Older persons in transition to need professional care in their homes will constitute a large group in municipalities in the future. The aim of this study was to obtain insight into nurses' experiences and perceptions of caring for patients in transition to receive homecare. Eleven home nurses divided into two focus groups were interviewed, and a phenomenological hermeneutical design was used. Four interpretations closely related to each other were revealed: it is essential to have an understanding of the patients' transition history; the nurse' repertoire is challenged in the transition process; care must be adapted to the patients' life world; the excellence of care is threatened by the context. The nurses strived to provide care based upon respect for the independent individual as a living whole. Their ambitions were, however, challenged and threatened by the caring context. The cooperation across organizational levels was pointed out as a critical factor with potential for improvement. This must be taken seriously to support the nurses in their endeavors to provide excellent care. 1. Introduction The transition from independence to needing professional help to manage daily self-care may bring about various types of distress and vulnerability to an individual. To receive the professional support needed in such situations, a healthy transition is vital [1]. Older persons in transition to need professional care in their homes will constitute a large patient group in Norwegian municipalities in the future, and many of them will have increasing needs for coordinated services [2]. In this respect, home care services and nurses working close to the patients in practice are crucial. They are key persons for enabling healthy transitions for older persons in need of home care and for dealing with challenges related to meeting the care needs of this patient group. As in other Western European countries, the demographic and epidemiological patterns in Norway are undergoing great changes. The number of older people expands, and, simultaneously, the number of persons with chronic and complex illnesses in this group expands [2]. One consequence of this development is that the amount of older persons in need of professional care in their own homes is increasing. While approximately 40,000 persons live in nursing homes today in Norway, more than 160,000 individuals receive municipal home care services, either in their private residences or in assisted living facilities [3]. This number is supposed to further increase after the Coordination Reform was brought into
References
[1]
K. L. Schumacher, P. S. Jones, and A. I. Meleis, “Helping elderly persons in transition: a framework for research and practice,” in Life Transitions in the Older Adult: Issues for Nurses and Other Health Professionals, E. A. Swanson and T. Tripp-Reimer, Eds., pp. 1–26, Springer, New York, NY, USA, 1999.
[2]
St.meld. nr. 47 [Report No 47 to the Storting], Samhandlingsreformen. Rett Behandling—P? Rett Sted—Til Rett Tid. [the Coordination Reform. Right Treatment—Right Place—Right Time], Helse- og omsorgsdepartementet [Ministry of Health and Care Services], Oslo, Norway, 2008-2009.
[3]
St. meld. nr. 25. [Report No. 25 to the Storting], Mestring, Mulighet Og Mening. Framtidas Omsorgsutfordringer. [Long Term Care-Future Challenges Coping, Possibilities and Meaning.], Helse- og omsorgsdepartementet [Ministry of Health and Care Services], Oslo, Norway, 2006.
[4]
V. Burholt and D. Naylor, “The relationship between rural community type and attachment to place for older people living in North Wales, UK,” European Journal of Ageing, vol. 2, no. 2, pp. 109–119, 2005.
[5]
B. Dale, H. I. Sovareid, M. Kirkevold, and O. Soderhamn, “Formal and informal care in relation to activities of daily living and self-perceived health among older care-dependent individuals in Norway,” International Journal of Older People Nursing, vol. 3, no. 3, pp. 194–203, 2008.
[6]
S. Ryan, A. A. McCann, and H. McCenna, “Impact of community care in enabling older people with complex needs to remain at home,” International Journal of Older People Nursing, vol. 4, no. 1, pp. 22–32, 2009.
[7]
C. Borg, I. R. Hallberg, and K. Blomqvist, “Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects,” Journal of Clinical Nursing, vol. 15, no. 5, pp. 607–618, 2006.
[8]
B. H?y, L. Wagner, and E. O. C. Hall, “Self-care as a health resource of elders: an integrative review of the concept,” Scandinavian Journal of Caring Sciences, vol. 21, no. 4, pp. 456–466, 2007.
[9]
B. McCormack, “A conceptual framework for person-centred practice with older people,” International Journal of Nursing Practice, vol. 9, no. 3, pp. 202–209, 2003.
[10]
L. Nordenfelt, “The concept of dignity,” in Dignity in Care for Older People, L. Nordenfelt, Ed., Wiley-Blackwell, West Sussex, UK, 2009.
