Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
J Multidiscip Healthc. 2013 Oct 4;6:379-89. doi: 10.2147/JMDH.S51947. eCollection 2013.
Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes.
A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach.
Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture.
To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.
在医院和家庭护理服务之间过渡的老年人处于特别脆弱的境地，并且面临因组织效率低下而导致的不幸后果的风险。本报告研究的目的是阐明家庭护理领导者如何体验对从医院过渡到自己家中的老年人进行护理管理。
采用定性研究设计。挪威南部两个市的 10 名家庭护理领导者参加了个人访谈。访谈文本被录音、逐字转录，并通过现象学-解释学方法进行分析。
从数据中推断出三个主要主题和七个子主题。第一个主要主题是家庭护理领导者感到家庭护理服务的组织受到挑战。与这一主题相关的有两个子主题。第一个是领导者缺乏对过渡过程的参与，第二个是他们受到在市一级的另一个层面决定护理管理的挑战。第二个主题是领导者感到他们处于不断变化和不稳定的环境中。与之相关的是，他们必须调整内部资源以适应外部需求和期望，并经历与重要他人缺乏沟通。第三个主题是领导者努力根据专业价值观提供护理。相关的两个子主题是，他们首先提供适当的内部系统和常规，其次是他们优先考虑可用的专业能力，并努力促进专业文化。
为了以专业的方式满足患者的复杂需求，家庭护理领导者在护理管理方面需要灵活和务实。这涉及到适当地利用可用的专业能力。不同组织层次和单位之间的协调和沟通被指出是需要改进的主要因素。
