The Transition from Hospital to Home: Older People’s Experiences
Affiliation(s)
1 Faculty of Health and Social Studies, Telemark University College, Porsgrunn, Norway. 2 Centre for Caring Research-Southern Norway, Telemark University College, Porsgrunn, Norway, and University of Agder, Grimstad, Norway. 3 Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
1 Faculty of Health and Social Studies, Telemark University College, Porsgrunn, Norway. 2 Centre for Caring Research-Southern Norway, Telemark University College, Porsgrunn, Norway, and University of Agder, Grimstad, Norway. 3 Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
ABSTRACT
The amount of older patients who are discharged from hospitals while continuing to need care is increasing in Norway. The transition between different care services has the potential for high rates of medication errors, incomplete or inaccurate information transfer, and lack of appropriate follow-up care. Thus, insight into the transition process is vital to understanding the complexity and vulnerability the patients are exposed to in this process. The aim of this phenomenological hermeneutic study was to describe and illuminate the lived experiences of older home residents during the transitions from hospital to home. Data were collected through narrative interviews, and an interpretation analysis based on a method developed by Lindseth and Norberg was conducted. Two themes and four subthemes, closely related to each other emerged from the structural analysis of the text: The theme “Relating to different systems of care” with the two subthemes “feeling disregarded” and “being humble”; and the theme “Adapting to life conditions” with the two subthemes “feeling vulnerable” and “coping with alterations”. The older people miss being seen as human beings as well as patients during the transition process. Despite the lack of information and participation in the transition process, they were grateful and humble to the systems of care they were a part of. This, however, also encompassed rejections of own needs. It is urgent that health care professionals focus on the older person’s individual needs and preferences. This means that care must be considered from the perspectives of the older person’s biographical as well as medical history, and the complexity of the situation.
The amount of older patients who are discharged from hospitals while continuing to need care is increasing in Norway. The transition between different care services has the potential for high rates of medication errors, incomplete or inaccurate information transfer, and lack of appropriate follow-up care. Thus, insight into the transition process is vital to understanding the complexity and vulnerability the patients are exposed to in this process. The aim of this phenomenological hermeneutic study was to describe and illuminate the lived experiences of older home residents during the transitions from hospital to home. Data were collected through narrative interviews, and an interpretation analysis based on a method developed by Lindseth and Norberg was conducted. Two themes and four subthemes, closely related to each other emerged from the structural analysis of the text: The theme “Relating to different systems of care” with the two subthemes “feeling disregarded” and “being humble”; and the theme “Adapting to life conditions” with the two subthemes “feeling vulnerable” and “coping with alterations”. The older people miss being seen as human beings as well as patients during the transition process. Despite the lack of information and participation in the transition process, they were grateful and humble to the systems of care they were a part of. This, however, also encompassed rejections of own needs. It is urgent that health care professionals focus on the older person’s individual needs and preferences. This means that care must be considered from the perspectives of the older person’s biographical as well as medical history, and the complexity of the situation.
Cite this paper
Hvalvik, S. , Dale, B. (2015) The Transition from Hospital to Home: Older People’s Experiences. Open Journal of Nursing, 5, 622-631. doi: 10.4236/ojn.2015.57066.
Hvalvik, S. , Dale, B. (2015) The Transition from Hospital to Home: Older People’s Experiences. Open Journal of Nursing, 5, 622-631. doi: 10.4236/ojn.2015.57066.
References
[1] Norwegian Knowledge Centre for the Health Services, Reinnleggelser av eldre i Norge [Readmission in Norwegian hospitals], 2012. [2] Report No. 47 to the Storting (2008-2009), Samhandlingsreformen. Rett behandling—På rett sted—Til rett tid. [The Coordination Reform. Proper Treatment—At the Right Place and Right Time], Norwegian Ministry of Health and Care Services. [3] Golden, A., Tewary, S., Dang, S. and Roos, B.A. (2010) Care Management’s Challenges and Opportunities to Reduce the Rapid Rehospitalization of Frail Community-Dwelling Older Adults. Gerontologist, 50, 451-458.
http://dx.doi.org/10.1093/geront/gnq015 [4] Coleman, E.A., Parry, C., Chalmers, S. and Min, S. (2006) The Care Transition Intervention. Archieves of Internal Medicine, 166, 1822-1828.
http://dx.doi.org/10.1001/archinte.166.17.1822 [5] Naylor, M.D., Aiken, L.H., Kurtzman, E.T., Oldes, D.M. and Hirschman, K.B. (2011) The Importance of Transitional Care in Achieving Health Reform. Health Affairs, 30, 746-754.
