190 M. Ha¨ggstro¨m et al. patient and is especially linked to positive outcomes for the patients in the ICU (Stein-Parbury & Liashenko, 2007). Creating a collaborative care culture is needed in functional ICU transitional care. According to Sandberg (2006), to achieve collaborative teamwork, there have to be different kinds of competency in the team, and the team members actually have to collaborate. To reach this point, all team members must act with the knowl- edge that all members possess important and ade- quate competencies, and that the solution is mutual giving and taking (Sandberg, 2006). Our theory shows us the importance of collaboration in planning between the team members involved in the care. Feelings and thoughts of hierarchy and status must be minimized; instead, the nurses should view each other as important parts of a chain with different competencies. According to Coombs (2003), team- work and a collaborative environment require a shared understanding of roles and working practices, but role definitions and power bases, based on traditional and historical boundaries, continue to exist. The ward nurses expressed frustration and some- times even anger over how they felt treated when coming to the ICU to receive a patient. Working together as a team in the organization is an im- portant issue to improve the process. According to Sandberg (2006), above all, the competence of the staff in the team influences the working environ- ment. The three aspects of competence in the working environment are professional competence, collaborative competence, and emotional compe- tence (Sandberg, 2006). Knowledge is empowering to those who develop it, those who use it and those who benefit from it (Meleis, Sawyer, Im, Hilfinger Messias & Schumacher, 2000). Also shown in the present study is that knowledge is an important element for collaboration between nurses involved in ICU transitional care. Hence, leaders must take responsibility in the organizations for encouraging and building a collaborative environment and a culture that improves ICU transitional care. ICU nurses are responsible for assisting the patients in coping with the transfer situation; they also must identify the patients’ needs so that an individual discharge plan can be created (Chaboyer, Foster, Kendall & James, 2002). Furthermore, our study shows that the ward nurses also must take early responsibility in planning the transition pro- cess. Whittaker and Ball also claims that ward nurses should be part of the process, as they are well suited to minimize the transfer anxiety for the patient (Whittaker & Ball, 2000). If the ward nurses play an early role in the process, the patient and his/her relatives can have their informational needs from the ward fulfilled, and the gap can be reduced. Since the patients had a great need for information when moving from the ICU care to the ward (Strahan & Brown, 2005), the nurses should be able to give this information to the patients and their relatives. The need for improved communication between the ICU nurses and the ward nurses is important for minimizing risks during ICU transitional care, according to Whittaker and Ball (2000). They describe this lack of functional communication as common, as the ICU nurses fail to adjust the handover information to the ward nurses’ needs. They also illuminate the fact that the ward nurses thought that the ICU nurses should dwell on the patients’ abilities (i.e. sitting up in the bed), the patients’ oral diet, etc. instead of the acuity of the illness. The results in our study showed, further- more, that the ICU nurses knew that they often used overly medical and technical language, but it was difficult for them not to use the language that they ordinarily employed in the ICU unit. The healthcare institution should pay attention to the ICU transitional process. The importance of a functional organization is also linked to economic factors. Green and Edmonds (2004) highlight the fact that a malfunctioned discharge process in ICU transitional care (among other things) could lead to the inability for the ICU to accept booked elective- surgery patients. The length of stay (LOS) in the ICU could be prolonged because of the patients’ needs for close observation and care that the general ward does not routinely provide. Further, an ICU liaison nurse could provide a more cost-effective, timely, and integrated approach for acute care. This nurse should have responsibilities for coordinating the transitional care, being a resource for the junior- based staff, and supporting the ward nurses if and when they provide care for patients with extended needs (Green & Edmonds, 2004). This study reveals the importance of evidence- based routines in ICU transitional care, and the need to handle the resources with care and prioritise the right choices. To gain knowledge of ICU transitional care, improvements must be carried out, so that the reality of care can afford us with evidence and instruct us in how to refine further our strategies and care. Further, the study also reveals that the nurses find the patients’ reactions to a recent transfer to be indivi- dual; therefore, individualised care and preparation are needed (c.f. Cutler & Garner, 1995). The routines must consider the individual patients’ needs and be patient-centred. Some of the ICU nurses thought that the discharge planning occurred too quickly and that the decisions for transfer were made only over the course of a day. Others experienced quite the contrary; the patient stayed in the ICU at