Reducing risks in complex care transitions in rural areas: a grounded theory

ABSTRACT

Purpose

Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses’ perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process.

Methods

A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses.

Results

The main concern in the transition process was “Care coordination in a complex context”. The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category “Actively communicating to reduce patient safety risks” was explained by the three categories– “Collaborating on expected care needs”, “Anticipating obstacles” and “Timing the departure”.

Conclusions

The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing.

KEYWORDS:

• Care transitions
• discharge
• grounded theory
• home healthcare
• hospital care
• inter-organizational cooperation
• nursing
• rural health services

Acknowledgments

The authors would like to thank all participants for sharing their experiences. The order of authors follows the ”first-last-author-emphasis” norm.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Access to the data set can be obtained by e-mail to the corresponding author upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Idun Winqvist

Idun Winqvist is a PhD student in nursing at the Department of Health Science at Mid Sweden University. Her research is on quality in care transfers from hospital to home healthcare in rural areas. Winqvist is a registered nurse (Bachelor’s degree 2013) and a district nurse (Master’s degree 2019) with experience in somatic inpatient care, home healthcare and primary care.

Ulla Näppä

Ulla Näppä is an assistant professor in nursing and Vice Head of Department at the Department of Health Science at Mid Sweden University. Her doctoral research has focused on chemotherapy treatments when approaching end of life as well as bereavement in palliative care. She is a specialist nurse in oncology in palliative care and has primarily worked as a registered nurse in palliative home healthcare for more than 15 years.

Helén Rönning

Helén Rönning is an assistant professor in nursing at the Department of Health Science at Mid Sweden University and has been Program Director for nursing education at Mid Sweden University. Her research areas are person-centered care, feelings of safety, participation and self-management, among the elderly in municipal care. Rönning has held managerial positions in municipal care and worked for more than 20 years as a registered nurse in cardiac care.

Marie Häggström

Marie Häggström is an associate professor in nursing and Head of Department at the Department of Health Science at Mid Sweden University. Her research interests are in the quality of care and patient safety concerning the care chain and care transfers. She has more than 20 years of experience in emergency healthcare and is an Intensive Care Nurse (Master’s degree 1997) and an Emergency and Accident Specialist Nurse (Master’s degree 1997).