Municipal Home Care Research Articles

ORAL HYGIENE AND THE INCIDENCE OF FUNCTIONAL DECLINE IN OLDER ADULTS AGED ≥75 YEARS: THE OHSAKA STUDY

Abstract Poor oral health has been identified as a risk factor for overall health. Management of oral problems is highly significant in the field of public health. This retrospective cohort study aimed to clarify the association between the oral hygiene and the incidence of functional decline in 134,957 participants aged 75 years or older, who underwent public dental checkups in Japan. The oral hygiene levels were scored by dentists as excellent, good, or poor. The outcome was the identification of functional decline based on Long-term Care Insurance certification. An association between the oral hygiene and the incidence of functional decline were assessed using the Fine and Gray model adjusted for clinically relevant factors. During the median observational period of 36 months, the incidence of functional decline was observed in 3,360 (5.3%) men and 2,693 (3.8%) women. The multivariable-adjusted model showed that poor oral hygiene was associated with functional decline in both men and women, respectively (Sub-hazard ratios [95% confidence interval] of Excellent, Good, and Poor: 1.00 [reference], 1.10 [0.99–1.24], and 1.57 [1.33–1.84], respectively for men; 1.00 [reference], 1.29 [1.14–1.46], and 1.56 [1.23–1.97], respectively for women). The findings of the present study suggest that municipal healthcare planning and home care should recommend oral hygiene in older adults aged ≥75 years.

Negotiating care in organizational borderlands: a grounded theory of inter-organizational collaboration in coordination of care

BackgroundAlthough coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.MethodsA qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.ResultsCoordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as “Negotiating care in organizational borderlands.” Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from “Dividing care by disease-specific expertise” to “Establishing paths for collaboration” and ultimately “Co-constructing a comprehensive whole.” These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.ConclusionsThe key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.

Measurement Properties of the Patient Assessment of Transitions in Healthcare Settings (PATH) Questionnaire

ABSTRACT Further evaluation of the Patient Assessment of Transitions in Healthcare settings (PATH) questionnaire measurement properties is needed to ensure high-quality measurement of patients’ experiences of healthcare provision which includes transitions across settings. The aim of this study was to determine structural validity and reliability for measurement of patient-experienced quality in healthcare transitions across hospital, GP, municipal rehabilitation, and/or home care settings for the PATH questionnaire through Rasch analysis. This study supports that PATH is a structurally valid measure for use in hospital, GP, and municipal home care. However, use of PATH for evaluation of municipal rehabilitation is not currently recommended. We find that PATH discriminates adequately between poor, moderate, and good patient-experienced quality of healthcare transitions without systematic differential item functioning. In conclusion, PATH enables valid and reliable planning and evaluation of initiatives to improve pathways which include transitions across healthcare settings.

Application of a new municipal management model of home care service in Barcelona: Assessment of workers' labour conditions, health, and well-being.

In 2018, Barcelona City Council implemented a pilot phase of an organisational change in the municipal home care service (HCS) system. Inspired by the Buurtzorg model, the new model promotes the creation of self-managing teams operating in a restricted community setting. To assess the pilot phase of the new model, focusing on employees' working and employment conditions as well as on their health and well-being outcomes. Mixed-methods impact evaluation. First, a quantitative evaluation was conducted between October 2018 and October 2020, using a pre-post study design with one pretest and two posttest measurements in an intervention and a comparison group. The intervention group was composed of the members of the work teams implemented in the pilot phase from October 2018 onwards (baseline n = 44). The comparison group consisted of workers from the same districts working under the usual HCS system (baseline n = 72). Next, a qualitative study was conducted in workers from the intervention group in winter 2021-2022 (n = 10). The pre-post study results yielded positive changes for the intervention group in social support and autonomy, as well as in many of the employment conditions. This group also experienced increases in psychological demands, painful positions, fatigue and psychological distress. Two main themes affecting workers' well-being emerged from the interviews: factors inherent to the self-management model and external factors. Health and well-being outcomes seem to depend on the balance between job demands, resources, and ways of channelling conflicts within teams.

With the best intentions: Implications on self-determination during Covid-19 restrictions.