http://dx.doi.org/10.1377/hlthaff.2011.0041 [6] Meleis, A.I. and Trangenstein, P. (1994) Facilitating Transitions: Redefinition of the Nursing Mission. Nursing Outlook, 42, 255-259.
http://dx.doi.org/10.1016/0029-6554(94)90045-0 [7] Report No. 10 to the Storting (2012-2013), God kvalitet—Trygge tjenester. Kvalitet og pasientsikkerhet i helseog omsorgstjenesten. [Good Quality—Safe Services. Quality and Patient Security in the Health and Care Services], Norwegian Ministry of Health and Care Services. [8] Galvin, K. and Todres, L. (2013) Caring and Well-Being: A Lifeworld Approach. Routeledge, London. [9] Bauer, M., Fitzgerald, L., Haesler, E. and Manfrin, M. (2009) Hospital Discharge Planning for Frail Older People and Their Family: Are We Delivering Best Practice? A Review of the Evidence. Journal of Clinical Nursing, 8, 2539-2546. http://dx.doi.org/10.1111/j.1365-2702.2008.02685.x [10] Dedhia, P., Kravet, S., Bulger, J., Hinson, T., Sridharan, A., Kolodner, K., Wright, S. and Howell, E. (2009) A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes. Journal of American Geriatric Society, 57, 1540-1546.
http://dx.doi.org/10.1111/j.1532-5415.2009.02430.x [11] Dunnion, M.E. and Kelly, B. (2008) All Referrals Completed? The Issues of Liaison and Documentation When Discharging Older People from an Emergency Department to Home. Journal of Clinical Nursing, 17, 2471-2479.
http://dx.doi.org/10.1111/j.1365-2702.2007.02084.x [12] Danielsen, B. and Fjær, S. (2010) Erfaringer med å overføre syke eldre pasienter fra sykehus til kommune [Experiences Related to the Transfer of Older Patients from Hospital to Municipality]. Sykepleien Forskning, 5, 28-34.
http://dx.doi.org/10.4220/sykepleienf.2010.0021 [13] Olsen, R.M. (2013) Information Exchange between Home Care and Hospital Nurses during Older Patients Transfer. PhD Thesis, Institutionen fõr Hãlsovetenskap, Mittuniversitetet, Sundsvall. [14] Hvalvik, S. and Reierson, I.Å. (2011) Transition from Self-Supported to Supported Living: Older People’s Experiences. International Journal of Qualitative Studies on Health and Well-Being, 6, 7914.
http://dx.doi.org/10.3402/qhw.v6i4.7914 [15] Foss, C. and Hofoss, D. (2011) Elderly Persons’ Experiences of Participation in Hospital Discharge Process. Patient Education and Counseling, 85, 68-73.
http://dx.doi.org/10.1016/j.pec.2010.08.025 [16] Foss, C., Romøren, T.I., Hofoss, D., Bragstad, L. and Kirkevold, M. (2012) Eldres erfaringer med utskriving frasykehus [Elderly Persons’ Experiences with Hospital Discharge]. Sykepleien Forskning, 7, 324-33.
http://dx.doi.org/10.4220/sykepleienf.2012.0154 [17] Bragstad, L.K., Kirkevold, M., Hofoss, D. and Foss, C. (2012) Factors Predicting a Successful Post-Discharge Outcome for Individuals Aged 80 Years and Over. International Journal of Integrated Care, 12, 1-10. [18] Dahlberg, K., Dahlberg, H. and Nystrøm, M. (2008) Reflective Life World Research. Student literature, Lund. [19] Gadamer, H.G. (1989) Truth and Method. 2nd Edition, Sheed and Ward, London. [20] Ricoeur, P. (1976) Interpretation Theory: Discourse and the Surplus of Meaning. Texas Christian University Press, Fort Worth. [21] World Medical Association (2008) Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. [22] Beauchamp, T.L. and Childress, J.F. (2009) Principles of Biomedical Ethics. 6th Edition, University Press Inc, Oxford. [23] Hvalvik, S. and Reierson, I.Å. (2015) Striving to Maintain a Dignified Life for the Patient in Transition: Next of Kin’s Experiences during the Transition Process of an Older Person in Transition from Hospital to Home. International Journal of Qualitative Studies on Health and Well-Being, 10, 1-10.
http://dx.doi.org/10.3402/qhw.v10.26554 [24] Bragstad, L.K., Kirkevold, M., Hofoss, D. and Foss, C. (2014) Informal Caregivers’ Participation When Older Adults in Norway Are Discharged from the Hospital. Health & Social Care in the Community, 22, 155-168.
