Time constraints, inadequate organizational conditions and insufficient collaboration create challenges for nurses leading the care of older adults in municipal home healthcare. This is shown in new research from Karlstad University.
In her doctoral thesis, Erica Lillsjö explored nurses’ patient-centred leadership in municipal home healthcare for older people. The findings show that nurses in municipal home healthcare strive to lead with a focus on the older person’s wishes, needs and best interests, while also seeking to create a sense of security for both the older person and their relatives.
– The nurses wanted to lead, and they wanted to lead in ways that promote person-centred care. However, the organizational conditions created challenges for their leadership, says Erica Lillsjö.
The thesis is based on survey responses and interviews with nurses, as well as interviews with care staff. The care staff consisted of assistant nurses and care assistants supervised by nurses in home healthcare.
Building relationships proved to be essential in nurses’ leadership, including relationships with the older person, relatives and care staff.
– Person-centred care is built on creating a relationship with the older person. This requires time and opportunities to meet, says Erica Lillsjö.
However, the findings also show that nurses and care staff work in an everyday environment characterized by time pressure and a high administrative workload for nurses. This can make it difficult for nurses to carry out home visits and for nurses and care staff to find time to meet.
– The nurses wanted to spend more time with older people, and both nurses and care staff wanted to work more closely together to promote good and safe care for older adults, says Erica Lillsjö.
The organization creates challenges
One major challenge concerns the organization of home healthcare, where collaboration does not always function optimally. Nurses work within a complex healthcare system governed by different legal frameworks, where cooperation between healthcare providers, such as municipalities and regions, is essential.
The findings show challenges in communication between nurses and care staff, as well as in collaboration with other healthcare providers, which jeopardizes patient safety. Nurses in home healthcare meet older people less frequently, while more assessments are conducted over the phone through care staff. At the same time, nurses describe situations where care staff sometimes lack sufficient competence, which may compromise patient safety and the older person’s sense of security. As a result, nurses need to provide increased support and supervision to care staff.
– Organizational conditions need to be created to enable nurses to lead effectively and to promote good and safe care for older adults. Therefore, organizational “silos” need to be dismantled, and home healthcare and social care need to be more closely integrated, says Erica Lillsjö.
