Home-based care is a central component of health services, yet research-based knowledge about nursing practice in this complex context remains limited. Nursing in home care requires considerable competence, particularly in detecting and responding to early signs of health deterioration among older care recipients. Given the negative consequences associated with conditions like functional ability limitations and frailty – and nurses’ responsibility in detection and prevention – it is crucial to support nurses. The aim of this project was to map research on functional ability (limitations) and frailty among older people in home- and facility-based care, and to explore nurses’ roles, functions, and clinical decision-making within home-based care.
First, a scoping review mapped research describing functional ability limitations and frailty among older people and identified models of care targeting these conditions. The findings indicated a discrepancy between older people’s experiences and nurses’ perspectives. Older people described these conditions as involving identity loss and an emotional struggle to maintain independence, while emphasising positive interpretations when adapting to their situation. In contrast, nursing practice was portrayed as reactive and guided by experience and intuition. Most models of care targeted functional ability limitations and focused on educating nurses. Second, building on this review, direct structured observations, think-aloud conversations, and interviews explored nurses’ scope of practice – roles, functions, and decision-making – among older people receiving home-based care. Third, the knowledge generated is planned to inform the development of an intervention aimed at supporting nurses’ practice and clinical decision-making.
The overarching goal of this project is to generate research-based knowledge to strengthen home-based nursing services. A systematic, knowledge-based approach can help ensure early signs of health deterioration are recognised and addressed promptly, saving lives and resources while improving health and quality of life for older people and their significant others – benefiting both providers and recipients of home-based care.
