title: [Seamless nursing care from the hospital to home].
authors.forename: Monique Sailer
authors.initials: MS
authors.lastname: Schramm
authors.forename: Rita
authors.initials: R
authors.lastname: Willener
mesh_terms: D000359:Aftercare / Q000458:organization & administration*; D002908:Chronic Disease / Q000451:nursing*; D003299:Cooperative Behavior; D006699:Home Care Services / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D033183:Interdisciplinary Communication; D009730:Nursing Assessment / Q000458:organization & administration; D010347:Patient Care Planning / Q000458:organization & administration; D010351:Patient Discharge; D013557:Switzerland