http://dx.doi.org/10.1111/hsc.12071 [25] Naylor, M.D. (2002) Transitional Care of Older Adults. Annual Review of Clinical Nursing, 20, 127-147. [26] Report Nr. 29 to the Storting (2012-2013) Morgendagens Omsorg [Tomorrow’s Care]. Norwegian Ministry of Health and Care Services. [27] Rydeman, I.B. and Törnquist, L. (2010) Getting Prepared for Life at Home in the Discharge Process: Form the Perspective of the Older Persons and Their Relatives. International Journal of Older People Nursing, 5, 254-264.
http://dx.doi.org/10.1111/j.1748-3743.2009.00190.x [28] Rydeman, I.B. and Törnquist, L. (2006) The Patient’s Vulnerability, Dependence and Exposed Situation in the Discharge Process: Experiences of District Nurses, Geriatric Nurses and Social Workers. Journal of Clinical Nursing, 15, 1299-1307.
http://dx.doi.org/10.1111/j.1365-2702.2006.01379.x [29] Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.L., Kjellgren, K., Lidén, E., Öhlen, J., Olsson, L.E., Rosén, H., Rydmark, M. and Sunnerhagen, K.S. (2011) Person-Centered Care: Ready for Prime Time. European Journal of Cardiovascular Nursing, 10, 248-251.
http://dx.doi.org/10.1016/j.ejcnurse.2011.06.008 [30] Schumacher, K.L., Jones, P.S. and Meleis, A.I. (1999) Helping Elderly Persons in Transition: A Framework for Research and Practice. In: Swanson, E.A. and Tripp-Reimer, T., Eds., Life Transitions in the Older Adult: Issues for Nurses and Other Health Professionals, Springer, New York, 1-26.
[1] Norwegian Knowledge Centre for the Health Services, Reinnleggelser av eldre i Norge [Readmission in Norwegian hospitals], 2012. [2] Report No. 47 to the Storting (2008-2009), Samhandlingsreformen. Rett behandling—På rett sted—Til rett tid. [The Coordination Reform. Proper Treatment—At the Right Place and Right Time], Norwegian Ministry of Health and Care Services. [3] Golden, A., Tewary, S., Dang, S. and Roos, B.A. (2010) Care Management’s Challenges and Opportunities to Reduce the Rapid Rehospitalization of Frail Community-Dwelling Older Adults. Gerontologist, 50, 451-458.
http://dx.doi.org/10.1093/geront/gnq015 [4] Coleman, E.A., Parry, C., Chalmers, S. and Min, S. (2006) The Care Transition Intervention. Archieves of Internal Medicine, 166, 1822-1828.
http://dx.doi.org/10.1001/archinte.166.17.1822 [5] Naylor, M.D., Aiken, L.H., Kurtzman, E.T., Oldes, D.M. and Hirschman, K.B. (2011) The Importance of Transitional Care in Achieving Health Reform. Health Affairs, 30, 746-754.
http://dx.doi.org/10.1377/hlthaff.2011.0041 [6] Meleis, A.I. and Trangenstein, P. (1994) Facilitating Transitions: Redefinition of the Nursing Mission. Nursing Outlook, 42, 255-259.
http://dx.doi.org/10.1016/0029-6554(94)90045-0 [7] Report No. 10 to the Storting (2012-2013), God kvalitet—Trygge tjenester. Kvalitet og pasientsikkerhet i helseog omsorgstjenesten. [Good Quality—Safe Services. Quality and Patient Security in the Health and Care Services], Norwegian Ministry of Health and Care Services. [8] Galvin, K. and Todres, L. (2013) Caring and Well-Being: A Lifeworld Approach. Routeledge, London. [9] Bauer, M., Fitzgerald, L., Haesler, E. and Manfrin, M. (2009) Hospital Discharge Planning for Frail Older People and Their Family: Are We Delivering Best Practice? A Review of the Evidence. Journal of Clinical Nursing, 8, 2539-2546. http://dx.doi.org/10.1111/j.1365-2702.2008.02685.x [10] Dedhia, P., Kravet, S., Bulger, J., Hinson, T., Sridharan, A., Kolodner, K., Wright, S. and Howell, E. (2009) A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes. Journal of American Geriatric Society, 57, 1540-1546.
http://dx.doi.org/10.1111/j.1532-5415.2009.02430.x [11] Dunnion, M.E. and Kelly, B. (2008) All Referrals Completed? The Issues of Liaison and Documentation When Discharging Older People from an Emergency Department to Home. Journal of Clinical Nursing, 17, 2471-2479.
