A new study offers an in-depth and uncommon insight into how registered nurses and nursing assistants work with fundamental care for older people within municipal home healthcare services. The study shows that care work is significantly more complex and multifaceted than what is often reflected in guidelines, schedules, and care plans.
“The study shows that everyday conditions have a major impact on care quality, and that fundamental care is more complex than what is often made visible in governing documents,” says Karin Sandberg, doctoral student in nursing at Karlstad University and one of the researchers behind the study.
The researchers examined how registered nurses and nursing assistants responsibilities and care activities—their scopeof practice—are expressed in real-life situations when older people with extensive health care needs receive care in their own homes. The study is based on direct observations of more than 3,000 care activities within home healthcare in western Sweden.
“Fundamental care is not only about performing various care interventions and medical tasks,” says Karin Sandberg. “It is about seeing the whole person and continuously assessing and adjusting the care based on the individual’s physical, psychological, and social needs.”
Care work spans multiple dimensions
The results show that registered nurses and nursing assistants often perform care interventions that go far beyond the initial purpose. Care simultaneously encompasses physical, psychosocial, and relational dimensions, where the interaction and relationship with the older person are central.
“Much of fundamental care happens in the small moments—in conversations, in observations, and in assessments made on the spot,” says Karin Sandberg.
The study also shows that both registered nurses and nursing assistants in practice participate in decisions and assessments that influence the direction of care, indicating that some decision-making has shifted from registered nurses to nursing assistants in day-to-day work.
The work environment affects care quality
The researchers identified several work environment factors that affected the ability to provide high-quality care. Interruptions, time pressure, and insufficient organizational support could limit staff’s ability to act and influence the quality of the care provided.
“If we want to improve home healthcare, we need to understand the conditions under which nurses and assistant nurses work. It’s not only about individual competence but also about how the organization enables or hinders good care,” says Karin Sandberg.
Important knowledge for the future of elderly care
As more older people live with complex care needs, home healthcare is becoming an increasingly important part of the healthcare system. The study shows that care work in the home is often more extensive and advanced than what is apparent in documentation and planning systems.
“A deeper understanding of how care work actually takes place can help develop care models that strengthen care quality while also creating more sustainable working conditions for staff,” says Karin Sandberg.
- The study, published in International Journal of Nursing Studies Advances:
“Nurses’ scope of practice and fundamental care in relation to older people: An exploratory home-based study” – ScienceDirect.
