Associations between nurse managers' leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study.

BACKGROUND: Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services. AIMS: To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers' leadership styles are associated with team culture and documented nursing competence planning. METHODS: A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers' background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers' transformational (relational) leadership and transactional (task-oriented) leadership styles. RESULTS: The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning. CONCLUSION: A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.

What matters to older adults? Exploring person-centred care during and after transitions between hospital and home.

AIMS AND OBJECTIVES: To explore person-centred care provided to a group of older adults (65+) by understanding their experiences of care received, their participation in care and what matters to them during and after the transition process between hospital and home. BACKGROUND: Although facilitating person-centred care (PCC) has gained increasing importance globally over the last few decades, its practical implementation has been challenging. This has caused difficulties in determining its core elements and best practices. Person-centred care aims to deliver healthcare services based on individuals' preferences. Several approaches have been developed to better implement person-centred care practices. The Norwegian transitional and follow-up model, 'Holistic Continuity of Patient Care', chooses the 'What Matters to You?' APPROACH: Other approaches include 'Shared Decision Making' and 'Continuity of Care'. DESIGN: This study employed a qualitative design. METHODS: Individual repeated interviews were conducted among eight participants. A hermeneutic exploratory research method was chosen. The COREQ checklist was followed. RESULTS: Three main themes related to person-centred care emerged: what matters in meetings with the individual healthcare worker, mobilising health-promoting capabilities and resources and what matters when being in the organisational healthcare system. CONCLUSION: To participate in their own health issues, older people need to be empowered and better informed about the importance and scope of person-centred care. 'What Matters to You?' is a good focus for the direction of care but can lead to a simplified understanding of individuals' preferences. Increased focus on how care recipients' capabilities and resources affect their responding is needed. RELEVANCE TO CLINICAL PRACTICE: Ensuring that person-centred aspects are incorporated into the entire healthcare system requires better methods of engaging and empowering older adults in healthcare settings; more focus on PCC competence and skills of healthcare professionals as well as better integration of PCC practices into healthcare administration and policies.

Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study.

BACKGROUND: The primary health care services are becoming increasingly complex, which presents challenges for the municipal nursing services. In Norway, municipal in-patient acute care (MipAC) has been introduced in all municipalities, and the competence at the services has been questioned. Few studies have examined the nursing services in the units. This study aims to get an overview of the nursing competence in those units across geographical regions, and different groups of organisation and localisation. METHODS: A cross-sectional study was conducted, and an ad hoc questionnaire was distributed to first-line leaders in all the MipAC units in Norway. Data were collected in the period between 6 March 2019 to 6 June 2019. Measures to get an overview of the nursing competence were ratio of registered nurses (RNs) in staff, count of shifts with only one RN on duty and count of RNs with master's degrees/specialisation. Descriptive comparative statistics were used. RESULTS: Of all 226 first-line leaders invited to participate, 207 (91.6%) responded to the questionnaire. Overall a considerable variance across the sample was revealed. The median ratio of RNs in staff was 56 (IQR = 40-70), the count of shifts with only one RN on duty median 28 (IQR = 5-49), and the count of RNs with a master's degree or specialisation median 3 (IQR = 0-5). The regions of Northern and Central Norway, MipACs located in nursing home and MipACs organised at long-term care units, showed significantly lower nursing competence in staff compared to the remaining institution and organisations. CONCLUSION: This study generates knowledge that can inform planning, priorities and interventions that may be initiated at all organisational and political levels concerning the MipAC services. An overall conclusion is that advanced nursing competence is lacking. The study also highlights the most urgent direction for improvements regarding nursing competence in the services. It seemed to be MipACs in Northern and Central Norway, and those located at nursing homes organised together with long-term care units, that needed improvements the most.

Testing Measurement Properties of the Norwegian Version of Electronic Health Literacy Scale (eHEALS) in a Group of Day Surgery Patients.

