Socially marginalized patients’ perspectives on hospital transition: A qualitative study

Background: Socially marginalized patients often have several contacts with healthcare and social service workers. Their healthcare needs are often complex as they often struggle with chronic diseases, multimorbidity, and severe social issues. Emergency departments serve an essential role in healthcare for socially marginalized patients, as proper care and support at the beginning of their patient pathways are vital for a coherent healthcare trajectory. Research has shown that social nurses with specialized knowledge and experience working with marginalized patients provide patient-centered care and coherence during hospital admission. However, limited research on the hospital transitions of socially marginalized patients has been undertaken. Therefore, this study aimed to explore the experiences of the transition from hospital to home of socially marginalized patients who receive social nursing during their hospital stay. <br/>Methods: This is a qualitative study performed with a phenomenological and hermeneutic approach at Odense University Hospital in Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled between January 2023 and March 2023. Sixteen patients were interviewed during hospital admission, and thirteen of the patients participated in a follow-up interview 7–22 days after discharge. The analysis was performed using systematic text condensation, and data storage and coding were supported by Nvivo 12. The analysis was synthesized in a workshop by the research group and afterward qualified by two patient representatives, who shared their reflections on the results.<br/>Ethical approval and informed consent: The study is registered with the Danish Data Protection Agency (22/47509). Participants gave oral and written consent to participate.<br/>Results: The participants' experiences of the transition from the hospital to home depended on three aspects: 1) how the discharge was planned, 2) their living circumstances after discharge, and 3) the level of support after discharge. While clear communication and a well-prepared discharge were important for a successful transition from the hospital to home, the participants experienced being rushed at discharge and many felt left out of the decision-making process. The hospitalization was a turning point for many participants’ daily lives as their physical condition required changes in their lifestyle to achieve the best possible recovery. The participants had interactions with many different social and healthcare services and many needed additional healthcare and support after discharge. However, many participants experienced poor multidisciplinary cooperation and standardized care options, which did not always match their needs.<br/>Discussion and conclusions: The findings revealed a silo-divided healthcare system, which is especially problematic for the care of patients with coexisting social and healthcare issues. This study identifies transitional care gaps in socially marginalized patients’ pathways related to poor multidisciplinary cooperation and standardized care. Knowledge of the hospital transitions of socially marginalized patients is important to provide early identification of healthcare needs and sufficient support in the emergency department and improve the patient pathway of patients with social vulnerability.<br/>Funding: This study was supported by the University of Southern Denmark, the Region of Southern Denmark, Novo Nordisk, Østifterne, and the Department of Emergency Medicine at Odense University Hospital.