[11]
S. Hvalvik and I. A. Reierson, “Transition from self-supported to supported living: older peoples' experiences,” International Journal of Studies in Health and Well-Being, No., vol. 6, no. 4, p. 7914, 2011.
[12]
A. I. Meleis and P. Trangenstein, “Facilitating transitions: redefinition of the nursing mission,” Nursing Outlook, vol. 42, no. 6, pp. 255–259, 1994.
[13]
J. J. LeVasseur, “A phenomenological study of the art of nursing: experiencing the turn,” Advances in Nursing Science, vol. 24, no. 4, pp. 14–26, 2001.
[14]
K. Murphy, “A qualitative study explaining nurses' perceptions of quality care for older people in long-term care settings in Ireland,” Journal of Clinical Nursing, vol. 16, no. 3, pp. 477–485, 2007.
[15]
C. Bassett, “Nurses' perceptions of care and caring,” International Journal of Nursing Practice, vol. 8, no. 1, pp. 8–15, 2002.
[16]
A. Clarke, E. J. Hanson, and H. Ross, “Seeing the person behind the patient: enhancing the care of older people using a biographical approach,” Journal of Clinical Nursing, vol. 12, no. 5, pp. 697–706, 2003.
[17]
I. Fagerberg and M. Kihlgren, “Registered nurses' experiences of caring for the elderly in different health-care areas,” International Journal of Nursing Practice, vol. 7, no. 4, pp. 229–236, 2001.
[18]
H. L. Seipke, “Assisted living, elderly women and sense of self: communicating the impact of reduction of long-standing activities,” Journal of Women & Aging, vol. 20, no. 1-2, pp. 131–148, 2008.
[19]
T. P. Shippee, ““but i am not moving”: residents' perspectives on transitions within a continuing care retirement community,” The Gerontologist, vol. 49, no. 3, pp. 418–427, 2009.
[20]
J. P. Tracy and S. DeYoung, “Moving to an assisted living facility: exploring the transitional experience of elderly individuals,” Journal of Gerontological Nursing, vol. 30, no. 10, pp. 26–33, 2004.
[21]
C. A. Walker, L. C. Curry, and M. O. Hogstel, “Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?” Journal of Psychosocial Nursing and Mental Health Services, vol. 45, no. 1, pp. 38–45, 2007.
[22]
P. Dedhia, S. Kravet, J. Bulger et al., “A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes,” Journal of the American Geriatrics Society, vol. 57, no. 9, pp. 1540–1546, 2009.
[23]
E. A. Coleman and R. A. Berenson, “Lost in transition: challenges and opportunities for improving the quality of transitional care,” Annals of Internal Medicine, vol. 141, no. 7, pp. 533–536, 2004.
[24]
E. A. Coleman, “Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs,” Journal of the American Geriatrics Society, vol. 51, no. 4, pp. 549–555, 2003.
[25]
K. Dahlberg, H. Dahlberg, and M. Nystrom, Reflective Lifeworld Research, Studentlitteratur, Lund, Sweden, 2008.
[26]
H. G. Gadamer, Truth and Method, Sheed and Ward, London, UK, 2nd edition, 1989.
[27]
K. Malterud, Fokusgrupper Som Forskningsmetode for Medisin Og Helsefag [Focus Groups as Research Method in Medicine and Health Sciences], Universitetsforlaget, Oslo, Norway, 2012.
[28]
V. Fleming, U. Gaidys, and Y. Robb, “Hermeneutic research in nursing: developing a Gadamerian-based research method,” Nursing Inquiry, vol. 10, no. 2, pp. 113–120, 2003.
[29]
B. E. Barba, J. Hu, and J. Efird, “Quality geriatric care as perceived by nurses in long-term and acute care settings,” Journal of Clinical Nursing, vol. 21, no. 5-6, pp. 833–840, 2012.
[30]
B. McCormack and T. McCance, Person-Oriented Nursing: Theory and Practice, Wiley Blackwell, Oxford, UK, 2010.
[31]
N. Chick and A. I. Meleis, “Transitions: a nursing concern,” in Nursing Research Methodology: Issues and Implementation, P. L. Chinn, Ed., pp. 237–257, Aspen Publication, Boulder, Colo, USA, 1986.