BACKGROUND AND AIM: In order to assess patients' ability to search, understand, and benefit from Internet-based information, several screening tools have been developed. One of these tools, which has been widely used, is the eHealth Literacy Scale (eHEALS). The aim of this study was to examine the measurement properties of the Norwegian version of the eHEALS, as it was used in a group of patients undergoing day surgery. METHODS: A cross-sectional survey study was conducted among 119 patients scheduled for day surgical treatment in a Norwegian hospital. The questionnaire included the screening tool eHEALS, which contains 8 items for assessing a person's information awareness skills, information seeking skills, and skills to evaluate and act based on the information. Cronbach's alpha coefficients and item-total correlations were assessed for estimating reliability of the eHEALS. Exploratory factor analysis with Oblimin rotation was used for assessing the validity of the scale. Eigenvalue was set to 1.0. RESULTS: A Cronbach's alpha coefficient of 0.89 for the total scale, values >0.82 for Alpha if Item Deleted, and moderate to high item-total correlations supported the homogeneity and internal consistency of the scale. A two-component solution explained a total of 74.8% of the variance, with the first component explaining 59.53% of the variance in the scale and included the items reflecting information awareness and seeking. The second component explained 15.23% of the variance, including items reflecting the ability to evaluate and act. CONCLUSION: The reliability of the Norwegian version of eHEALS, used in a group of patients undergoing day surgery, was good. The internal structure, with two distinct factors, is in line with several previous studies. The eHEALS appears to be an appropriate tool for assessing eHealth literacy among this patient group.

Systematic Use of Song and Music in Dementia Care: Health Care Providers' Experiences.

BACKGROUND AND AIM: Using song and music in a systematic way in residential dementia care may have several positive impacts on the patients, as well as the care providers. The aim of this study was to explore how health care providers experienced taking responsibility for conducting a song and music program in dementia care in nursing homes. METHODS: An explorative, qualitative study design was used. Focus groups were formed by 17 health care providers from 3 different nursing homes. These providers had experience implementing and using the "Gjenklang" ("reverberation") song and music program especially developed for people with dementia. Focus group interviews were transcribed verbatim, and systematic text condensation was used for analysing the data. RESULTS: Three categories with associated subcategories emerged from the analysis process. The categories were 1) the music program increased the staff's consciousness and awareness; 2) the music program evoked the patients' emotions and reactions; and 3) maintaining enthusiasm over time. CONCLUSION: The general opinion among the participants was that using the song and music program in a systematic and planned way had many benefits and positive impacts on the patients, as well as the staff. However, it was challenging to make it a part of the daily routine. Thus, it is important that the leaders of the units take responsibility to ensure continuity and maintain engagement among the staff over time.

Facilitating holistic continuity of care for older patients: Home care nurses' experiences using checklists.

AIMS AND OBJECTIVES: To explore home care nurses' experiences of implementation and use of checklists developed for improving continuity of care for older patients (65+ years). BACKGROUND: The Norwegian Coordination Reform was implemented to improve coordination between hospitals and communities and facilitate a quicker return to home community after hospital discharge. To follow-up, national learning networks were initialised to improve pathways for chronically ill older patients, including the development and use of standardised checklists. DESIGN: An explorative qualitative design was chosen. METHODS: Three focus group interviews were conducted, including 18 registered nurses from eight municipalities in southern Norway. Systematic text condensation was used to analyse the interview texts. The COREQ checklist was followed. RESULTS: Three categories emerged from the analysis. (a) "The implementation process" included the experiences of a chaotic beginning, the importance of involvement, the leaders' role and resource allocation. (b) "Pros and cons of checklists in use" included the informants' experiences of checklists' usefulness for nurses and the patients. (c) "Competence needed" included the need for a comprehensive set of formal, experiential and social competences. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The leaders' role, support and engagement are decisive for a successful implementation. To succeed and establish solid routines, allocating resources when implementing new laborious routines, such as checklists, is important. To improve holistic continuity of care to chronically ill older patients, checklists should be customisable to each patient's needs, be comprehensive enough to grasp the essence in what to be done at several time points, but at the same time brief enough to be operational. Checklists can be a useful tool for home care nurses, if customised to the individual municipality and the staffs' working routines. It is important that the staff have versatile and extensive competencies enabling them to use the checklists appropriately.

Exploring nursing competence to care for older patients in municipal in-patient acute care: A qualitative study.

AIM: To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care. BACKGROUND: An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance. DESIGN: A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied. METHODS: A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding. FINDINGS: Two main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment." CONCLUSION: Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success. RELEVANCE TO CLINICAL PRACTICE: This study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.

