"It is two worlds" cross-sectoral nurse collaboration related to care transitions: A qualitative study.

AIMS AND OBJECTIVES: To explore how the hospital and home care nurses talk about and experience cross-sectoral collaboration related to the transitional care of frail older patients. BACKGROUND: Effective communication and collaboration between nurses involved in care transition are crucial for a safe patient handover. Organisational systems to support cross-sectoral collaboration have been developed but do not always promote the intended dialogue and precise and useful exchange of information. Other factors may also be of importance to an effective and constructive cross-sectoral nurse collaboration. DESIGN: A qualitative design using thematic analysis. METHODS: Data were extracted from 24 focus group interviews conducted with registered nurses from eight hospital wards and six municipalities and a total of 165 hr of observations conducted in three hospital wards and three municipalities. The study was reported according to the COREQ guidelines. RESULTS: The perception of nursing and care differed across sectors. The nurses expressed having shared goals for the patients-however, these goals derived from different values, the perception of nursing and approach to the patients. The lack of knowledge of each other's working conditions created assumptions and preconceptions, which affected communication and collaboration related to planning and executing care transition negatively. CONCLUSIONS: The nurses perceived the hospital and home care as" two worlds". The collaboration between the nurses was characterised by insufficient communication and preconceptions rather than concrete knowledge and different cultures and professional identities. It can be questioned whether cross-sectoral collaboration between nurses should be characterised as interprofessional rather than intraprofessional collaboration as the features of the nurses' collaboration. RELEVANCE TO CLINICAL PRACTICE: Organisational and political systems should recognise that nurses in different sectors are taking care of various aspects of nursing when planning on policies to support cross-sectoral collaboration. More possibilities for nurses across sectors to meet should be made available.

Nurses' perception of how an e-message system influences cross-sectoral communication: A qualitative study.

AIM: To investigate hospital and home care nurses' experiences on how an e-message system influences cross-sectoral communication 2 years after introduction. BACKGROUND: Cross-sectoral communication is identified as the main barrier for high quality in transitional care. An e-message system was introduced to ensure dialogue and precise and useful information exchange. METHODS: Nurses from one hospital and six collaborating municipalities were included. Semi-structured focus group interviews and participation observation was conducted and data were analysed using content analysis. RESULTS: The e-message system was used in both sectors but did not promote cross-sectoral dialogue. The home care nurses expressed distrust in the information from the hospital. The hospital nurses' intention was to provide relevant and accurate information but their main focus was to fulfil the standards within the system rather than the quality of the information exchanged. CONCLUSIONS: The e-message system supports a one-way information flow, rather than the intended loop of information exchange and dialogue. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognise that although an e-message system is being used in a clinical setting, it may not support exchange of high-quality information and dialogue. Focus must be on both standards as well as quality when new systems are introduced.

Nurses' perspectives on how an e-message system supports cross-sectoral communication in relation to medication administration: A qualitative study.

AIMS AND OBJECTIVES: To describe nurses' perspectives on how an e-message system supports communication between hospital and home care nurses in relation to medication administration. BACKGROUND: Medication administration is a complex process involving a high risk of error. Unclear communication and lack of updated information about medication have been identified as the leading cause of medication errors during care transitions. E-message systems are progressively being used to improve information exchange across sectors, yet little is known about their usage for exchange of medication information between nurses. DESIGN: A qualitative design using content analysis. METHODS: Focus group interviews were conducted with nurses from eight hospital wards and six municipalities (n = 79). Participant observations were conducted in three hospital wards and in three municipalities (165 hr). RESULTS: The e-message system did not provide the information needed by the home care nurses to ensure safe medication administration after discharge due to (1) limitations of the system, (2) hospital nurses' lack of knowledge about home care nurses' information needs and (3) hospital nurses' lack of access to medication information. Due the home care nurses' perception of responsibility, they bypassed the e-message system to get the information. CONCLUSIONS: The home care nurses perceived themselves as the last link in the safety chain. As such, access to adequate information was essential for the nurses to ensure safe medication administration; however, the e-message system did not support exchange of the information needed. RELEVANCE TO CLINICAL PRACTICE: E-message systems must meet home care nurses' need for information to ensure that safe medication administration does not depend on the knowledge of the individual nurse. Moreover, other system factors that influence interprofessional collaboration and nurses' cross-sectoral communication must be addressed.