Ward nurses' experiences of the discharge process between intensive care unit and general ward.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. AIMS AND OBJECTIVES: The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. DESIGN AND METHODS: Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen. FINDINGS: The analysis revealed three themes that reflect the challenges in nursing former ICU patients a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients. CONCLUSIONS: The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need. RELEVANCE TO CLINICAL PRACTICE This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period.