Psychometric testing of the Norwegian version of the questionnaire Family Satisfaction in the Intensive Care Unit (FS-ICU-24).

INTRODUCTION: The questionnaire, Family Satisfaction in the Intensive Care Unit (FS-ICU-24), was developed to assess relatives' satisfaction with care and involvement in decision-making processes when a close family member stays in the ICU. AIM: This study was aimed at describing the translation and exploring the psychometric properties of the Norwegian version of the questionnaire. METHODS: The study design was a cross-sectional survey. After translating the questionnaire according to recommended procedures, 123 close relatives of patients, recently treated in ICU, responded to a mailed questionnaire including the FS-ICU-24-No. Item-to-total correlations and Cronbach's alpha coefficient were assessed for estimating reliability and construct validity was assessed by the "known groups" technique and explorative factor analysis. RESULTS: The Cronbach's alpha coefficient of 0.96 and significant item-to-total correlations supported the homogeneity of the instrument. The construct validity was reflected in significant differences in median scores on the total scale and subscales between the group reporting lower degrees of satisfaction and the group reporting higher degrees of satisfaction. Two fixed factors with an eigenvalue >1, and an explained variance of 62.5%, emerged from the factor analysis. CONCLUSION: The FS-ICU-24-No showed promising psychometric properties regarding reliability in this study group, which may indicate that the instrument is suitable for assessing family members' satisfaction with care and decision making in Norwegian ICU.

Using information and communication technology in the recovery after a coronary artery bypass graft surgery: patients' attitudes.

BACKGROUND: Patients who have undergone a coronary artery bypass graft (CABG) surgery are exposed to physical and mental problems after discharge from the specialist hospital and are often in need of post-discharge support and follow-up. AIM: This study aimed to explore the attitudes of CABG patients toward using information and communication technology (ICT) during the first year of recovery after discharge from hospital. METHODS: A cross-sectional design utilizing an electronic survey was employed. The sample consisted of 197 patients who had undergone a CABG surgery during 2015. The questionnaire included questions about follow-up needs, contacts with health professionals, use of the Internet, and attitudes toward using ICT in the recovery phase. RESULTS: Mean age of the participants was 67.3 years; 18.3% were women. A total of 48.2% of the patient group was satisfied with the pre-discharge information. Only 27% had contacted the hospital after discharge. Whereas 58.4% of the participants had used the Internet to acquire information, only 30.4% found this information to be useful. Many patients (40%) reported that they could benefit from online health information and Skype meetings with professionals. More than 30% reported that nutritional guidance on the Internet could be motivating for choosing healthy diets, and 42.6% reported that Internet-based illustrative videotapes could be motivating for undertaking physical training. CONCLUSION: ICT can be useful and resource-saving for patients who have undergone a CABG surgery, as well as for the health care services. The technology must be appropriately tailored, with regard to content and design, to be helpful for patients.

Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study.

Aim: The aim of this study was to explore family members' satisfaction with care and decision-making during the intensive care units stay and their follow-up needs after the patient's discharge or death. Design: A cross-sectional survey study was conducted. Methods: Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS-ICU 24) and questions about follow-up needs. Descriptive and non-parametric statistics and a multiple linear regression were used in the analysis. Results: A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision-making. Follow- up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow-up needs.

Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people.

AIM AND OBJECTIVES: To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness. BACKGROUND: Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support. DESIGN: This study employed a cross-sectional design. METHOD: A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants' sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods. RESULTS: A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition. CONCLUSIONS: The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness. IMPLICATIONS FOR PRACTICE: Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.

Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: Patients' experiences.

Introduction The way in which telemedicine contributes to promote coping and independence might be undervalued in the development of telemedicine solutions and the implementation of telemedicine interventions. This study explored how home-living patients diagnosed with chronic obstructive pulmonary disease (COPD) experienced follow-up using telemedicine, and the extent to which the implemented technology was able to support and improve the patients' coping resources and independence. Methods A qualitative approach with individual semi-structured interviews was used. Ten patients diagnosed with COPD participated. The data were transcribed verbatim and a qualitative content analysis method was used, including analyses of the manifest and latent content of the texts. Results The participants' positive attitude to handling and understanding the technology and the positive and negative feelings related to use the technology derived the theme: "The telemedicine solution is experienced as comprehensible and manageable and provides meaning in daily life". The importance of telemedicine services that provided trust and confidence, the intervention's impact on independence and self-management and the intervention's ability to support integrity and meaning in life, derived the theme: "The telemedicine intervention contributes to stress reduction caused by illness burden and facilitates living as normally as possible". Discussion The impact of a telemedicine intervention might be influenced by the experience of a technological solution that requires little effort to deal with, while it must also provide meaning in life. Furthermore, the telenurses' expertise and the intervention's flexibility, i.e. possibilities for individual adaption, might promote coping to facilitate living as normally as possible despite illness.