In times of crisis, the interests of the individual might be sacrificed for the health and safety of others. The aim of this study was to explore the situation under Covid-19 for persons with intellectual disabilities, focusing on implications on the right to self-determination within health protection. To understand how the relevant legal framework was governed by authorities and service providers during the Covid-19 pandemic, we have performed semi-structured interviews with 19 service providers in municipal home care services. Many residents were provided adequate and adapted information about Covid-19, but very few were involved in the introduction and implementation of infection control measures. Our study has revealed how a crisis such as the pandemic not only puts the health of people with intellectual disabilities at risk, but also challenges their right to self-determination.

Cross-sectoral exchange of nurses: An intervention study.

In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated. The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them. Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

Inter-Organizational Home Care Nursing Teams: A Comparison of a Region Wide Organizational Change Initiative With Success Factors Identified by Forerunners and Team Theory

Teamwork is considered something positive. While there is much research on teamwork in healthcare, research on teamwork in home care nursing is limited. As the need for home care nursing is likely to increase in the future, it is of great interest to investigate the circumstances associated with the implementation of teamwork in home care nursing. The present study compares the results from a large change initiative intended to foster inter-organizational teamwork between municipal home care nurses and doctors employed by the region, with success factors identified by forerunners and contemporary team theory. Eighteen participants representing the organizations involved in the change initiative, and 6 participants from the forerunners, were interviewed, and 3 success factors were identified: fixed doctors in team, co-location of staff, and a shared team identity. However, for the studied change initiative, few of the success factors were present. Since the success factors are similar to factors associated with effective teamwork in the literature, this is problematic. The results indicate that there was a focus on the division of labor between the municipalities and the region rather than on interdisciplinary cooperation. They also suggest that the change initiative, as it worked in practice, did not always make sense from the perspective of the nurses and doctors involved. Thus, we suggest that measures are taken to ensure that change initiatives, like the 1 studied, also make sense on the local level in the organization where most of the implementation takes place.

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.

Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations. This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home. This study has a qualitative design with a lifeworld approach. A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70-93 years. Care-dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain. Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living. Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers’ experiences in Region Stockholm

BackgroundIn the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.MethodA descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.ResultsThree themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.ConclusionSocial care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

Logistics of care: Trust-reform and self-managing teams in municipal home care services

Abstract The central idea in trust-reform is to improve service delivery by granting professional autonomy and acknowledging the experiential knowledge of professionals. In this article, we study trust-reform bottom-up from the perspective of frontline care workers. Our aim is to discuss the challenges for care work and care workers who have been organised in self-managing teams, paying particular attention to the organising of the daily work in the teams. This study draws on data from four months of fieldwork in Norwegian municipal home care services for older people. The article sheds light on some problematic aspects in trust-reform regarding the relationship between frontline workers’ autonomy and responsibility on the one hand and the lack of authority and managerial support on the other hand. The study demonstrates that trust-reforms within public service delivery can be experienced as delegation of logistical tasks and enhanced responsibility instead of delegation of the authority that is necessary for professional care work to be performed. As such, trust-reforms risk obstructing rather than advancing their declared intentions of strengthening professional agency in care work, and rather than distributing management tasks, trust-reforms need to strengthen the management function in order to succeed.

TalkingMats as a decision aid to promote involvement in choice and decision-making around home care services for older people with mild to moderate dementia – study protocol for a randomized controlled trial

BackgroundIn Sweden, 72% of people with dementia live in ordinary housing. Of these, 50% receive home care services. Older people with dementia may benefit from developments in decision-making support which aim to facilitate their ability to communicate their personal needs and preferences with care managers and staff in home care services. In this study, we will test and evaluate the use of TalkingMats in Swedish municipal home care services for older people with mild to moderate dementia. TalkingMats is a low-technology communication tool, to help people with communication difficulties express their views. It uses a simple system of picture symbols which are placed on a textured mat. This study will provide insight into the extent to which TalkingMats benefits older people with dementia to feel more involved in decisions related to home care services. In addition, this study will assess the extent to which the use of TalkingMats promotes service providers’ efforts to involve service recipients in decision making. The implementation of TalkingMats in home care services will also be studied.MethodsA parallel group, two-armed randomized controlled trial design in which TalkingMats and Usual Conversation Method will be compared. Two specific situations where older people with dementia must make decisions about home care services will be studied. First, a follow-up needs-assessment conversation between study participants and care managers will be studied. Second, a conversation between participants and home care staff regarding the delivery of the decided home care services will be studied. In addition, a qualitative approach will be used to gain an understanding of study participant and service provider experiences of the impact and implementation of TalkingMats.DiscussionThe combined exploratory, descriptive, and experimental study design is considered an important strength which will facilitate multi-facetted knowledge production concerning the involvement and communication needs of older people with dementia generally and within the context of home care services specifically. Combining qualitative and quantitative methods will maximize our ability to assess the effects of TalkingMats.Trial registrationClinicalTrials.gov ID: NCT05561998. Registered in September 28, 2022.