http://dx.doi.org/10.1111/j.1365-2702.2007.02084.x [12] Danielsen, B. and Fjær, S. (2010) Erfaringer med å overføre syke eldre pasienter fra sykehus til kommune [Experiences Related to the Transfer of Older Patients from Hospital to Municipality]. Sykepleien Forskning, 5, 28-34.
http://dx.doi.org/10.4220/sykepleienf.2010.0021 [13] Olsen, R.M. (2013) Information Exchange between Home Care and Hospital Nurses during Older Patients Transfer. PhD Thesis, Institutionen fõr Hãlsovetenskap, Mittuniversitetet, Sundsvall. [14] Hvalvik, S. and Reierson, I.Å. (2011) Transition from Self-Supported to Supported Living: Older People’s Experiences. International Journal of Qualitative Studies on Health and Well-Being, 6, 7914.
http://dx.doi.org/10.3402/qhw.v6i4.7914 [15] Foss, C. and Hofoss, D. (2011) Elderly Persons’ Experiences of Participation in Hospital Discharge Process. Patient Education and Counseling, 85, 68-73.
http://dx.doi.org/10.1016/j.pec.2010.08.025 [16] Foss, C., Romøren, T.I., Hofoss, D., Bragstad, L. and Kirkevold, M. (2012) Eldres erfaringer med utskriving frasykehus [Elderly Persons’ Experiences with Hospital Discharge]. Sykepleien Forskning, 7, 324-33.
http://dx.doi.org/10.4220/sykepleienf.2012.0154 [17] Bragstad, L.K., Kirkevold, M., Hofoss, D. and Foss, C. (2012) Factors Predicting a Successful Post-Discharge Outcome for Individuals Aged 80 Years and Over. International Journal of Integrated Care, 12, 1-10. [18] Dahlberg, K., Dahlberg, H. and Nystrøm, M. (2008) Reflective Life World Research. Student literature, Lund. [19] Gadamer, H.G. (1989) Truth and Method. 2nd Edition, Sheed and Ward, London. [20] Ricoeur, P. (1976) Interpretation Theory: Discourse and the Surplus of Meaning. Texas Christian University Press, Fort Worth. [21] World Medical Association (2008) Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. [22] Beauchamp, T.L. and Childress, J.F. (2009) Principles of Biomedical Ethics. 6th Edition, University Press Inc, Oxford. [23] Hvalvik, S. and Reierson, I.Å. (2015) Striving to Maintain a Dignified Life for the Patient in Transition: Next of Kin’s Experiences during the Transition Process of an Older Person in Transition from Hospital to Home. International Journal of Qualitative Studies on Health and Well-Being, 10, 1-10.
http://dx.doi.org/10.3402/qhw.v10.26554 [24] Bragstad, L.K., Kirkevold, M., Hofoss, D. and Foss, C. (2014) Informal Caregivers’ Participation When Older Adults in Norway Are Discharged from the Hospital. Health & Social Care in the Community, 22, 155-168.
http://dx.doi.org/10.1111/hsc.12071 [25] Naylor, M.D. (2002) Transitional Care of Older Adults. Annual Review of Clinical Nursing, 20, 127-147. [26] Report Nr. 29 to the Storting (2012-2013) Morgendagens Omsorg [Tomorrow’s Care]. Norwegian Ministry of Health and Care Services. [27] Rydeman, I.B. and Törnquist, L. (2010) Getting Prepared for Life at Home in the Discharge Process: Form the Perspective of the Older Persons and Their Relatives. International Journal of Older People Nursing, 5, 254-264.
http://dx.doi.org/10.1111/j.1748-3743.2009.00190.x [28] Rydeman, I.B. and Törnquist, L. (2006) The Patient’s Vulnerability, Dependence and Exposed Situation in the Discharge Process: Experiences of District Nurses, Geriatric Nurses and Social Workers. Journal of Clinical Nursing, 15, 1299-1307.
http://dx.doi.org/10.1111/j.1365-2702.2006.01379.x [29] Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.L., Kjellgren, K., Lidén, E., Öhlen, J., Olsson, L.E., Rosén, H., Rydmark, M. and Sunnerhagen, K.S. (2011) Person-Centered Care: Ready for Prime Time. European Journal of Cardiovascular Nursing, 10, 248-251.
http://dx.doi.org/10.1016/j.ejcnurse.2011.06.008 [30] Schumacher, K.L., Jones, P.S. and Meleis, A.I. (1999) Helping Elderly Persons in Transition: A Framework for Research and Practice. In: Swanson, E.A. and Tripp-Reimer, T., Eds., Life Transitions in the Older Adult: Issues for Nurses and Other Health Professionals, Springer, New York, 1-26.