Electronic exchange of discharge summaries between hospital and municipal care from health personnel's perspectives

<p><strong>Introduction</strong>: Information and communication technologies (ICT) are seen as potentially powerful tools that may promote integration of care across organisational boundaries. Here we present findings from a study of a Norwegian project where an electronic interdisciplinary discharge summary was implemented to improve communication and information exchange between the municipal care service and the associated hospital.<br /><strong>Objective</strong>: To investigate the implications of introduction and use of the electronic discharge summary for health staff, and relate it to the potential for promoting integration of care across the hospital-municipality boundary. <br /><strong>Methods</strong>: We conducted semi-structured interviews with 49 health care providers. The material was analysed using a three-step process to identify the main themes and categories. <br /><strong>Findings</strong>: The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate.<br /><strong>Conclusion</strong>: Introduction of electronic discharge summaries did not result in a significant increase in integration of care. However, the project was a catalyst for the collaborating participants to address their interaction from new perspectives.</p

Cultural diversity between hospital and community nurses: implications for continuity of care

Introduction: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. <br /><br />Challenges: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. <br /><br />Discussion: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future

Nurses’ information management at patients’ discharge from hospital to home care

PURPOSE: The purpose of this paper is to explore and compare hospital and home care nurses’ assessment of their information management at patients’ discharge from hospital to home care before and after the hospital implemented an electronic nursing discharge note. THEORY: This paper draws on the concept of inter-organizational continuity of care, and specifically addresses the contribution of the implementation of an electronic patient record (EPR). METHODS: The study has a prospective descriptive design. A questionnaire addressing the information that hospital and home care nurses exchange when patients need continuing care after hospitalization was developed and used. RESULTS: Hospital and home care nurses differed in the way they assessed the structures and content of the information they exchanged, both before and after the EPR implementation. CONCLUSION AND DISCUSSION: There is a need to take account of the different organizational contexts within which the two nursing groups work. The organizational context (hospital versus home care) has implications for the nurses’ assessment of the information they exchange. In further development of EPR, it is therefore essential to clarify the context-related information needs of the various health care provider groups as part of the commitment to patient safety

Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single‑case study

Today, the ageing population is larger than ever before, and people who are living longer with chronic illnesses and multimorbidity need support from multiple healthcare service levels. Similarly, healthcare systems are becoming increasingly specialised and fragmented. The World Health Organization has highlighted novel policies for developing integrated and person-centred services. However, patients, next of kin and health professionals face several challenges in managing healthcare during the care trajectory. Limited literature has addressed the challenges experienced by these groups. Therefore, this study aimed to identify the dilemmas and deliberations faced by patients, next of kin and health professionals during the care trajectory of elderly patients with complex healthcare needs.Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single‑case studypublishedVersio

Unpacking Healthcare Professionals’ Work to Achieve Coherence in the Healthcare Journey of Elderly Patients: An Interview Study

Aim: Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain. Methods: This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed. Results: The analyses revealed three central themes in the healthcare professionals’ work to build coherence in the patients’ care trajectory: Working to manage a patient’s illness trajectory during the course of the patient’s life, working to achieve a comprehensive overall picture, and considering multiple options in a “patchwork” terrain. Conclusion: Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person’s journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient’s life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient’s complex care trajectory. Keywords: older, care trajectory, complex healthcare, health personnel, interdisciplinarypublishedVersio

The Impact of an In-service Educational Program on Nurses' Knowledge and Attitudes Regarding Pain Management in an Ethiopian University Hospital

Background: Although pain control for hospitalized patients is a central issue for all health care providers, nurses' knowledge, and attitudes are the major barriers. Educational program is a strategy to improve nurses' knowledge and attitudes on pain management. However, there is paucity of information on how in-service education program influences nurses' knowledge and attitudes score for pain management in Ethiopia. The objective of this study was therefore, to investigate the influence of an in-service educational program on nurses' knowledge and attitudes regarding pain management in an Ethiopian university hospital.Methods: A quasi-experimental study was conducted between 1 October and 15 November 2016. Totally 111 nurses working at Jimma University Medical Center participated in the study. We provided 2 consecutive days of intensive pain management education with a follow-up training session after 1 month. Knowledge and Attitudes Survey Regarding Pain (KASRP) was used as a tool for measuring the impact of educational program. Data were analyzed using the Wilcoxon signed-rank test, and results were considered significant at p &lt; 0.05.Result: Of the 111 nurses, who participated in the study, 39.5% were female, 46.8% had a baccalaureate degree, and 67.6% had worked in nursing for 6–10 years. The mean age of respondents was 26.9 (SD ± 5.6) years. On average, participants answered 41.4% of the survey items correctly before the intervention and 63.0% after the intervention. The mean rank score of nurses' knowledge and attitudes regarding pain significantly improved following participation in the educational program (Z = −9.08, p &lt; 0.001).Conclusion: The educational program improved nurses' scores for pain management knowledge and attitudes. This may lead to more effective pain management by nurses

Interaction Beyond Boundaries, 2009.

