Journal of clinical nursing · 2026
Nurses' Scope of Practice in Home-Based Care: An Observational Study of Care Activities, Clinical Decision-Making, and Contextual Modulators-The DECIDE Project.
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Flyum Ida Røed, Borglin Gunilla, Eklund Anna Josse, Pavedahl Veronica, Gjevjon Edith Roth
Аннотация
BACKGROUND AND AIM: Nurses' scope of practice is central to healthcare delivery. While scope of practice is well described conceptually, there is limited empirical research capturing how it is enacted in everyday clinical practice. This study aimed to describe scope of practice in home-based care, focusing on care activities, clinical decision-making, professional autonomy and contextual modulators.
DESIGN: A multi-method observational design.
SETTING: Three nursing teams within home healthcare services in a Norwegian municipality-the DECIDE project.
METHODS: Quantitative and qualitative data were collected through structured observations guided by a conceptual framework. Data were analysed using descriptive statistics and qualitative categorisation.
RESULTS: A total of 827 care activities were observed across 239 observations. Care activities most often addressed physical and medical needs, while psychosocial needs were less frequently observed. Registered nurses more often engaged in both direct and indirect care and primarily delivered compensatory care. Clinical decision-making was most frequently observed during assessment, while other phases of the nursing process, particularly evaluation, were less evident. These patterns were consistently associated with contextual modulators observed during care delivery.
CONCLUSIONS: Nurses' scope of practice in home-based care is enacted through care activities and emerges as a context-sensitive, system-level phenomenon shaped by contextual modulators. Registered nurses frequently performed tasks beyond planned visits, while non-registered nurses concentrated on activities of daily living. Both groups showed limited engagement with the evaluation phase of the nursing process.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strengthening clinical leadership, decision-making autonomy, and organisational support may support enactment of scope of practice and improve care quality in home-based settings.
REPORTING METHOD: The study followed reporting standards for mixed-methods research and was appraised using the Mixed Methods Appraisal Tool.
PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was incorporated at the DECIDE project level but not in this observational study.
DESIGN: A multi-method observational design.
SETTING: Three nursing teams within home healthcare services in a Norwegian municipality-the DECIDE project.
METHODS: Quantitative and qualitative data were collected through structured observations guided by a conceptual framework. Data were analysed using descriptive statistics and qualitative categorisation.
RESULTS: A total of 827 care activities were observed across 239 observations. Care activities most often addressed physical and medical needs, while psychosocial needs were less frequently observed. Registered nurses more often engaged in both direct and indirect care and primarily delivered compensatory care. Clinical decision-making was most frequently observed during assessment, while other phases of the nursing process, particularly evaluation, were less evident. These patterns were consistently associated with contextual modulators observed during care delivery.
CONCLUSIONS: Nurses' scope of practice in home-based care is enacted through care activities and emerges as a context-sensitive, system-level phenomenon shaped by contextual modulators. Registered nurses frequently performed tasks beyond planned visits, while non-registered nurses concentrated on activities of daily living. Both groups showed limited engagement with the evaluation phase of the nursing process.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strengthening clinical leadership, decision-making autonomy, and organisational support may support enactment of scope of practice and improve care quality in home-based settings.
REPORTING METHOD: The study followed reporting standards for mixed-methods research and was appraised using the Mixed Methods Appraisal Tool.
PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was incorporated at the DECIDE project level but not in this observational study.