Home Care Nurses' Experiences of the Use and Introduction of the Subacute Functional Decline in the Elderly Instrument.

Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses' perception of this new assessment tool and its effectiveness has not been evaluated. This study aims to explore home care nurses' experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients' needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered.

Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study.

In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters. The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care. We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis. Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care'). The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.

Trust-based service innovation of municipal home care: a longitudinal mixed methods study

BackgroundIn Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in healthcare. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM.MethodsThe TM elements were developed through a comprehensive participatory process, resulting in the decision to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients.ResultsThe patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed.ConclusionsTrust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare.

Effects of the Labour Inspectorate Authority’s regulatory tools on psychosocial and biomechanical work factors in Norwegian home care services: a cluster randomised controlled trial

ObjectivesThis study aimed to determine the effects of the Labour Inspectorate Authority’s (LIA’s) regulatory tools on psychosocial and biomechanical work factors in the Norwegian municipal home care services.MethodsA cluster-randomised controlled...

‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios

ObjectiveSafety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity...

Tensions between infection control regulations and the home care working environment: An interview study with health care providers early during the COVID-19 pandemic

Background: Therefore, the objective of this study was to elucidate caregivers’ experiences of ordinary homes as a working environment in home care and home health care during the COVID-19 pandemic. At the beginning of the pandemic, hospital care was in focus and the care of older adults was criticized around the world. Design and methods: Semi-structured qualitative interviews were conducted in two municipalities in Sweden between March 2020 and May 2021. One large municipality (population 155,000) with experience of care recipients with COVID-19, and a smaller municipality (population 32,000) were included; both had a focus on preventing the spread of the infection. A total of 27 participants working in home care were interviewed; these were occupational therapists, physical therapists, nurses, and assistant nurses. The interview material was analyzed using content analysis. Results: The interviews provided a comprehensive insight into the complex work environment in municipal home care during the pandemic. The staff had to deal with constantly changing information and new guidelines. They were also given new tasks and work routines that demanded more planning and were time-consuming. The staff experienced higher workload and pressure during the pandemic and did not have enough time to recover. Conclusions: During a pandemic situation, the information must be comprehensive and gathered in one place, and the managers must ensure sufficient staffing levels, time for reflection, and support for prioritization. The managers must also ensure the mental health of staff and meet their needs for recovery, both at and outside work.

Aesthetic wisdom of older workers

PurposeThe purpose of this study is to propose the notion of the value and contribution of the wisdom of older workers in working life.Design/methodology/approachUsing a framework of organisational aesthetics, this paper presents an empirical case study analysing the material collected from Finnish municipal home care services and sheltered accommodation designed for older people. Through the analysis of the stories of older and younger employees, the case study shows how workers construct ideas of skills related to ageing, how the wisdom of older workers has been transformed into practices and how aesthetic wisdom might benefit this social process.FindingsThe findings reveal three characteristics of ageing wisdom – caring, graceful and joyful wisdom – that all present focused sensitivity, emphasizing the subject’s experience, feelings and emotions. The findings also illustrate how the authority of older workers made visible this feeling-driven wisdom and values, and through these means, enhanced the skills of younger employees.Social implicationsThe present paper challenges the debate on ageing which has mainly focused on the problems of older workers in a social context.Originality/valueThis paper provides new insights into the skills of older workers in the empirical and theoretical framework of organisational aesthetics.

Next of kin\u2019s experiences of registered nurses\u2019 leadership close to older adults in municipal home care in Sweden: an interview study

BackgroundNext of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care.MethodsIndividual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis.ResultsThe results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve.ConclusionsNext of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care.