Hospital nurses’ experiences of assessing health status changes in stem-cell transplanted patients in home care: A qualitative study

Abstract

Aims and objectives: To explore hospital nurses’ experience assessing changes in the health status of stem-cell transplanted patients in home care (HC). Background: Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients’ health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses’ experience assessing patients’ health status at home when patients undergo stem-cell transplantation were found. Design: Qualitative study with an explorative design. Methods: Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist. Results: Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients’ general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments. Conclusions: Effective communication and clinical intuition enhanced the assessment of patients’ general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments. Relevance to clinical practice: Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients’ health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses’ confidence in their assessments.