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Abstract
BackgroundThis article concerns Swedish family physicians' (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients. The aim was to develop a model to illuminate this process from the FPs' perspective.MethodsSemi-structured interviews were conducted with 13 FPs concerning one of their patients with home care by a DN. The interview focused on one patient's treatment and care by different care providers and the collaboration among them. Grounded theory methodology (GTM) was used in the analyses.ResultsIt was essential for FPs to collaborate with and rely on DNs in the medical treatment of home care patients. According to the FPs, factors such as the disease, FPs' working conditions and attitude determined how much of the initiative in this treatment FPs retained or left to DNs. Depending on the circumstances, two different roles were adopted by the individual FPs: medical conductors who retain the initiative and medical consultants who leave the initiative to DNs. Factors as the disease, DNs' attitudes towards collaboration and DNs' working conditions influenced whether or not the FPs felt that grounds for relying on DNs were satisfactory. Regardless of the role of the FP, conditions for medical treatment were judged by the FPs to be good enough when the grounds for relying on the DN were satisfactory and problematic when they were not.ConclusionsIn the role of conductor, the FP will identify when the grounds for relying on the DN are unsatisfactory and be able to take action, but in the role of consultant the FP will not detect this, leaving home care patients without appropriate support. Only when there are satisfactory grounds for relying on the DN, will conditions for providing home care medical treatment be good enough when the FP adopts a consultative role.
Highlights
This article concerns Swedish family physicians’ (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients
Factors influencing whether FPs retain or leave the initiative in the medical treatment to the DNs
In what circumstances conditions for medical treatment are considered good enough or problematic in relation to the role taken by the FP and in relation to the grounds for relying on the DN for medical treatment
Summary
This article concerns Swedish family physicians’ (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients. The shift from hospital to community and primary care for the ageing population has increased the need for all types of home care in Sweden as well as in most western countries [1,2,3,4]. A growing number of patients are receiving home health care in Sweden today. In 2008 approximately 200,000 patients received home care, the majority of them from district nurses (DNs). A shortage of nurses and physicians available for this care in Sweden has resulted in a gap between resources and demands that might jeopardise good quality care and home care patients’ safety [3,8,9]
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