The work of nurses to provide good and safe services to children receiving hospital‐at‐home: A qualitative interview study from the perspectives of hospital nurses and physicians

Abstract

Aim To explore and describe the work performed by the nurses providing hospital‐at‐home care to children and their families from the perspectives of hospital nurses and physicians. Background To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital‐at‐home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians’ perspectives on the work performed and competence needed when children receive hospital treatment in the family's home. Design A qualitative descriptive design with semi‐structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital‐at‐home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on ‘expert nursing’ supported the discussion of results. Results We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital‐at‐home; and nurses serving as the ‘hub’ between the different parties. Conclusion The results demonstrate the complexity of the work performed by hospital nurses when children received hospital‐at‐home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating ‘hub’ for actors involved, taking care of patient safety on a daily basis. Relevance to clinical practice The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.

Negotiating safety and responsibility in caregiving to children receiving hospital‐at‐home: A Norwegian study of parents and homecare nurses' experiences

“…The authors of this paper have previously published two articles regarding HAH, and earlier findings might have coloured the analysis and the research process (Aasen et al, 2018 , 2021 ). Additionally, the first author (L.A.) is an intensive care nurse with extensive working experience with sick children and their parents, which might have influenced how she emphasised and followed certain themes in the interviews and conversations with the nurses and parents.…”

“…In an earlier study, we found that parents based their trust in the services on whether the professionals were competent to care for their child's diseases at home (Aasen et al, 2018 ). Likewise, hospital nurses and physicians emphasised the importance of nurses having solid skills when treating hospitalised children at home (Aasen et al, 2021 ). Other researchers have noted that the treatment of children at home is challenging for homecare nurses due to a lack of experience, training or education in paediatric nursing (Castor et al, 2017 ; Lee et al, 2021 ).…”

Music therapy in paediatric palliative care: A scoping review

“…What is more, symptoms can differ among children, and exact prognoses can be elusive. A study by Aasen et al (2022b) shows the complexity of the work performed by hospital nurses when children receive hospital-at-home, and this complexity emerges in the studies included in this scoping review and the work carried out by music therapists.…”

“…In the middle of these complex treatment situations, there are healthcare workers providing, and patients and families receiving, services which often depend on relationships. Building a trusting relationship and alignment with the impacted child and the family is central to accomplishing safe and effective paediatric care (Aasen et al, 2022b), and this is a fundamental value of music therapy in hospital-at-home as well. While working in the home of the patient, the music therapist is both a guest and a professional service provider.…”

“…In the last three decades, in turn, healthcare services in Europe have undergone a reorganisation that has included a comprehensive shift from hospitalisation to home care. Various ambulatory services combining hospital and home treatment have also emerged (Aasen et al, 2022b). Although the large regions often served by a hospital or hospice make travelling to patients' homes time-consuming, Himelstein et al (2004) highlight the need to make palliative care available in any setting, including the patient's home.…”