Rehabilitation Nurse's Perspective on Transitional Care: An Online Focus Group

Area of Science:

• Healthcare Management
• Nursing
• Rehabilitation

Background:

• Rising chronic illness and dependence necessitate improved care transitions.
• The World Health Organization advocates for care model reorganization to address these challenges.
• Ensuring continuity of care is crucial for patients transitioning between healthcare settings.

Purpose of the Study:

• To analyze nurses' perspectives on transitional care for dependent individuals.
• To identify strategies for effective rehabilitation care after hospital discharge.
• To understand the role of nurses in managing care transitions for vulnerable populations.

Main Methods:

• A focus group methodology was employed.
• Rehabilitation nurses from hospital and community settings participated.
• Content analysis was used to interpret the data.

Main Results:

• Four key themes emerged: promoting continuity of care, the role of advanced practice nurses as care managers, empowering patients and caregivers, and enhancing care coordination.
• Strategies were identified to minimize care fragmentation.
• Patient participation in transitional care was highlighted as essential.

Conclusions:

• Transitional care strategies can reduce fragmentation and improve patient engagement.
• Effective transitional care enhances the quality of care and professional satisfaction.
• Sustainable healthcare systems benefit from robust transitional care models.