title: Cooperation in the care for patients with home enteral tube feeding  throughout the care trajectory: nurses' perspectives.
abstract: OBJECTIVE
  The aim of this study was to explore how the planning, daily care and follow-up procedures work in the care trajectory for patients treated with home enteral tube feeding, from the perspective of hospital and community care nurses.
  
  
  BACKGROUND
  Discharge planning for patients in need of home enteral tube feeding is a complex process. Several studies have described routines for discharge and care of patients with home enteral tube feeding in the care trajectory, but few studies have investigated how this really works.
  
  
  METHODS
  A qualitative method with a phenomenographic approach was used. Interviews, with open-ended questions, with ten nurses from both hospitals and communities were performed.
  
  
  RESULTS
  One main category, 'cooperation', emerged, which describes an hierarchical relationship to three description categories: 'nurses' knowledge', 'nurses' view of responsibility' and 'nurses' professional awareness and commitment'. Each of these contained two sub-categories showing a positive and a negative pole.
  
  
  CONCLUSIONS
  Cooperation in the care of patients with home enteral tube feeding throughout the care trajectory was influenced by the nurses' knowledge about enteral tube feeding, the discharge-planning process, and whether their responsibility was clearly distributed. Whether nurses had a patient- or task-oriented attitude was also important. Inefficient cooperation was considered having negative effects on the quality of care regarding home enteral tube feeding.
  
  
  CONCLUSIONS
  This study has stressed the need for improving cooperation and communication between nurses at hospitals and in communities, as well as for increasing nurses' level of knowledge, to make home enteral tube feeding work in a safe way. It also has illuminated the urgent need to clarify responsibility distribution at the workplace, which is a question for nurse managers. Discussions should be undertaken among nurses about guidelines for tube feeding care and discharge process, as this is the responsibility of all professional nurses.
authors.affiliation: Department of Nursing, Karlstad University, Karlstad, Sweden. kaisa.bjuresater@kau.se
authors.forename: Kaisa
authors.initials: K
authors.lastname: Bjuresäter
authors.forename: Maria
authors.initials: M
authors.lastname: Larsson
authors.forename: Gun
authors.initials: G
authors.lastname: Nordström
authors.forename: Elsy
authors.initials: E
authors.lastname: Athlin
mesh_terms: D004750:Enteral Nutrition; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D009726:Nurses / Q000523:psychology*; D013548:Sweden