Struggle with a gap between ICUs and general wards 185 Sheltering Defending the patients Looking for affinity Seeking organizational intertwining Striving for control Seeking improved collaboration Seeking assurance of the patients’ ability Wanting access to the necessary Wishing for routines tools Relying on or that facilitate questioning one’s own patient centeredness ability STRUGGLING WITH A GAP Figure 1. Illustrating the main concern for the nurses: struggling with a gap. The three categories*sheltering, seeking organizational intertwining, and striving for control*are related to the core category. The bridge over the gap is built by the properties of two categories. All categories are connected with each other. It is important that we give the patient courage and trust before the actual discharge, one has to inform and support the patients and tell them that they actually are getting better and that they will manage the new level of care. (ICU nurse) The nurses expressed the sense that because of the differences between the ICU and the general wards, it was important that their level of care was adjusted to patients’ medical statuses. The altered staff ratio between the ICU and the general ward was visible also in the fact that ICU nurses often had a physician in charge near the patient, while the ward nurses more seldom had a physician at the ward. At the ICU, there were fewer*but often sicker*patients being cared for, compared to the general ward where nurses were responsible for many more. The ward nurses expressed that they sometimes felt over- whelmed, stressed, and tired when they knew that they would receive a patient from ICU, because of the extra workload involved. During the patients’ first days at the ward*after the patient was trans- ferred from ICU*the ward nurses sometimes had difficulties handling patients or relatives who ex- pressed that they were used to obtaining help more immediately in the ICU. I think that the staff ratio mirrors in the re- lation . . . I mean if they are calling for you at six pm and want help, and you don’t have the time then, they are very disappointed. And, it’s diffi- cult, difficult to make them understand . . . (Ward nurse) According to the nurses, the differences in the environment greatly contributed to the cultural gap. The environmental differences affected the nurses, especially since the patients and relatives reacted to the sudden environmental change in their care. The technological environments in the ICUs were de- scribed as noisy and disturbing, and ICU nurses or other staffs were always close. The patients were continually monitored and attached to machines. The general ward’s environment was described as calmer and with more possibilities to take action personally. According to ward and ICU nurses, the