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Purpose: Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process. Methods: A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses. Results: The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories-- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure". Conclusions: The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to present success factors for increasing quality and safety of intensive care unit (ICU) transitional care as described by co-workers at the sharp end using the core values of total quality management (TQM) as a theoretical lens. Methodology/Approach: The study had a qualitative design, with data from nine interdisciplinary focus group discussions, including co-workers from the intensive care and general wards. Data were sorted into TQM core values and analysed using qualitative content analysis. Findings: Quality and safety in transfer processes requires a holistic view, avoiding silos, shared arenas for collaboration, and evidence-based methodologies and tools for safe transfers. Research Limitation/Implication: A limitation of this study is that it only portrays the challenges encountered by two hospitals during the process of transitional care in the ICU. Originality/Value of paper: By using TQM core values as a theoretical lens, we could present a usable, holistic picture of success factors and how to improve the transfer process. Category: Research paper [ABSTRACT FROM AUTHOR]

Background : The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist. Aim : To obtain a deeper understanding of Registered Nurse Anesthetists' main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia. Participants: A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II). Method: A classic grounded theory approach with a qualitative design was used for this study. Findings: The RNAs' main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: 'Having a back-up plan', 'Getting into the right frame of mind', 'Evaluating the patient's reactions', 'Using one's own experience', 'Dealing with uncertainty', 'Pressure from others', and 'Being interrupted'. The theory, Safeguarding the patient in the process of extubation, emerged. Conclusion: To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR. [ABSTRACT FROM AUTHOR]

Abstract Objective: The aim of this study was to describe critical care nurses' and ward nurses' perceptions of the benefits and challenges with a nurse-led follow-up service for intensive care-survivors at general wards. Background: Patients recently transferred from intensive care to the general ward are still vulnerable and require complex care. There are different models of intensive care follow-up services and some include ward visits after transfer from intensive care. Research methodology/design: This study had a qualitative design. Data from 13 semi-structured interviews with Swedish critical care nurses and ward nurses were analysed using qualitative content analysis. Findings: The findings consisted of one theme, namely, " Being a part of an intra-organisational collaboration for improved quality of care ", and four subthemes: " Provides additional care for the vulnerable patients , " Strengthens ward-based critical care ", " Requires coordination and information ", and " Creates an exchange of knowledge ". The nurse-led follow-up service detected signs of deterioration and led to better quality of care. However, shortage of time, lack of interaction, feedback and information about the function of the follow-up service led to problems. Conclusion: The findings indicate that ward visits should be included in the intensive care follow-up service. Furthermore, intra-organisational collaboration seems to be essential for intensive care survivors' quality of care. [ABSTRACT FROM AUTHOR]

Objective: Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians. Aim: To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs. Research methodology/setting: Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied. Results: The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm. Conclusion: Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety. [ABSTRACT FROM AUTHOR]

Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients' transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient's care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to provide a deeper understanding of the experience of intensive care staff regarding the reduction in the use of medical technology prior to patients' transfer from the ICU. Background: The goal of ICU transitional care, provided for intensive care patients before, during and after the transfer from the ICU to another care unit, is to ensure minimal disruption and optimal continuity of care for the patient. To smooth this transition, there is a need to prepare for a less technological environment and therefore also a need for a gradual reduction in the use of monitoring equipment. Method: Group interviews and individual interviews, together with participant observations, were conducted with ICU staff in two hospitals in Sweden. The data were analysed using classic grounded theory. Results: The main concern was the ICU staff's ambiguity regarding whether and how to reduce the use of medical technology devices. Insecurity about weaning patients from medical equipment combined with a lack of standardized routines made it difficult for staff to reduce the technical support. The core category describes how the ambiguity was solved primarily by ' prioritizing control'. However, this often caused the ICU staff to use advanced technology while the patients were in the ICU until the ward staff arrived, even if this should have been handled otherwise. Why and how the ICU staff used the strategy of ' prioritizing control' is further explained in the categories ' being affected by cultural/contextual aspects', 'searching for guidance and a shared understanding' and ' weighing advantages with more v s less technology'. Conclusion: It is important to consider ICU staff ambiguity concerning the reduction in technology and to establish strategies for a safe and structured transitional phase with step-down procedures in which technology and monitoring is gradually reduced prior to transfer from ICU. [ABSTRACT FROM AUTHOR]