Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study

Abstract

Aims and objectives This study aimed to (1) describe the development of integrated services between hospital‐based heart failure nursing services and municipally located home care nurses’ services and (2) identify the benefits of this collaboration for the development of home care nursing services. Background Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved. Design A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure. Methods Data were field notes from observations at meetings of the steering group designing the services, visits to patients’ homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist. Results In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients’ homes. A clinical pathway was developed to assure effective assessment of patients’ condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition. Conclusions The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services. Relevance to clinical practice The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.

Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study

“…Ethnographic qualitative studies involve observation of the patients and caregivers in their real-world settings to determine how they behave in specific contexts. Ethnographic research collects comprehensive information from multiple sources such as interviews, caregiver perspectives, non-participant observation of healthcare visits and home tours, among others, and has previously been carried out to investigate QoL in patients with HF 12 22–27. Previous ethnographic studies conducted in patients from the UK identified barriers to interventions for HF and critical points on disease pathways which resulted in an increase in the risk of admission 28–30…”

Changes in home care clients’ characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data

“…Another example is Iceland, where the government has working on integrating health and social services and increased cooperation between emergency services and primary care [32,33]. Various steps have also been taken to improve collaboration and information sharing between these two services, for example, development of clinical pathways for the treatment of heart failure [34,35] and opening electronic access to hospital health records for home care nurses. Home care nurses indicate that these measures have changed the working conditions in home care nursing so that frail older people with more complex health problems can live at home.…”

Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all‐cause death in heart failure patients

“…Data from the China Hypertension Survey (CHS) show that 1.3% of the Chinese adult population aged ≥35 years had HF. It has been emphasized that nurses play an important role in assessing, monitoring, and providing patient care as well as improving outcomes in HF (Bjornsdottir et al, 2021 ; Ordóñez‐Piedra et al, 2021 ; Sezgin et al, 2017 ; Yang et al, 2020 ; Zhang et al, 2020 ). However, more advanced and intensive care means greater burdens on nurses and other care‐givers.…”