Mid Sweden University

Purpose: Although previous research indicates that care transitions differ between rural andurban areas, the knowledge of challenges related to care transitions in rural areas appearslimited. This study aimed to provide a deeper understanding of what registered nurses’perceive as the main concerns in care transitions from hospital care to home healthcare inrural areas, and how they handle these during the care transition process.

Methods: A Constructivist Grounded Theory method based on individual interviews with 21registered nurses.

Results: The main concern in the transition process was “Care coordination in a complexcontext”. The complexity stemmed from several environmental and organizational factors,creating a messy and fragmented context for registered nurses to navigate. The core category“Actively communicating to reduce patient safety risks” was explained by the three categories–“Collaborating on expected care needs”, “Anticipating obstacles” and “Timing the departure”.

Conclusions: The study shows a very complex and stressed process that includes severalorganizations and actors. Reducing risks during the transition process can be facilitated byclear guidelines, tools for communication across organizations and sufficient staffing.

Background

Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses’ perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas.

Methods

We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian’s definition of structures regarding the quality of care.

Results

The structural conditions were represented by three themes; (I) “Distances and inaccessibility” explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) “Competence of the actors” explains continuity, knowledge and collaboration among the individuals involved. (III) “Levels of organizational governance” explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others.

Conclusions

Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

Background: Leadership is vital for well-coordinated healthcare and affects the quality of care and patient safety. Nursing leaders are crucial in creating appropriate structures and processes to enhance patient outcomes during care transitions in a rural context. Despite their importance to care transitions, there is limited research on nursing leaders’ perspectives in rural settings. This study explored nursing leaders’ concerns regarding the provision of quality care during transitions from hospital care to home healthcare in rural areas and their experiences in improving these processes.

Methods: A qualitative study using constructivist grounded theory methodology was conducted. Twenty nursing leaders in hospital and rural municipal care in Sweden were interviewed. All were educated in social care or healthcare, most in nursing, and most had a master’s degree. Data were analyzed using constant comparative analysis.

Results: Nursing leaders’ main concern about creating quality care in transitions was a lack of clearly defined, shared goals for a high-quality care transition. The core category explaining their approach was minding one’s unit by working within organizational unit borders. Three categories further explained this: (I) promoting nursing competence by recruiting and training nurses, emphasizing patient involvement, (II) ensuring continuous care flow by collaborating within one’s organization and clarifying rights and obligations, and (III) evaluating collaboration within each unit.

Conclusions: Seamless care transitions are challenging when nursing leaders lack clear, mutually shared quality goals for care transitions. Implications for nursing management include improving collaborative routines, establishing common platforms, and integrating patient input throughout the process, as these measures are essential for enhancing interorganizational collaboration in rural care transitions.

Background

The transition from hospital to home represents a pivotal and potentially high-risk phase for older adults, especially within rural contexts where geographical remoteness, limited resources, and decentralized healthcare infrastructure amplify vulnerabilities. Existing literature offers limited insight into the experiences of rural older adults during this transitional process. Therefore, this study aimed to explore older adults’ experiences of transitioning from hospital to home in rural settings and to describe how they felt during the process.

Methods

This qualitative study used open, unstructured interviews to explore older adults’ experiences of hospital-to-home transitions in a rural region of northern Sweden. Nine older adults (aged 69–85) who had recently been discharged from somatic inpatient wards of a county hospital participated. In one interview, the spouse of one of them also participated. Data were analyzed using a six-phase Reflexive Thematic Analysis.

Results

Older adults’ hospital-to-home transitions were experienced as twofold, involving both a physical transition from hospital to home and an inner transition of self-image. Their experiences related to three interconnected dimensions: organizational, psychological, and social. The themes identified were “Knowing one’s way through the healthcare system,” “Understanding and managing one’s thoughts and emotions,” and “Feeling socially connected.”

Conclusions

Care transitions for older adults in a rural context are complex and highly personal; therefore, healthcare professionals must thoroughly assess each individual’s specific circumstances, including their psychological resources and social networks, during care planning.