Family members' lived experiences of everyday life after intensive care treatment of a loved one: a phenomenological hermeneutical study.

AIMS AND OBJECTIVES: To illuminate relatives' experiences of everyday life after a loved one's stay in an intensive care unit. BACKGROUND: Relatives of intensive care patients experience considerable stress that can have a long-lasting effect on their everyday lives. Relatives frequently report anxiety, depression and complicated grief as a result of their experiences in the intensive care unit. DESIGN: A qualitative design was chosen. METHODS: Thirteen relatives were interviewed 3 months to 1 year after the discharge or death of an intensive care unit patient. A phenomenological hermeneutical method was used to explore family members' lived experiences upon returning home after their loved ones' stay in the intensive care unit. RESULTS: Two themes emerged from the analysis of the data: (1) changes in everyday life and emotional reactions, and (2) managing changes and need of support and follow-up from the ICU. CONCLUSIONS: Family members experience changes in emotions, roles and responsibilities after returning home. They must maintain control of themselves and adapt to the changes to face the future. They cope by using their personal resources and support from others. Some are in further need of follow-up from the intensive care unit staff. RELEVANCE TO CLINICAL PRACTICE: Nursing education could focus increasingly more on the significance of communication and personal support, which helps family members cope during patients' stay and experience a sense of personal strength when returning home. Further research should address how to identify and support those with special needs after the intensive care unit stay.

Psychometric properties of Antonovsky's 29-item Sense of Coherence scale in research on older home-dwelling Norwegians.

AIM: The aim of this study was to test the homogeneity and construct validity of the Sense of Coherence 29-item scale (SOC-29) among older home-dwelling Norwegians. METHODS: A postal questionnaire, consisting of background variables, five health-related questions, the SOC-29, and three other instruments measuring mental health, self-care ability, and risk for undernutrition, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. A total of 2069 participants were included. Homogeneity was assessed with Cronbach's alpha coefficient and item-to-total correlations. The construct validity was assessed with "the known-groups technique," a linear stepwise regression analysis with SOC score serving as the dependent variable and with confirmatory factor analysis. RESULTS: With a Cronbach's alpha coefficient of 0.91 and statistically significant item-to-total correlations, the SOC-29 was found to be homogeneous. Construct validity was supported because the SOC-29 could separate known groups with expected high and low scores. The factors that could predict SOC were mental health, self-care ability, feeling lonely, being active, and chronic disease or handicap. Evidence of construct validity was displayed in a confirmatory factor analysis that confirmed SOC-29 as one theoretical construct with the three dimensions, comprehensibility, manageability, and meaningfulness. CONCLUSIONS: The Norwegian version of the SOC-29 is a reliable and valid instrument for use in research among older people. The results confirm that SOC has a particularly strong relationship with mental health and self-care ability.

Nursing staff interactions during the older residents' transition into long-term care facility in a nursing home in rural Norway: an ethnographic study.

BACKGROUND: Future challenges in many countries are the recruitment of competent staff in long-term care facilities, and the use of unlicensed staff. Our study describes and explores staff interactions in a long-term care facility, which may facilitate or impede healthy transition processes for older residents in transition. METHODS: An ethnographic study based on fieldwork following ten older residents admission day and their initial week in the long-term care facility, seventeen individual semi-structured interviews with different nursing staff categories and the leader of the institution, and reading of relevant documents. RESULTS: The interaction among all staff categories influenced the new residents' transition processes in various ways. We identified three main themes: The significance of formal and informal organization; interpersonal relationships and cultures of care; and professional hierarchy and different scopes of practice. CONCLUSIONS: The continuous and spontaneous staff collaborations were key activities in supporting quality care in the transition period. These interactions maintained the inclusion of all staff present, staff flexibility, information flow to some extent, and cognitive diversity, and the new resident's emerging needs appeared met. Organizational structures, staff's formal position, and informal staff alliances were complex and sometimes appeared contradictory. Not all the staff were necessarily included, and the new residents' needs not always noticed and dealt with. Paying attention to the playing out of power in staff interactions appears vital to secure a healthy transition process for the older residents.

