Implementing an early supported discharge intervention to nursing homes and respite care centers after hip fracture: A qualitative study of staff experiences and field observations

Abstract

Background

An enhanced standardized interdisciplinary cooperation (ESIC) model was introduced to improve collaboration between hospitals, nursing homes and respite care centers (NH-RCC) after hip fracture. It involved structured post-discharge care and 2-week extended hospital care, requiring new collaborative practices whose success depended on how NH-RCC staff perceived and enacted the intervention.

Methods

An ethnographically inspired design was applied, combining field observations and semi-structured interviews with Health and Social Care Personnel (HSCP) in 10 NH-RCCs until saturation was reached. Observations followed Spradley's nine-domain framework. Interview data were analyzed using Braun and Clarke's thematic analysis within a hermeneutic framework. Observational findings were used to assess alignment.

Results

Twelve interviews (8-33 min) and 180 h of observations were conducted. Participants were NH-RCC nurses (n = 7), outreach nurses (n = 3), and social and health care assistants (n = 2).

Four overarching themes revealed dualistic findings. The use of Early Warning Score was integrated into daily routines (Theme 1, Normalization of the intervention in everyday practice) and supported a broader clinical view of residents (Theme 2, Clinical awareness, ethics and relational care). However, some nurses experienced a problematic shift from direct care towards documentation (Theme 3, Role restructuring and coordination work). Mobilization was often omitted in vulnerable residents. Also, incomplete discharges and project tasks were a source of frustration (Theme 4, Systemic constraints and safety vulnerabilities).

Conclusion

We found that an ESIC model can be integrated into NH-RCC routines and enhance HSCPs clinical awareness. However, professional roles and prioritization of mobilization need clearer alignment between clinical goals and practice.