[Transferring palliative-care patients from hospital to community care: A qualitative study]
- PMID: 27842728
- PMCID: PMC6876029
- DOI: 10.1016/j.aprim.2016.09.003
[Transferring palliative-care patients from hospital to community care: A qualitative study]
Abstract
Aim: To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes.
Design: Qualitative phenomenological study carried out in 2014-2015.
Setting: Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively.
Participants: A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting.
Method: Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method.
Results: Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer".
Conclusions: Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home.
Objetivo: Conocer la experiencia de las enfermeras gestoras de casos sobre la transferencia de pacientes que requieren cuidados paliativos desde el hospital hasta su domicilio.
Diseño: Estudio cualitativo de corte fenomenológico realizado en 2014-2015.
Emplazamiento: Distritos sanitarios Poniente y Almería, cuyos hospitales de referencia son el Hospital de Poniente y Torrecárdenas, respectivamente.
Participantes: Mediante muestreo intencional se seleccionó a 12 enfermeras de casos de la provincia de Almería.
Método: Se grabaron 7 entrevistas abiertas y un grupo de discusión, hasta alcanzar la saturación de los datos. El análisis de datos siguió el procedimiento de Colaizzi.
Resultados: Emergieron 3 categorías: 1) la enfermería de gestión de casos como servicio de calidad orientado al ciudadano; 2) fallos de los sistemas de información; con las subcategorías «información previa de pacientes insuficiente e inadecuada» y «medios de comunicación interniveles ineficaces para una enfermería avanzada», y 3) deficiencias en la planificación del alta, con las subcategorías «deficiente gestión de recursos durante el ingreso», «incertidumbre sobre el momento del alta» y «recursos humanos insuficientes para coordinar la transferencia».
Conclusiones: Las enfermeras gestoras de casos se consideran como un servicio de calidad. Pero creen que existen problemas de coordinación, información y planificación del alta de los pacientes paliativos desde el hospital. Sería útil revisar los circuitos de envío de los informes de cuidados y la planificación al alta para que los pacientes paliativos tengan gestionados todos los recursos necesarios en el momento de ser transferidos a su domicilio.
Keywords: Continuidad de cuidados; Continuum of care; Cuidados paliativos; Investigación cualitativa; Palliative care; Patient transfer; Qualitative research; Transferencia de pacientes.
Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
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