title: Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales.
abstract: BACKGROUND
  Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail.
  
  
  OBJECTIVE
  To examine conditions for continuity and integration of the patient perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients.
  
  
  METHODS
  Explorative Participatory Action Research (PAR).
  
  
  METHODS
  An acute, general medical ward at a Danish university hospital.
  
  
  METHODS
  Hospital and municipality nurses (n = 29). Nursing records (n = 12).
  
  
  METHODS
  Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis.
  
  
  RESULTS
  Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient perspective in care trajectories of older, chronically ill patients. Although they adhered to these ideals, they rarely pursued them in practice. Hindering factors were: organisational values, episodic focus on patients and lack of time. They felt caught in a value conflict between nursing professional values and system values, which caused a feeling of powerlessness, maintaining status quo in their clinical practice.
  
  
  CONCLUSIONS
  The prevailing episodic focus and the competing rationales on the ward constituted a barrier to continuity and integration of the patient perspective in a comprehensive way.
authors.affiliation: Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Kjerholt
authors.forename: Lis
authors.initials: L
authors.lastname: Wagner
authors.forename: Charlotte
authors.initials: C
authors.lastname: Delmar
authors.forename: Jane
authors.initials: J
authors.lastname: Clemensen
authors.forename: Tove
authors.initials: T
authors.lastname: Lindhardt
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000451:nursing*; D055812:Community-Based Participatory Research; D003266:Continuity of Patient Care; D003718:Denmark; D017144:Focus Groups; D005851:Geriatric Nursing; D006801:Humans; D007407:Interviews as Topic; D009731:Nursing Audit
keywords: care trajectory; continuity; nursing values; older patients; patient perspective; powerlessness