Patient’s gender, age | Patient’s main health problem, number of diagnoses, and ward | Participants in the care-planning meeting |
---|---|---|
P#1 Female, 86 years | Fractured arm. > 2 diagnoses. Start of stay at rehabilitation/intermediate care unit, city municipality. | Patient and a nurse. |
P#2 Female, 96 years | Chest pains and abdominal pain. > 4 diagnoses. Start of stay at rehabilitation/intermediate care unit, city municipality. | Patient and a nurse. |
P#3 Female, 97 years | Fall, fractured neck of femur, with infection. > 5 diagnoses. End of stay at rehabilitation ward, city municipality. | Patient, case manager from office handling allocation of services, physiotherapist, nurse, home care nurse, and daughter. Three nursing students observed the meeting. |
P#4 Female, 98 years | Several falls assumed to be caused by orthostatic hypotension. > 2 diagnoses. End of stay at rehabilitation ward, city municipality. | Patient, case manager from office handling allocation of services, nurse at the ward, home care nurse, daughter, and adult granddaughter. |
P#5 Female, 62 years | Pneumonia. > 5 diseases. Middle of stay at intermediate care unit, city municipality. | Patient, husband, case manager from office handling allocation of services, and nurse from the ward. One nursing student observed the meeting. |
P#6 Female, 91 years | Weakened by cumulative effect of multiple conditions. > 5 diagnoses. Middle of stay at rehabilitation ward, city municipality. | Patient, case manager from office handling allocation of services, home care nurse, and ward nurse. Daughter and two sons. |
P#7 Male, 94 years | Functional decline and emerging needs for home care services. > 5 diagnoses. Meeting at patient’s home before short-term stay at nursing home, rural municipality. | Patient, wife, and nurse in home care services. |
P#8 Female, 96 years | Syncope. > 2 diagnoses. Meeting at patient’s home, right after stay in intermediate unit, rural municipality. | Patient and nurse in home care services. |
P#9 Female, 86 years | Hip surgery. > 5 diagnoses. Middle of stay at short-term ward, rural municipality. | The patient did not wish to participate in the meeting. Four daughters, head nurse at care home, physiotherapist, and nurse. |
P#10 Male, 75 years | Fractured neck of femur. > 4 diagnoses. End of stay at short-time ward, rural municipality. | Patient, head nurse in home care services, physician, physiotherapist, mental health nurse, case manager, daughter, son, and nurse from home care services. |