The influence of sociodemographic factors and close relatives at hospital discharge and post hospital care of older people with complex care needs: nurses’ perceptions on health inequity in three Nordic cities

Abstract

Hospital discharge of older people in need of both medical and social care following their hospital stay requires extensive coordination. This study aims to examine and compare the views of nurses in three Nordic cities on the influence of sociodemographic factors and having close relatives, for the hospital discharge and post hospital care of older people with complex health and social care needs. Thirty-five semi-structured interviews (Copenhagen n = 11, Tampere n = 8, Stockholm n = 16) with nurses were conducted. The nurses were identified through the researchers’ networks, invitation and snowball sampling, and recruited from hospitals, primary care practices, home care units, home nursing units, and geriatric departments. The interviews were transcribed and analysed using thematic analysis. Interpretations were discussed and agreed within the team. Four main themes and 13 sub-themes were identified. Across the cities, informants reported that the patient’s health status, rather than their gender or ethnicity, steered the discharge date and further care. Care costs, commonly reported in Tampere but also in Copenhagen and Stockholm including costs for medications and home help, were considered barriers for disadvantaged older people. Home situation, local arrangements and differences in collaboration between healthcare professionals at different sites also influenced the hospital discharge. Generally, the patient’s health status steered the hospital discharge and post-hospital care. Close relatives were regarded important and a potential advantage. Some informants tried to compensate for the absence of close relatives, highlighting the importance of care systems that can compensate for this to minimise avoidable inequity.

The organisation and responsibility for care for older people in Denmark, Finland and Sweden: outline and comparison of care systems

“…These changes are partly driven by the rapidly ageing population, with high demand for health and social care, a major challenge that Finland shares with its Nordic neighbours [ 8 ]. Indeed, care coordination can facilitate the care to older people with complex health and social care needs [ 9 ]. Managing the responsibility for both health and social care at the same administrative level (i.e.…”

“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

“…Previous studies have found that bilingual healthcare workers as well as relatives are commonly used for translation in EDs and other healthcare settings instead of professional interpreters. [ 22 , 23 ] Using relatives for translation has however been found to be error-prone. [ 24 ] Further, the usage of relatives, especially younger children, can be problematic from both the carer perspective and relative perspective.…”

“…[ 24 ] Further, the usage of relatives, especially younger children, can be problematic from both the carer perspective and relative perspective. [ 23 , 25 ] Patients not having access to an interpreter can also result in extensive mistakes. For instance, in a case in California, a healthy kidney was removed instead of the diseased one, as a patient underwent a nephrectomy after the patient signed a consent form in English and was not provided with an interpreter.…”

Healthcare professionals’ perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals

“…A semi-structured interview guide was developed based on previous research to address the research questions [1,8,30,31]. The interview guideline included questions on the health professionals' contributions, responsibilities, and influence on the discharge process.…”