Implementing an early supported discharge intervention to nursing homes and respite care centers after hip fracture: A qualitative study of staff experiences and field observations

BACKGROUND: An enhanced standardized interdisciplinary cooperation (ESIC) model was introduced to improve collaboration between hospitals, nursing homes and respite care centers (NH-RCC) after hip fracture. It involved structured post-discharge care and 2-week extended hospital care, requiring new collaborative practices whose success depended on how NH-RCC staff perceived and enacted the intervention. METHODS: An ethnographically inspired design was applied, combining field observations and semi-structured interviews with Health and Social Care Personnel (HSCP) in 10 NH-RCCs until saturation was reached. Observations followed Spradley's nine-domain framework. Interview data were analyzed using Braun and Clarke's thematic analysis within a hermeneutic framework. Observational findings were used to assess alignment. RESULTS: Twelve interviews (8-33 min) and 180 h of observations were conducted. Participants were NH-RCC nurses (n = 7), outreach nurses (n = 3), and social and health care assistants (n = 2). Four overarching themes revealed dualistic findings. The use of Early Warning Score was integrated into daily routines (Theme 1, Normalization of the intervention in everyday practice) and supported a broader clinical view of residents (Theme 2, Clinical awareness, ethics and relational care). However, some nurses experienced a problematic shift from direct care towards documentation (Theme 3, Role restructuring and coordination work). Mobilization was often omitted in vulnerable residents. Also, incomplete discharges and project tasks were a source of frustration (Theme 4, Systemic constraints and safety vulnerabilities). CONCLUSION: We found that an ESIC model can be integrated into NH-RCC routines and enhance HSCPs clinical awareness. However, professional roles and prioritization of mobilization need clearer alignment between clinical goals and practice.