Exploring the Support Provided by the Formal and Informal Network Members during “Hospital at Home” Treatment from a Nursing Perspective: An Interview Study

Abstract

Pressure on healthcare systems to address growing population needs is forcing services to adapt, which includes supporting acute patients in the community. One emerging service in the United Kingdom that offers this level of treatment is “Hospital at Home” (HaH). Self-management support is an area of particular importance in this context considering that acute treatment is provided in a community setting with limited input and monitoring by healthcare professionals. There is currently limited understanding about the range of formal and informal support and resources needed and accessed by patients in such circumstances, and whether and how HaH professionals engage with the everyday contexts and the network members of patients. Semistructured interviews were conducted with nurses (n = 9) from a single Hospital at Home site to further understand their experiences of providing acute treatments in the context of patients’ homes; and how self-management and social network support roles are perceived. Thematic analysis was used and four themes were identified: The value of prioritising illness work at home within a discourse of person-centered care; the work involved in the “naturally” therapeutic environment of the home; partners as key members of the informal care team; limited awareness and engagement with (in)formal networks. Findings demonstrate tensions between discourses where nurses idealise the value of the home and a holistic service provision, while in practice prioritising illness (over relational, emotional, and practical) work and delivering a service that is routinised, and time- and cost-efficient. Nurses recognise the positive role of network members for illness management in the context of people’s everyday life, but awareness and engagement are limited to partners and the formal services that HaH staffs are familiar with. Developing a better understanding of the role of social networks (SNs) in supporting people with acute needs at home can help improve patient experiences and care and HaH services, especially for people who are vulnerable, with complex needs, living alone, and with limited access to resources.