Family members' experiences of being cared for by nurses and physicians in Norwegian intensive care units: a phenomenological hermeneutical study.

OBJECTIVES: When patients are admitted to intensive care units, families are affected. This study aimed to illuminate the meaning of being taken care of by nurses and physicians for relatives in Norwegian intensive care units. RESEARCH METHODOLOGY/DESIGN: Thirteen relatives of critically ill patients treated in intensive care units in southern Norway were interviewed in autumn 2013. Interview data were analysed using a phenomenological hermeneutical method inspired by the philosopher Paul Ricoeur. RESULTS: Two main themes emerged: being in a receiving role and being in a participating role. The receiving role implies experiences of informational and supportive care from nurses and physicians. The participating role implies relatives' experiences of feeling included and being able to participate in caring activities and decision-making processes. CONCLUSION: The meaning of being a relative in ICU is experienced as being in a receiving role, and at the same time as being in a participating role. Quality in relations is described as crucial when relatives share their experiences of care by nurses and physicians in the ICU. Those who experienced informational and supportive care, and who had the ability to participate, expressed feelings of gratitude and confidence in the healthcare system. In contrast, those who did not experience such care, especially in terms of informational care expressed feelings of frustration, confusion and loss of confidence. However, patient treatment and care outweighed relatives' own feelings.

Nutritional self-care among a group of older home-living people in rural Southern Norway.

BACKGROUND: Older home-living people are an at-risk group for undernutrition, particularly those who are living alone. Lack of knowledge about healthy dietary habits, altered taste sensation, and declined health status are shown to be some of the factors related to undernutrition. The aims of this study were to explore how a small group of older people in Southern Norway perceived their nutritional self-care. METHODS: An exploratory qualitative approach, combined with a simple self-report questionnaire, was used. Five persons living in rural areas in Southern Norway, who in a former study were screened and found to be at risk for undernutrition, participated. Qualitative data assessed by means of individual self-care talks in the persons' own homes were analyzed using directed content analysis. A simple self-report questionnaire containing demographic variables, two health-related questions, and the Nutritional Form For the Elderly (NUFFE-NO) instrument was filled out at baseline and 6 months after the self-care talks. RESULTS: The qualitative data showed that the participants had adequate knowledge about healthy and nutritious diets. They were aware of and motivated to adapt their diet to their current state of health and to perform the necessary actions to maintain an optimal nutritional status and nutritional self-care. CONCLUSION: Older people living at home are a diverse group. However, this study showed that they may have sufficient knowledge, willingness, and ability to perform nutritional self-care, even if they live alone and have several chronic illnesses and impaired health.

Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences.

BACKGROUND: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. METHODS: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. RESULTS: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. CONCLUSION: To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.

Nurses' Experiences of Caring for Older Persons in Transition to Receive Homecare: Being Somewhere in between Competing Values.

Older persons in transition to need professional care in their homes will constitute a large group in municipalities in the future. The aim of this study was to obtain insight into nurses' experiences and perceptions of caring for patients in transition to receive homecare. Eleven home nurses divided into two focus groups were interviewed, and a phenomenological hermeneutical design was used. Four interpretations closely related to each other were revealed: it is essential to have an understanding of the patients' transition history; the nurse' repertoire is challenged in the transition process; care must be adapted to the patients' life world; the excellence of care is threatened by the context. The nurses strived to provide care based upon respect for the independent individual as a living whole. Their ambitions were, however, challenged and threatened by the caring context. The cooperation across organizational levels was pointed out as a critical factor with potential for improvement. This must be taken seriously to support the nurses in their endeavors to provide excellent care.

The meaning of actualization of self-care resources among a group of older home-dwelling people--a hermeneutic study.

Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: "Desire to carry on", "Be of use to others", "Self-realization", and "Confidence to manage in the future". The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system.