New ways of collaboration between health care providers, i.e. physicians and nurses in hospital and the community health care need to be taken into account to meet the challenges in health care where more patients need post-hospital home health care (HHC). Despite great emphasis on clarifying what information should be exchanged between the organisations - existing information flow and content is characterized by mono-professional patterns. The implication is lack of information, inaccurate information, errors, and that the providers spend much time to receive adequate information. We have limited knowledge about the providers' reasoning when they produce and exchange information across organisations. In this project we aim to develop knowledge about hospital nurses' and doctors' production and exchange of information when they interact with colleagues in the community health care. Four research questions are identified: 1. What criteria do health providers use in hospital care systems when they provide information about the patient's need for community care (CC) throughout the patient's stay, from admission to discharge? 2. How do health providers in CC evaluate the information received from their colleagues in hospital care systems about the patient's hospital stay? 3. How do health providers use the patient journal in the information exchange with CC during the patient's stay and what effect does the electronic patient journal system have on the information exchange? 4. What is the significance of the characteristics of the professions and organizations in the production and exchange of information? Both interviews and questionnaires will be used through two phases. First, interviews will be conducted with health providers from the hospital and community care. The results of these interviews will be the basis for the development of a questionnaire. Second a representative selection of health providers of medical and surgical departments in general hospitals in Norway will be surveyed using this questionnaire

Bridging the Information Gap in Patient Transitions, 2012 - questionnaire

The health care sector is facing huge challenges due to the demographic and economic constraints. The municipal health care sector is expected to receive an even more important role in the health care sector in the years to come. This implies a greater need for collaboration and communication, hence interaction, between health care providers, both across the sector and within the different parts. One often proposed solution to improve interaction in health care is to employ ICT, so-called eHealth. By strengthening interaction, the aim is in turn to improve quality of care for patients and make health care more efficient. The overall objective of the project is to develop knowledge about intra- and inter-organisational electronic interaction between health care providers. More specifically, our aim is to obtain knowledge of how the introduction of a standardised tool for electronic interaction, illustrated by the ELIN-k system, affects collaboration and cooperation between nurses and physicians in municipal and with nurses and physician in the specialist health care. The project is divided into two sub-objectives: 1) exploring local adaption of a central guideline and how information and communication practices are affected, and 2) to describe how the national initiated ELIN-k standard affects the organisations of interaction and the nurses and physicians experiences regarding the introduction of the system for electronic interaction. We will draw on a combination of qualitative and quantitative methods to study the introduction of the ELIN-k system applying participant observation, interviews, surveys and document studies

Bridging the Information Gap in Patient Transitions, 2012 - qualitative interviews

The health care sector is facing huge challenges due to the demographic and economic constraints. The municipal health care sector is expected to receive an even more important role in the health care sector in the years to come. This implies a greater need for collaboration and communication, hence interaction, between health care providers, both across the sector and within the different parts. One often proposed solution to improve interaction in health care is to employ ICT, so-called eHealth. By strengthening interaction, the aim is in turn to improve quality of care for patients and make health care more efficient. The overall objective of the project is to develop knowledge about intra- and inter-organisational electronic interaction between health care providers. More specifically, our aim is to obtain knowledge of how the introduction of a standardised tool for electronic interaction, illustrated by the ELIN-k system, affects collaboration and cooperation between nurses and physicians in municipal and with nurses and physician in the specialist health care. The project is divided into two sub-objectives: 1) exploring local adaption of a central guideline and how information and communication practices are affected, and 2) to describe how the national initiated ELIN-k standard affects the organisations of interaction and the nurses and physician experiences regarding the introduction of the system for electronic interaction. We will draw on a combination of qualitative and quantitative methods to study the introduction of the ELIN-k system applying participant observation, interviews, surveys and document studies