184 M. Ha¨ ggstro¨m et al. Table II. Illustration of steps in coding process: core category, categories, subcategories, and how they are grounded in data. Interview text Subcategory Category Core Planning is the most important! Nowadays, long-term Wishing for routines Seeking planning hardly exists. that facilitate patient organizational centeredness intertwining . . . For example, if we had planning in time, the physician Wanting access to the Striving for in charge for the ICU that week could start planning the necessary tools control first day of the week, and then, we could prepare for the actual patient to move later that week. Then, you could write your epikris and prepare the ward for things that they may have to get . . . . I would say that it is absolutely the most important that I, as Defending the patients Sheltering a nurse, am totally convinced that the patient is well- Seeking assurance of the Striving for prepared physically, so that their medical status is in the patients’ ability control condition needed for an altered level of care . . . . So, there is no serious setback for the patient at the ward. . . . Sometimes, the patients have supplements that we never Relying on or questioning Striving for have seen before . . . . We do not have the competence and one’s own ability control knowledge for that! . . . . . . . Often, nobody sees you and notices that you are there.... Looking for affinity Sheltering You do not want to feel like a bit of the wallpaper when you are waiting for the patient at the ICU . . . . One almost apologizes for being there . . . . Seeking improved Seeking collaboration organizational intertwining Struggling with a gap caused by the gap. The strategy sheltering described how the nurses were defending the patients and looking for affinity. The category, seeking organiza- tional intertwining described the seeking for an improved collaboration between the ICU and the general ward and a wish for routines that facili- tated patient centeredness, so the gap would be easier to handle. The third strategy described how the nurses were striving for control, which meant that they wanted access to the necessary tools for their nursing care and were relying on*or ques- tioning their own competence, so that they were confident that they were competent and able to care for the patients for which they were respon- sible. They also wanted to be certain that the patients’ recovery were sufficient for the ward staffs’ competence, and were seeking assurance of the patient’s ability. The theory showed that if the nurses felt a loss of control and lack of intertwin- ing and collaboration, they sheltered their patients. The ability to perform the intertwining was negatively affected, and instead they sheltered, even though the need for collaboration and inter- twining was even more salient. The categories and their subcategories were linked together as seen in Figure 1. Struggling with a gap The main concern, struggling with a gap, was a problem for the ICU nurses and the ward nurses. The gap consisted of cultural differences in the environment, differences in the nurses’ compe- tence, and uncertainty about how to communicate. The gap influenced the nurses’ work between the departments and their own unit. The ICU nurses were, to a great extent, medically focused; they talked about saving the patients’ lives, and how their actions were immediate and extremely con- trolled, always managing and monitoring. The ward nurses’ care focused more on supporting the patients’ strengths, and monitoring was a minor part of their care. The dynamic between the ICU nurses and the ward nurses also influenced the nurses’ struggles with a care gap, frequently in a negative manner. The differences in the care culture made the nurses feel safe in their own environment and also feel a shelter within the own group. The gap was main- tained by lack of collaboration and lack of liaison between the wards and the ICUs. The ICU nurses expressed that they were well aware of the differ- ences connected to an altered level of care and thought that it should be considered in the planning. The ward nurses indicated that this gap also was obvious for the patients and relatives and that they had to support the patients and their relatives through the gap caused by an altered care culture. According to the ICU nurses it was important that they did not confirm the patients’ or relatives’ mistrust and anxiety before and during the transfer.