 , 49 , 52 , 64 , 84 , 86 ] and poor care continuity [ 37 , 51 , 58 , 80 ], lack of clarity of responsibility [ 52 , 54 , 61 , 71 , 72 , 86 ], insufficient interprofessional communication [ 35 , 60 , 66 , 71 , 78 ] and a perception that specialists were unwilling to offer medical advice beyond their area of expertise [ 44 , 58 , 78 ]. Limited functionality of electronic health record systems was noted by healthcare professionals to perpetuate these experiences, impacting on the reliability of medication history [ 37 , 52 , 83 ] and, in some instances, positioning people living with MLTC as the source of information for healthcare professionals [ 37 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Bellass,

Scharf,

Errington

et al. 2024

BMC Med

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Background Multiple long-term conditions—the co-existence of two or more chronic health conditions in an individual—present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals. Methods We undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings. Results Of 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care. Conclusions Qualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.

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Section: Resultsmentioning

confidence: 99%

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Bellass,

Scharf,

Errington

et al. 2024

BMC Med

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“…The present study found that the patients’ participation in care and their cooperation with the home healthcare team had a determining role in their own safety. According to the evidence, chronic and elderly people45 patients are more exposed to health threats due to complexities of care. Therefore, the safety conditions of home healthcare for these patients should be assessed more carefully once they enter the home or even before it 46…”

Section: Discussionmentioning

confidence: 99%

Contributing factors involved in the safety of elderly people with chronic illness in home healthcare: a qualitative study

et al. 2023

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IntroductionPatients receiving home care are often elderly people with chronic illnesses that increasingly experience patient safety barriers due to special care needs.ObjectiveThe present study was conducted to determine the factors involved in the safety of elderly patients with chronic illnesses receiving home care.MethodsA qualitative study with a conventional content analysis method was conducted in home care agencies of Tehran, Iran from August 2020 to July 2022. For data generation, semistructured interviews were conducted with 11 nurses, 2 nurse assistants, 1 home care inspector (an expert working at the deputy of treatment) and 3 family caregivers. Moreover, four observational sessions were also held. Data analysis was done using the five-step Graneheim and Lundman method.ResultsAccording to the results, the facilitators of the safety of the elderly patients with chronic illnesses included the family’s participation, nurse’s competence, efficiency of the home care agency management and patient’s participation in patient safety. The barriers to patient safety included problems created by the family, nurse’s incompetence, inefficiency of the home care agency, patient’s prevention of patient safety, home care setting limitations and health system limitations.ConclusionThe majority of the factors involved in the safety of elderly patients with chronic diseases receiving home care had dual roles and could serve as a double-edged sword to guarantee or hinder patient safety. Identification of the facilitators and barriers can assist nurses and the healthcare system in planning and implementing patient safety improvement programmes for elderly patients with chronic illnesses.

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“…Research has shown the structural conditions that affect the ability to deliver good quality care during care transitions from hospital to home. These are material resources like access to electronic aids [ 42 , 43 ] and bed availability, human resources such as the patient’s health status [ 44 ], and staffing issues [ 43 , 45 ], and organizational structures such as national expectations [ 46 ]. However, despite environmental inequities between urban and rural residents, to our knowledge, no previous studies have explored these aspects from a nursing perspective, focusing on rurality.…”

Section: Introductionmentioning

confidence: 99%

Quality of care during rural care transitions: a qualitative study on structural conditions

2023

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Background Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses’ perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. Methods We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian’s definition of structures regarding the quality of care. Results The structural conditions were represented by three themes; (I) “Distances and inaccessibility” explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) “Competence of the actors” explains continuity, knowledge and collaboration among the individuals involved. (III) “Levels of organizational governance” explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. Conclusions Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

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Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions

Cited by 4 publications

References 38 publications

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

Contributing factors involved in the safety of elderly people with chronic illness in home healthcare: a qualitative study

Quality of care during rural care transitions: a qualitative study on structural conditions

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