Transition from hospital to home care: a mixed methods study in light of Meleis's Theory.

Objectives: to understand transition from hospitalization to home care from the perspective of patients/family members.

Methods: a mixed methods study of concomitant transformative design, with qualitative weighting. Recruitment took place in a hospital in the Midwest, carried out with patients and family members during home visits between ten and 30 days after hospital discharge, between April and September 2022. The Barthel Index, Care Transitions Measure (CTM-15) and audio-recorded interviews were used. Data were analyzed according to transitions theory and integrated using the fusion strategy.

Results: twenty-six patients and 18 family members participated. The nature of transitions involves new care and readmission. In the facilitating and inhibiting conditions, low income and lack of primary care monitoring stood out, and the response pattern was unsatisfactory (CTM-15 score 59.23).

Conclusions: transition from hospital to home care was unsatisfactory. Nurses and multidisciplinary teams should pay attention to actions that include effective discharge planning.