The work of nurses to provide good and safe services to children receiving hospital-at-home: A qualitative interview study from the perspectives of hospital nurses and physicians

Abstract

Aim: To explore and describe the work performed by the nurses providing hospital-at-home care to children and their families from the perspectives of hospital nurses and physicians.

Background: To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital-at-home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians' perspectives on the work performed and competence needed when children receive hospital treatment in the family's home.

Design: A qualitative descriptive design with semi-structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital-at-home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on 'expert nursing' supported the discussion of results.

Results: We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital-at-home; and nurses serving as the 'hub' between the different parties.

Conclusion: The results demonstrate the complexity of the work performed by hospital nurses when children received hospital-at-home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating 'hub' for actors involved, taking care of patient safety on a daily basis.

Relevance to clinical practice: The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.

Keywords: home care services; hospital-based; paediatric nursing; professional-family relations; qualitative research.