Continuity of Chronic Wound Care Across Hospital-to-Home Transitions: A Qualitative Study of Hospital and Community Nurses’ Experiences
Élodie Montaigne, Anne-Marie Ollitrault, Nsuni Met, Aline CorvolAim
To explore how hospital nurses (HNs) and community nurses (CNs) in France manage chronic wound care for older adults across settings, and how their practices shape continuity of care during hospital-to-home transitions.
Design
Qualitative descriptive study combining ethnographic shadowing and a focus group.
Methods
Fieldwork took place in a French university hospital, across four units: acute geriatrics, rehabilitation, vascular surgery, dermatology. The focus group involved CNs from seven different self-employed nursing practices. We shadowed 15 HNs for approximately 92 h and conducted one focus group with 7 CNs. Data were analyzed inductively using constant comparison, with a second-stage interpretive analysis informed by Meleis’ transitions theory.
Results
Four interconnected processes shaped continuity of chronic wound care across the transition: (1) nursing expertise in wound management was expressed differently across hospital and community settings; (2) discharge coordination was fragmented, with rare nurse-to-nurse communication and insufficient transfer of wound-specific information; (3) organizational logics diverged, with discontinuous hospital workflows and time-pressured, fee-for-service-constrained community visits; and (4) patient involvement during hospitalization was limited, constraining engagement and preparedness post-discharge. Continuity was frequently maintained through compensatory work from nurses.
Conclusion
Continuity of chronic wound care depends less on nursing expertise than on the organizational conditions enabling that expertise to be mobilized across settings.
Impact
This study highlights the need for more integrated transitional care, including clearer and more consistent responsibilities at discharge, structured nurse-to-nurse discharge communication, and earlier patient involvement in wound care management.