Volume 20, Issue 5 (August 2022)
Nursing and Midwifery Journal 2022, 20(5): 408-422 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Hosseini S J, Firooz M, Heydari A. CONCEPT ANALYSIS OF FRAGMENTED CARE WITH WALKER AND AVANT MODEL. Nursing and Midwifery Journal 2022; 20 (5) :408-422
URL: http://unmf.umsu.ac.ir/article-1-4660-en.html
URL: http://unmf.umsu.ac.ir/article-1-4660-en.html
1- Ph. D student in nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2- Ph. D student in nursing, Nursing and Midwifery School, Golestan University of Medical Sciences, Gorgan, Iran
3- Professor of Nursing, Nursing and midwifery care research center, Mashhad University of Medical Sciences, Mashhad, Iran ,heydaria@mums.ac.ir
2- Ph. D student in nursing, Nursing and Midwifery School, Golestan University of Medical Sciences, Gorgan, Iran
3- Professor of Nursing, Nursing and midwifery care research center, Mashhad University of Medical Sciences, Mashhad, Iran ,
Abstract: (3382 Views)
Background & Aims: Care is a complex and subjective concept, and most nursing theorists consider it the most important action of nurses in dealing with patients. However, inaccuracy in providing comprehensive care by the medical staff has caused disintegration of care and thus the concept of fragmented care (FC) is formed. Although this concept is often used by researchers, its dimensions have not been fully identified. The aim of this study was to analyze the concept of FC.
Materials & Methods: Concept Analysis of FC based on the Walker and Avant's method (2019) was carried out in eight steps by searching and analyzing studies from reliable information databases such as Scopus, Pubmed, Web of Sciences, and Google Scholar search engine. We used the keywords: Fragmentation, Fragmented, and Care without time limit until May 2022. Finally, 26 articles related to the concept were analyzed.
Results: FC had different dimensions. Lack of coordination, planning, teamwork, and holistic view were the most important dimensions. This type of care can occur at different relationship levels of nurse-patient, both within and between wards and different medical centers.
Conclusions: The present study identified different dimensions of the concept of FC. Future studies can use the results of this study to develop a scale as well as to design interventions effective in reducing its incidence.
Materials & Methods: Concept Analysis of FC based on the Walker and Avant's method (2019) was carried out in eight steps by searching and analyzing studies from reliable information databases such as Scopus, Pubmed, Web of Sciences, and Google Scholar search engine. We used the keywords: Fragmentation, Fragmented, and Care without time limit until May 2022. Finally, 26 articles related to the concept were analyzed.
Results: FC had different dimensions. Lack of coordination, planning, teamwork, and holistic view were the most important dimensions. This type of care can occur at different relationship levels of nurse-patient, both within and between wards and different medical centers.
Conclusions: The present study identified different dimensions of the concept of FC. Future studies can use the results of this study to develop a scale as well as to design interventions effective in reducing its incidence.
Type of Study: Review article |
Subject:
پرستاری
References
1. McClendon P. Authentic caring: Rediscover the essence of nursing. Nurs Manage 2017; 48(10):36-41. [DOI:10.1097/01.NUMA.0000524813.18664.7c] [PMID]
2. Wolf ZR, France NEM. Caring in nursing theory. Int J Hum Caring 2017;21(2):95-108. [DOI:10.20467/HumanCaring-D-17-00021.1]
3. Aghabarary M, Nayeri ND. Nurses' perceptions of futile care: A qualitative study. Holist Nurs Pract 2016;30(1):25-32. [DOI:10.1097/HNP.0000000000000128] [PMID]
4. Borimnezhad L, Seyedfatemi N, Mardani Hamooleh M. Concept analysis of palliative care using Rodgers' evolutionary method. Iran J Nurs 2014 Feb;26(86):1-5. [Google Scholar]
