| The purpose of this study was to describe the clinical and continuing care data and information that registered nurses communicate and exchange, the coordination mechanisms they use and prefer, and the interdependencies involved in interorganizational coordination of patients who are in transition across organizational boundaries of different health care settings. A synthesis of theories on task interdependencies and interorganizational coordination was used to generate the model that guided this study. Self-report questionnaires and a Focus Group were used to collect data from 24 registered nurses that included data and information about 92 patients in transition between different health care settings. Findings demonstrated that the process of asking practicing RNs about their data and information needs was effective and yielded substantive results. Results of parametric and nonparametric statistics indicated that data and information about psychosocial, medical, clinical nursing care, and continuing care were relevant to the management of care for these patients. The findings emphasized that (1) the data and information that RNs communicated and exchanged within a specific category varied by health care setting (home health or hospital) and with the severity of illness of the patient; (2) RNs in the home health setting, regardless of corporate affiliation, indicated that they would like more and different clinical nursing care data than hospital nurses as they coordinated the care of patients in transition; (3) the mechanisms RNs used to communicate and exchange data and information were not those that they preferred, and did not vary with the severity of illness of patients; however, their preferences and mechanisms used were related to the health care setting. The interorganizational interdependencies related to the arrangement and provision of equipment were confirmed as important considerations for RNs managing the care of patients in transition and were shown to vary according to the patient's severity of illness and health care setting. These findings suggest important considerations for nursing practice, research, and education; informing the development of automated systems that enable RNs to get the amount, depth, and specificity of data and information for continuing care across organizational boundaries. Recommendations were discussed for further study. |
