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This study analyses the interaction between nurses and paraplegic patients who are indicative of chronically ill persons in their pursuit of self-determination and autonomy, concerning all aspects of life. The study aims at closing a gap in the research about nurse-patient interaction. Data were collected in two German hospitals. We used problem-focussed interviews with nurses and patients, and participant observation at three points of time during the process of mobilisation. Data were analysed by hermeneutic case-reconstruction. The focus of analysis was on themes that were important for patients while receiving care and on how nurses perceive and interpret these themes. In several steps of analysis the categories were derived from the data, then the corresponding ones were linked together in order to establish key categories. This allowed identifying themes of concern for patients during the nursing process. In the next step, the patients' perspective was contrasted with the nurses' perspective. Central themes identified by this comparison were finally documented in a case description. Results show that communication during the nursing process and active participation are of central concern for patients.

This study analyses the interaction between nurses and paraplegic patients. The way how nurses perceived, interpreted and dealt with important themes for patients during the process of care determines the quality of interaction. Based on these findings we developed a model for interaction in the nursing process that is characterised by its orientation towards a mutual understanding. This model enables nurses to systematise nursing negotiation processes, from identifying problems to determining options for interventions to decision-making.

As part of an extensive research project on securing continuity of care through Pflegeüberleitung, data on experiences of patients and their relatives regarding discharge from hospital were collected and analysed by means of a qualitative study. Ten focused interviews were conducted and analysed with five patients and five relatives, respectively. From the results of the patient interviews, the subjective experience of being ill was identified as a main issue, constituting a dimension which pervades all other categories of the results. Patients judge nursing measures regarding the discharge planning in the light of this dimension. The results of the interviews with relatives indicate the lack of interdisciplinary cooperation and coordination. Relatives complain about the missing attempts to come to agreements and about their perspective not being considered regarding care needs as well as the date of discharge. There is a need for the development of new approaches to care and treatment in the hospital which allow for the patient's and the relatives' participation and co-shaping, thereby recognizing an altered understanding of the respective roles. In order to achieve systematic integration of the clients' perspectives, thus securing individual continuity of care, programmes for professional consultancy play an important part of these new approaches.

Until a few years ago, continuity of care in connection with a client's transition from one care setting to another was not considered part of the primary objectives of the health system, due to a strict division of intramural and extra-mural care systems. Nowadays, epidemiological as well as sociographic developments have changed the situation fundamentally. As their common main objective, the different approaches towards Pflegeüberleitung focus on the management of interfaces by reducing breaks in co-ordination, thereby improving the quality of the service. As part of an extensive research project in three hospitals from March 2000 to February 2002 on securing continuity of care through Pflegeüberleitung, specific attention was rendered to the views of nurses involved in it. One of the main findings emerging from the self-assessment focuses on the uncertainty of the nurses involved in Pflegeüberleitung about their own work within the hospital context. This reflects the still insufficient integration of Pflegeüberleitung in the hospital system. Here, organization is still centered on "discharge" as the main work aim rather than the patients' interests reaching beyond system borders.

Continuity of care between health care institutions is of increasing importance. In a two-year research project on this topic extensive participant observation was carried out for data gathering in three hospitals in Düsseldorf (Germany). In each institution four patients were observed until their discharge and all interactions between them and health care professionals were documented using a semi-structured data-gathering instrument. Furthermore, the researchers questioned the involved professionals after each situation. Altogether a total of 980 situations were documented during 100 shifts, thus professional activities aiming at continuity of care can be regarded as extensively covered. The results show that care professionals (nurses, physicians, social workers etc.) in the three participating hospitals only incompletely assess individual needs or even fail to do so at all. In addition, there is no regular interprofessional collaboration and the professionals' horizon is essentially limited to their own institution. Patients and their relatives are not systematically involved and their views rarely considered. Two cases are used as examples to illustrate these aspects. A third example shows that also successful processes were observed. In most cases, however, the implicit logic of the hospital system dominates over individual needs and therefore a successful continuity of care processes cannot be assumed. Finally, the necessity for a fundamental change of this counterproductive systems logic is briefly discussed.