title: Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement.
abstract: OBJECTIVE
  To investigate registered hospital and nursing home nurses' experiences of coordination and communication within and between care settings when older persons are transferred from nursing homes to hospital and vice versa.
  
  
  BACKGROUND
  It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.
  
  
  METHODS
  A descriptive study design with a qualitative approach was used.
  
  
  METHODS
  In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.
  
  
  RESULTS
  Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursing home registered nurses suggested increased collaboration to understand each other's work situation better.
  
  
  CONCLUSIONS
  Communication and coordination among hospital and nursing home registered nurses need to be furthered improved. Registered nurses' coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursing care and unnecessary transfer and admission to hospital.
authors: Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden. marie.kirsebom@pubcare.uu.se
authors: Marie
authors: M
authors: Kirsebom
authors: Barbro
authors: B
authors: Wadensten
authors: Mariann
authors: M
authors: Hedström
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D017144:Focus Groups; D006739:Hospital Administration; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D013548:Sweden