International Journal of Qualitative Studies on Health and Well-being. 2009; 4: 181 192 ORIGINAL ARTICLE Struggle with a gap between intensive care units and general wards MARIE HA¨ GGSTR O¨M PhD student, KENNETH ASPLUND Professor & LISBETH KRISTIANSEN PhD Department of Health Sciences, Mid Sweden University, SE-Sundsvall, Sweden Abstract Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process*the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses’ ‘‘struggling with a gap.’’ The ‘‘gap’’ was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients’ ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved. Key words: Collaborating, discharge process, ICU discharge, grounded theory, nursing, transitional care Introduction Transition is a well-known term and means a process or period’s characteristics of change, passing from one state, stage, form, or activity to another. The transition process from Intensive Care Units, ICU, to the general ward involves the patient, their relatives, and the staff. Critically ill patients in the ICU often experience many transitions, from the time they are acutely sick until they recover and return to their homes (Chaboyer, James & Kendall, 2005). The transfer of patients from the ICU is an everyday procedure. It is an accepted part of the ICU nurse’s routine work, but also an important element of providing quality care (Odell, 2000). There are approximately 40,000 patients a year admitted to Swedish Intensive Care, and it is expensive care (URL 1). Critical care beds are a finite resource, and the decision to transfer depends both on the individual’s physical condition and on the demand for beds (Gibson, 1997). In this study, ICU transitional care is used and defined as ‘‘care provided before, during and after the transfer of an ICU patient to another care unit that aims to ensure minimal disruption and optimal care for the patient. This care may be provided by ICU nurses, acute care nurses, physicians and other healthcare profes- sionals’’ (Chaboyer et al., 2005). Discharge planning is a part of ICU transitional care. It is a part of the process that aims to provide continuity of care for the patients. The effects of a poorly coordinated discharge can lead to readmission to the ICU and also avoidable deaths. If the transfer for the indivi- dual patient is accompanied by scarce, inadequate or untimely knowledge or preparation, it may be perceived as a threat to security (Whittaker & Ball, 2000). It is well known that patients in a critical care environment may suffer both psychological and physical problems caused by the stress of being in the ICU (Coyle, 2001; Cutler & Garner, 1995; Gustad, Chaboyer & Wallis, 2008). The terms Correspondence: Marie Ha¨ggstro¨ m, Department of Health Sciences, Mid Sweden University, SE-Sundsvall, Sweden. Tel: 4660-148669. E-mail: marie.haggstrom@miun.se (Accepted May 26 2009) ISSN 1748-2623 print/ISSN 1748-2631 online # 2009 Informa UK Ltd DOI: 10.1080/17482620903072508