Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study

Abstract

Aims and objectives: This study aimed to (1) describe the development of integrated services between hospital-based heart failure nursing services and municipally located home care nurses' services and (2) identify the benefits of this collaboration for the development of home care nursing services.

Background: Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved.

Design: A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure.

Methods: Data were field notes from observations at meetings of the steering group designing the services, visits to patients' homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist.

Results: In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients' homes. A clinical pathway was developed to assure effective assessment of patients' condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition.

Conclusions: The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services.

Relevance to clinical practice: The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.

Keywords: advanced practice nurses; competencies; ethnography; expertise; heart failure; home care nurses; integrated services; knowledge; trans-situational.