resources that were available at the ward. Some- times, however, a patient was moved to the general ward when it was known that he or she was soon going to die. These patients were moved to obtain a calmer environment for the patient and, above all, his or her relatives. Prior to the transfer, the ICU nurses sought signs confirming the patients’ ability to transition to an altered level of care. The timing of discharge was crucial, and the inclusion criteria for moving from the ICU could vary. Sometimes, the nurses stopped a discharge when it was occurring too fast, and sometimes, they pushed it through and made it go faster. The time of preparation for the transfer and the discharge was sometimes minimal, and the decisions for the discharge were made ‘‘over a day.’’ The nurses could not always offer an explanation for the length of times they spent deciding to transfer a patient. Sometimes the move was simply caused by an acute situation that demanded more beds in the ICU. Discussion The aim of this study was to obtain a deeper understanding of the main concerns in the ICU transitional process as experienced by nurses in intensive care units and general wards in Sweden. Our theory shows a close connection between the nurses’ main concern in ICU transitional care* struggling with a gap in a multitude of areas such as communication, technology, staff readiness*and the strategies for diminishing or bridging this gap, sheltering, seeking organizational intertwining, and striving for control. The gap between the highly technological culture in the ICU and the culture in a general ward may be difficult to reduce totally. Nevertheless, there must be a way to improve and develop care by planning and working out routines; for that, there has to be knowledge of the ICU transitional care process and education for the staff. The goal of medical care should not only be to free up a bed for another patient in need, even if the resources of healthcare institutions are limited. Other authors have ob- served the gap between ward and ICU transitional care. According to Coyle (2001) the ICU transi- tional care is influenced by the gap between the ICU and the aftercare at a general ward. Coyle found that the gap is caused by differences in routines, environments, and loss of invasive mon- itoring, which can cause transfer anxiety without proper preparation and explanation. On the con- trary, our study shows that these differences are a consequence of the gap, rather than its cause. A recent literature review (Lin, Chaboyer & Wallis, 2009) showed that intensive care discharge is Struggle with a gap between ICUs and general wards 189 influenced by organizational factors, individual factors and teamwork factors. The transition process could be improved by enabling integration through professional meetings, and by creating mutual understanding between staff members in different settings in health care (Lundin, Danielson & Ohrn, 2007). Their findings are similar to ours, highlighting the importance of having strategies on hand for building bridges, and also the need for professional meetings for enabling integration. This sort of intervention should be carried out with knowledge of research into ICU transitional care. Since 1979, concerned professionals have dis- cussed the possibility of nursing interventions to reduce the stress that the patients meet in the gap between the ICU and the general ward (Schwartz & Brenner, 1979). The nurses in our study are also aware of the importance of connecting these two links in the chain of healthcare*an organizational inter- twining*so that the patient receives the best care. However, there seem to be difficulties in the ICU transitional care process that need to be remedied. The nursing staff could be a key group in developing and implementing new procedures in the ICU discharge process (Chiung-Jung Jo & Coyer, 2007). Our study illuminates the nurses’ ambiguity as to what extent they are responsible for ICU transitional care and what authority they possess. In spite of this, the study showed very little action towards improve- ment by the nurses. According to Woodrow (1997) nursing increasingly needs nurses that are highly and actively involved in their practices. The nurses should question and ponder what they are doing. Our study showed that the ward nurses expressed that their workload sometimes was too heavy and that the knowledge of receiving an ICU patient could make them feel overwhelmed. In a study by Hallin and Danielson (2007), the nurses balanced strain and stimulation in their daily work, which contained more stressful work than stimulating work situations. The nurses expressed demands of adaptability, high work- ing capacity, strength and patience so that they could handle every sort of assignments in their profession at a general ward (Hallin & Danielson, 2007). This fact makes it even more important to have routines and strategies that facilitate the nurses’ workload in ICU transitional care. Healthcare is moving towards more patient- centred service, a philosophy of care that emphasizes working across professional and organizational boundaries to support quality service improvements. The improvements are, to a great extent, dependent on the staff ’s willingness to collaborate in the process (Coombs & Dillon, 2002). Collaboration between physicians and nurses is highly important for the