Nurses' experiences of transitions of older patients from hospitals to community care. A nation-wide survey in Norway

Abstract

Background and Aims: Moving older patients from hospitals to community services is a critical phase of integrated care. Yet, large-scale research on the quality of these transitions has been missing. Consequently, it has been difficult to assess to what extent and how patient transitions need to be improved. The purpose of this research was to gather the perspective of nurses involved in the transition of older patients (defined as patients 65 years or older) in Norway. Methods: Data were collected in 2017 among Norwegian nurses with two nation- wide web-based surveys, one among nurses working at in-patient wards in acute hospitals, and another among nurses in home nursing and nursing homes in the com- munity. We sent emails to all nurses who were members of the Norwegian Nurses Organisation (NSS), where most Norwegian nurses are organised. The email included a recommendation by the NSS. Instructions in the email and the online questionnaire ensured that only nurses involved in the transition of older patients participated. The online questionnaire assessed nurses' evaluations of the quality of patient transitions and information exchange between the services involved in patient transitions. Results: 4312 nurses working in community care services and 2421 nurses at in- patient wards at hospitals responded. Both groups were predominantly female (94%), and nearly 90% of Norway's 428 municipalities were included in the study. Com- pared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with the information exchange on patients' condition and needs. Further, when comparing groups of community nurses, we found that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. Conclusion: We conclude that hospital nurses should have more face-to-face or tele- phone contact with community nurses, and specifically with home nurses. Further, we suggest promoting a mutual understanding of the older patients' pathway from one service to the other, and to improve co-ordination across the services. We sug- gest that one means to achieve such improvements is to use multi-disciplinary discharge teams, while another is to develop case management or care navigator roles specific to the discharge process.