186 M. Ha¨ ggstro¨m et al. patient and/or relatives sometimes felt a sense of relief when leaving the noisy ICU and moving to a calmer ward. Alternatively, the differences also often contributed to anxiety. The gap influenced the nurses’ work situation, and it simplified matters if the gap was reduced. Sheltering The cultural differences made the nurses seek shelter in their own and well-known area, where they sought affinity with their own group and defended the patients and their relatives. Looking for affinity. There existed visible dynamics between the nurses in the different departments; the nurses felt safe with their own group and often questioned the others, looking for affinity within their own group. They often talked in ‘‘us and them’’ terms, and according to many ward nurses, they sometimes felt insecure, frustrated, and of less worth when they met ICU nurses, especially in the ICU ward. In addition, the actual technological environ- ment was unknown and made the ward nurses feel insecure. You can feel unbelievably ‘‘small’’ when you are getting a patient from ICU . . . Their language is totally different and if you ask what it means, you can really be questioned. I sometimes feel like a fly on the wall . . . (Ward nurse 1) Yes, you want to be noticed and to be seen when you are going in the ICU . . . (Ward nurse 2) Good encounters and confirmation were impor- tant factors; the ward nurses wanted to be seen and met respectfully and equally when they came to the ICU ward. In addition to the importance of good encounters between the two wards, it was also significant to understand instead of questioning each other. The ward nurses expressed that one of the important bricks in their workplace was a visible, mutual understanding of both workplaces’ situations and competences. The ICU nurses also expressed that the relationship with the ward nurses sometimes needed improvement. Mostly, their wishes con- cerned proper communication, and they wanted to erase the feelings of counteraction from the ward nurses concerning when to come and actually move the patient from the ICU. Defending the patients. The nurses were often worried about the patients’ well-being during the process. The ward nurses often took action to defend ‘‘their own patients,’’ especially if the patients were well known to the staff at the ward. They sometimes visited or called ICU to get information concerning the patient’s status. For the ICU nurses, a great deal of their work concerned negotiations with the physicians, defending their patients regarding when and if the patients were ready to be discharged. I think that I always need to slow the discharge . . . Yes! I think that they are transferred way too soon nowadays . . . Yes, I may have seen the patient many more days than the physician and know how fragile he really is, and then the physician comes and takes a look and says*ready for the ward . . . You need to know that the patient is medically able to move to the ward. (ICU nurse) Because of downsized numbers of hospital beds, the nurses often needed to compromise their own ideals regarding how transitional care should be handled. The nurses felt that the focus in ICU transitional care was seldom on the patients, although they often tried to be their advocate and counsellor. More often, the participants expressed that the focus was all on moving the patient to another clinic and making a new bed for another patient in need; patient-centeredness was forgotten. This way of thinking concerned the nurses. I think it is because everyone is thinking of their own needs and forgets the patient’s experience of their journey. I think-that many think that I will do my job, and then others can take over . . . (ICU nurse) Seeking organizational intertwining Strategies of how to intertwine and overlap ICU transitional care were important for handling the gap, and an ICU nurse said: ‘‘The process should be like a net, where no mesh is broken and it is just continuing.’’ The process was described as unclear by the ICU nurses and often determined by what- ever the physician for the day wanted to do. When nurses and doctors could create collaboration be- tween departments, and use similar routines that facilitated patient centeredness, ICU transitional care was carried out more successfully. Seeking improved collaboration. Collaboration bet- ween the ICU and general ward was of great importance for creating organizational intertwining and was sometimes used (and sometimes not). When the icu staff and the ward staff collaborated, it was often to secure the transfer of a patient with