5. Pusari ND. Eight 'Cs' of caring: a holistic framework for nursing terminally ill patients. Contemp Nurse 1998;7(3):156-60. [DOI:10.5172/conu.1998.7.3.156] [PMID]
6. Bolderston A, Lewis D, Chai MJ. The concept of caring: Perceptions of radiation therapists. Radiography 2010;16(3):198-208. [DOI:10.1016/j.radi.2010.03.006]
7. Poghosyan L, Norful AA, Martsolf GR. Primary Care Nurse Practitioner Practice Characteristics: Barriers and Opportunities for Interprofessional Teamwork. J Ambul Care Manage 2017;40(1):77-86. [DOI:10.1097/JAC.0000000000000156] [PMID] [PMCID]
8. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care 2013;13:e010. [DOI:10.5334/ijic.886] [PMID] [PMCID]
9. Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care: a concept analysis. J Adv Nurs 2009;65(7):1509-17. [DOI:10.1111/j.1365-2648.2009.05027.x] [PMID]
10. Gustafsson N, Leino-Kilpi H, Prga I, Suhonen R, Stolt M. Missed Care from the Patient's Perspective - A Scoping Review. Patient Prefer Adherence 2020;14:383-400. [DOI:10.2147/PPA.S238024] [PMID] [PMCID]
11. Davis KM, Eckert MC, Shakib S, Harmon J, Hutchinson AD, Sharplin G, et al. Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019;8(12):e15006. [DOI:10.2196/15006] [PMID] [PMCID]
12. Love L, Newmeyer A, Ryan-Wenger N, Noritz G, Skeens MA. Lessons learned in the development of a nurse-led family centered approach to developing a holistic comprehensive clinic and integrative holistic care plan for children with cerebral palsy. J Spec Pediatr Nurs 2022;27(1):e12354. [DOI:10.1111/jspn.12354] [PMID]
13. Bender M, Connelly CD, Glaser D, Brown C. Clinical nurse leader impact on microsystem care quality. Nurs Res 2012;61(5):326-32. [DOI:10.1097/NNR.0b013e318265a5b6] [PMID]
14. Burgermeister D, Kwasky A, Groh C. Promoting mental health concepts in a doctor of nursing practice curriculum: an integrated and global approach. Nurse Educ Pract 2012;12 (3):148 -52. [DOI:10.1016/j.nepr.2011.10.012] [PMID]
15. Bender M, Connelly CD, Brown C. Interdisciplinary collaboration: the role of the clinical nurse leader. J Nurs Manag 2013;21(1):165-74. [DOI:10.1111/j.1365-2834.2012.01385.x] [PMID]
16. Goodwin N. Understanding Integrated Care. Int J Integr Care 2016;16(4):19.
https://doi.org/10.5334/ijic.2609 [DOI:10.5334/ijic.2530] [PMID] [PMCID]
17. Yi M, Lee SW, Kim KJ, Kim MG, Kim JH, Lee KH, et al. [A review study on the strategies for concept analysis]. Taehan Kanho Hakhoe Chi 2006;36(3):493-502. [DOI:10.4040/jkan.2006.36.3.493] [PMID]
18. Walker LO, Avant KC. Strategies for Theory Construction in Nursing. 6th ed. Upper Saddle River, NJ: Pearson; 2019. [URL]
19. Schrag D, Xu F, Hanger M, Elkin E, Bickell NA, Bach PB. Fragmentation of care for frequently hospitalized urban residents. Med Care 2006;44(6):560-7. [DOI:10.1097/01.mlr.0000215811.68308.ae] [PMID]
20. Oxford Learner's Dictionaries [Internet]2022. [12 May 2022]. Available from: https://www.oxfordlearnersdictionaries.com/definition/english/fragmentation?q=fragmentation. [URL]
21. Cambridge Dictionary [Internet]2022. [cited 2022]. Available from: https://dictionary.cambridge.org/dictionary/english/fragmentation. [URL]
22. Abrams SA. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatr 2013;1(2):42-8. [DOI:10.1542/peds.2013-0420] [PMID]
23. Vajehyab [Internet]2022. Available from: https://www.vajehyab.com/?q=%DA%AF%D8%B3%DB%8C%D8%AE%D8%AA%D9%87. [URL]
24. investopedia [Internet]2022. Available from: https://www.investopedia.com/terms/f/fragmentation.asp. [URL]
25. Zheng C, Habermann EB, Shara NM, Langan RC, Hong Y, Johnson LB, et al. Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery. J Am Coll Surg 2016;222(5):780-789e2. [DOI:10.1016/j.jamcollsurg.2016.01.052] [PMID] [PMCID]
26. Pryor J, Haylen D, Fisher M. Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service. J Clin Nurs 2021;30(11-12):1633-44. [DOI:10.1111/jocn.15717] [PMID]
27. Ejegi-Memeh S, Sherborne V, Harrison M, Taylor B, Senek M, Tod A, et al. Patients' and informal carers' experience of living with mesothelioma: A systematic rapid review and synthesis of the literature. Eur J Oncol Nurs 2022;58:102122. [DOI:10.1016/j.ejon.2022.102122] [PMID]
28. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care 1977;15(4):347-9. [DOI:10.1097/00005650-197704000-00010] [PMID]
29. Pollack CE, Hussey PS, Rudin RS, Fox DS, Lai J, Schneider EC. Measuring Care Continuity: A Comparison of Claims-based Methods. Med Care 2016;54(5):e30-4. [DOI:10.1097/MLR.0000000000000018] [PMID] [PMCID]
30. Allen D, Badro V, Denyer-Willis L, Ellen Macdonald M, Paré A, Hutchinson T, et al. Fragmented care and whole-person illness: Decision-making for people with chronic end-stage kidney disease. Chronic Illn 2015;11(1):44-55. [DOI:10.1177/1742395314562974] [PMID]
31. Kreitzer MJ. Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Med J 2015;6(2):e0016. [DOI:10.5041/RMMJ.10200] [PMID] [PMCID]
32. Frandsen BR, Joynt KE, Rebitzer JB, Jha AK. Care fragmentation, quality, and costs among chronically ill patients. Am J Manag Care 2015;21(5):355-62. [Google Scholar]
33. Phillippi JC, Holley SL, Thompson JL, Virostko K, Bennett K. A Planning Checklist for Interprofessional Consultations for Women in Midwifery Care. J Midwifery Womens Health 2019;64(1):98-103. [DOI:10.1111/jmwh.12900] [PMID]
34. Timmins L, Kern L, Ghosh A, Urato C, Rich E. Predicting Fragmented Care: Beneficiary, Primary Care Physician, and Practice Characteristics. Health Serv Res 2021;56(S2):60-1. [DOI:10.1111/1475-6773.13782] [PMCID]
35. Berry LL, Rock BL, Smith Houskamp B, Brueggeman J. Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clin Proc 2013;88(2):184-94. [DOI:10.1016/j.mayocp.2012.10.016] [PMID]
36. Cristina ML, Spagnolo AM, Giribone L, Demartini A, Sartini M. Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review. Int J Environ Res Public Health 2021;18(10):5333. [DOI:10.3390/ijerph18105333] [PMID] [PMCID]
37. Kern LM, Safford MM, Slavin MJ, Makovkina E, Fudl A, Carrillo JE, et al. Patients' and Providers' Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: a Qualitative Study. J Gen Int Med 2019;34(6):899-907. [DOI:10.1007/s11606-019-04859-1] [PMID] [PMCID]
38. Curry R, Hollis J. An evolutionary approach to team working in primary care. Br J Community Nurs 2002;7(10):520-7. [DOI:10.12968/bjcn.2002.7.10.10665] [PMID]
39. King BJ, Gilmore-Bykovskyi AL, Roberts TJ, Kennelty KA, Mirr JF, Gehring MB, et al. Impact of Hospital Context on Transitioning Patients From Hospital to Skilled Nursing Facility: A Grounded Theory Study. Gerontologist 2018;58(3):521-9. [DOI:10.1093/geront/gnx012] [PMID] [PMCID]
40. Cranwell K, Polacsek M, McCann TV. Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services. J Psychiatr Ment Health Nurs 2017;24(6):337-47. [DOI:10.1111/jpm.12322] [PMID]
41. Di Pollina L, Gillabert C, Kossovsky M. [Integrated care systems for elderly people]. Rev Med Suisse 2008;4(172):2044-7. [Google Scholar]
42. Cohen-Mekelburg S, Rosenblatt R, Gold S, Shen N, Fortune B, Waljee AK, et al. Fragmented Care is Prevalent Among Inflammatory Bowel Disease Readmissions and is Associated With Worse Outcomes. Am J Gastroenterol 2019;114(2):276-90. [DOI:10.1038/s41395-018-0417-9] [PMID]
43. Kailasam M, Guo W, Hsann YM, Yang KS. Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study. BMJ Open 2019;9(3):e022965. [DOI:10.1136/bmjopen-2018-022965] [PMID] [PMCID]
44. Tarnasky AM, Achey MA, Wachsmuth LP, Williamson H, Thomas SM, Commander SJ, et al. Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis. Pediatr Hematol Oncol 2021;38(8):731-44. [DOI:10.1080/08880018.2021.1922557] [PMID]
45. Tinetti ME, Esterson J, Ferris R, Posner P, Blaum CS. Patient priority-directed decision making and care for older adults with multiple chronic conditions. Clin Geriatr Med 2016;32(2):261-75. [DOI:10.1016/j.cger.2016.01.012] [PMID]
46. Sohl-Kreiger R, Lagaard MW, Scherrer J. Nursing case management: relationships as a strategy to improve care. Clin Nurse Spec 1996;10(2):107-13. [DOI:10.1097/00002800-199603000-00016] [PMID]
47. Dollard J, Harvey G, Dent E, Trotta L, Williams N, Beilby J, et al. Older People Who Are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients' Pathways of Care. J Frailty Aging 2018;7(3):193-5. [DOI:10.14283/jfa.2018.12] [PMID]
