Work in an intermediate unit: balancing between relational, practical and moral care

To explore the activities carried out and the conditions required to enable satisfactory work in an intermediate unit for patients aged 60 and older.

In recent years, several intermediate units have been established to improve the clinical pathway from hospital to home for older patients.

Qualitative study.

Data were obtained from interviews with eight patients and 16 healthcare providers working in the unit and from observations in six multidisciplinary meetings and six report meetings in the unit. Transcripts of interviews and field notes were analysed using a method for systematic text condensation.

Care performed as a balance between relational, practical and moral aspects seems to be important to render good service to patients and to ensure the providers' job satisfaction. Most patients experienced their stay in the unit as positive. The providers highlighted 'suitable patients', an appropriate physical environment and communicating computer systems as significant factors for performing treatment and for providing nursing and rehabilitation in a caring manner.

When environmental and organisational conditions exert pressure on the working situation, care as a practical activity seems to be prioritised at the expense of the two other aspects. The findings indicate that unfavourable environmental and organisational conditions impede patients' recovery process and thereby a good clinical pathway.

To recruit, support and retain a multidisciplinary staff to the best interest of patients, it seems to be important to perform care work as a balance between relational, practical and moral activities.