Collaboration between professionals in primary and secondary healthcare services about hospital-at-home for children: A focus group study from the perspectives of stakeholders.

Collaboration among healthcare providers is regarded as a promising method to improve care quality and patient outcomes with limited human and financial resources. In Norway, "hospital-at-home" refers to care given by teams from the hospital pediatric wards who provide treatment and care in the family's home. When children need home visits multiple times daily, the hospital-at-home often reaches out to municipality healthcare providers, asking them to share this task. We aimed to explore the collaboration between stakeholders to gain knowledge on matters concerning the transfer of pediatric competence between hospital and home-based care, and to gain insight into how to set up the service for children in the future. We conducted three focus group interviews. The results showed that managing hospital-at-home collaboratively came with various challenges concerning unclear responsibilities between hospitals and homecare services and several obstacles to setting up cooperation across service levels. Thus, positive collaboration experiences between hospital and homecare settings were shared. Formalizing this collaboration was considered important for future collaboration. Building competence and learning from and with each other ensures better conditions for success if the collaboration is organized and facilitated through agreements between the hospital and the municipalities.

The work of nurses to provide good and safe services to children receiving hospital-at-home: A qualitative interview study from the perspectives of hospital nurses and physicians.

AIM: To explore and describe the work performed by the nurses providing hospital-at-home care to children and their families from the perspectives of hospital nurses and physicians. BACKGROUND: To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital-at-home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians' perspectives on the work performed and competence needed when children receive hospital treatment in the family's home. DESIGN: A qualitative descriptive design with semi-structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital-at-home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on 'expert nursing' supported the discussion of results. RESULTS: We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital-at-home; and nurses serving as the 'hub' between the different parties. CONCLUSION: The results demonstrate the complexity of the work performed by hospital nurses when children received hospital-at-home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating 'hub' for actors involved, taking care of patient safety on a daily basis. RELEVANCE TO CLINICAL PRACTICE: The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.

Being in control and striving for normalisation: A Norwegian pilot study on parents' perceptions of hospital-at-home.

In recent decades, there has been a shift from hospitalisation to home care throughout the Western world, even for children. Hospital-at-home for children is in a developmental phase and represents a new service model in Norway. The aim of this pilot study conducted in a Norwegian healthcare setting was to explore how parents with a sick child experienced early hospital discharge and further care at home. The qualitative data are drawn from nine interviews with parents with a child admitted to hospital-at-home. Transcripts of interviews were analysed using a method of qualitative content analysis. In the analysis, Antonovsky's salutogenic perspective on how people cope in demanding life situations was applied. The results show that the parents experienced hospital-at-home as providing a calmer, more predictable family life compared to hospitalisation. They argued that good information and training in medical procedures prior to hospital discharge made hospital-at-home easier to master. The participants pointed out the importance of the professionals' competence and their ability to interact with the child and the parent. The certitude that they could return to the hospital at any time made them feel safe and in control. The parents associated hospital-at-home with a kind of normalisation of their family life. They had a prominent need for normalisation, and this was probably a motivation for agreeing to the hospital-at-home arrangement. The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of health care is established; there must be a certain volume of patients and the distance to the hospital must be clearly limited. Norwegian policymakers should initiate more pilot testing of hospital-at-home for children. Users and clinicians should be involved in establishing and evaluating these services.

Negotiating safety and responsibility in caregiving to children receiving hospital-at-home: A Norwegian study of parents and homecare nurses' experiences.

Healthcare policies in Western countries increasingly emphasise the avoidance of hospitalisation to reduce hospital admissions. Hospital-at-home for children is a treatment offered to children at home that would otherwise require hospitalisation. Norway practices a model where homecare services play a significant role in assisting the hospital when children need home visits beyond the capacity of what the hospital can offer. Although homecare nurses' work has been affected by several changes in recent decades, few have reported on what these changes imply for homecare nurses' work and family caregivers. The aim of this study was to explore how parents and homecare nurses worked and collaborated in home visits to children receiving hospital-at-home, focusing on how they negotiated caregiving. We conducted 16 interviews: six interviews with parents and 10 interviews with homecare nurses. The interviews were analysed thematically. Both parents and homecare nurses described these home visits as challenging, indicating experiences of distrust. Parents had carefully observed homecare nurses, checking whether they knew how to treat the child and perform the clinical procedures. Homecare nurses had invested much energy into being perceived as calm and trustworthy by the parents. We applied the perspective of negotiation to understand the work and collaboration reported by parents and homecare nurses when unsafety or uncertainty was experienced during home visits, revealing the complexity of their roles in dealing with such events. The results showed the reciprocal dependency between the parents and the homecare nurses that enabled them to perform caregiving work in partnership, sharing responsibility. Our findings suggest that the collaboration with hospital-at-home has an impact on the feeling of safety and control for both parties. We question whether there is a danger of too much responsibility being left with the parents when homecare services are involved.