48. Rosenberg NA, Zulman DM. Measures of care fragmentation: Mathematical insights from population genetics. Health Serv Res 2020;55(2):318-27. [DOI:10.1111/1475-6773.13263] [PMID] [PMCID]
49. Liu CW, Einstadter D, Cebul RD. Care fragmentation and emergency department use among complex patients with diabetes. Am J Manag Care 2010;16(6):413-20. [Google Scholar]
50. Gormley DK, Costanzo AJ, Goetz J, Israel J, Hill-Clark J, Pritchard T, et al. Impact of Nurse-Led Interprofessional Rounding on Patient Experience. Nurs Clin North Am 2019;54(1):115-26. [DOI:10.1016/j.cnur.2018.10.007] [PMID]
51. Kaufman EA, McDonell MG, Cristofalo MA, Ries RK. Exploring barriers to primary care for patients with severe mental illness: frontline patient and provider accounts. Issues Ment Health Nurs 2012;33(3):172-80. [DOI:10.3109/01612840.2011.638415] [PMID]
52. Wu MP, Lin PF, Lin KJ, Sun RS, Yu WR, Peng LN, et al. Integrated care for severely disabled long-term care facility residents: is it better? Arch Gerontol Geriatr 2010;50(3):315-8. [DOI:10.1016/j.archger.2009.05.004] [PMID]
53. Ganann R, Weeres A, Lam A, Chung H, Valaitis R. Optimization of home care nurses in Canada: A scoping review. Health Soc Care Community 2019;27(5):e604-e21. [DOI:10.1111/hsc.12797] [PMID] [PMCID]
54. Boockvar KS, Litke A, Penrod JD, Halm EA, Morrison RS, Silberzweig SB, et al. Patient relocation in the 6 months after hip fracture: risk factors for fragmented care. J Am Geriatr Soc 2004;52(11):1826-31. [DOI:10.1111/j.1532-5415.2004.52512.x] [PMID] [PMCID]
55. McCabe PJ. Spheres of clinical nurse specialist practice influence evidence-based care for patients with atrial fibrillation. Clin Nurse Spec 2005;19(6):308-17; quiz 18-9. [DOI:10.1097/00002800-200511000-00010] [PMID]
56. Groenvynck L, de Boer B, Hamers JPH, van Achterberg T, van Rossum E, Verbeek H. Toward a Partnership in the Transition from Home to a Nursing Home: The TRANSCIT Model. J Am Med Dir Assoc2021;22 (2):351 -6. [DOI:10.1016/j.jamda.2020.09.041] [PMID]
57. Cham S, Wen T, Friedman A, Wright JD. Fragmentation of postoperative care after surgical management of ovarian cancer at 30 days and 90 days. Am J Obstet Gynecol 2020;222(3):255.e1-.e20. [DOI:10.1016/j.ajog.2019.09.005] [PMID]
58. Kern LM, Ringel JB, Rajan M, Colantonio LD, Casalino LP, Reshetnyak E, et al. Ambulatory Care Fragmentation and Incident Stroke. J Am Heart Assoc 2021;10(9):e019036. [DOI:10.1161/JAHA.120.019036] [PMID] [PMCID]
59. Karacop E, Enhos A, Bakhshaliyev N. Impact of postdischarge care fragmentation on clinical outcomes and survival following transcatheter aortic valve replacement. Herz 2021;46(Suppl 2):180-6. [DOI:10.1007/s00059-020-04976-2] [PMID]
60. Solomon DH. Postfracture interventions disseminated through health care and drug insurers: attempting to integrate fragmented health care delivery. Osteoporos Int 2011;22 Suppl 3:465-9. [DOI:10.1007/s00198-011-1698-7] [PMID]
61. Stulberg DB, Dahlquist I, Jarosch C, Lindau ST. Fragmentation of Care in Ectopic Pregnancy. Matern Child Health J 2016;20(5):955-61. [DOI:10.1007/s10995-016-1979-z] [PMID]
62. Snow K, Galaviz K, Turbow S. Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review. J Gen Intern Med 2020;35(5):1550-8. [DOI:10.1007/s11606-019-05366-z] [PMID] [PMCID]
63. Wang A, Li Z, Rymer JA, Kosinski AS, Yerokun B, Cox ML, et al. Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry. Am J Cardiol 2019;124(6):912 -9. [DOI:10.1016/j.amjcard.2019.06.005] [PMID]
64. Deschodt M, Laurent G, Cornelissen L, Yip O, Zúñiga F, Denhaerynck K, et al. Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis. Int J Nurs Stud 2020;105:103552. [DOI:10.1016/j.ijnurstu.2020.103552] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Contact Information
Address: Urmia University of Medical Sciences, Deputy of Research and Technology,Djahad Ave.,
Urmia-5714783734, IRAN
P.O. Box: 1138,
Tel: 044 - 331937224
Fax: 044 - 32240642
E-Mail:
j.nur.mid
gmail.com, unmfumsu.ac.ir