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

BMC Nursing

Research

Marie Häggström¹  Ulla Näppä¹  Idun Winqvist¹ 

[1] Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, S-851 70, Sundsvall, Sweden;

关键词: Continuity of Care;    Homecare Services;    Nursing;    Patient Care Management;    Patient discharge;    Patient transfer;    Rural Health Services;    Rural nursing;    Transitional care;    Quality of Health Care;   

DOI  :  10.1186/s12912-023-01423-5

 received in 2023-04-25, accepted in 2023-07-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRegistered 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.MethodsWe 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.ResultsThe 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.ConclusionsCare 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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