Transitional care for older persons with need of geriatric rehabilitation nursing interventions

Abstract

Abstract Background The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured. Objective This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs. Methods This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out. Results The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. Conclusions It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.

Keywords

• Nursing
• Rehabilitation
• Transitional care
• Continuity of Care
• Functionality