Thesis: Clinical observation of deteriorating frail older patients. Improving the competence of homecare professionals
Torunn Strømme’s thesis explored healthcare professionals’ knowledge of clinical observation in homecare and how this practice was changed by the implementation of a competence improvement programme. Strømme defended her thesis at the Faculty of Health Sciences the 24th of August 2023.
The thesis was conducted in three phases and adopted a multi-method qualitative, sequential design. The first study developed knowledge of homecare professionals’ observational competence in the early recognition of deterioration in frail older patients prior to the implementation of a competence improvement program. The second study described and analysed the implementation of the competence improvement programme for the systematic observation of frail older patients. The third study described the outcomes of the competence improvement programme. Observations, focus-group interviews, and individual interviews were conducted, and the sample comprised homecare professionals, managers, and professional development nurses in in two different municipalities.
The thesis demonstrates that clinical observation of frail older patients is multifaceted, and that competence improvement is difficult. Prior to the competence program, clinical observation had a low priority and vital signs were rarely measured to detect early deterioration of frail older patients. The competence improvement programme was experienced as important by most homecare professionals, yet the belonging learning tools were applied differently in the two homecare settings. In some situations, such as with patient falls and new patients, the competence program changed professionals’ clinical observation, nevertheless, their situation awareness of patients’ deterioration was still insufficient. The program was sustained by regular activities integrated into the homecare work routines, but it was also challenged by organisational issues such as sick leave, turnover, and busy work plans. As such, the implementation of the competence improvement programme was influenced by the programme itself, the professionals, the organisation, and the external context.
Torunn Strømme (50) is an ICU nurse and have a master’s degree in health science from the University of Stavanger. She has a position as an associate professor in nursing at the Faculty of Health Sciences.
Supervisors
Main supervisor:
Professor Karina Aase, University of Stavanger
Co-supervisor:
Professor Ingrid Tjoflåt, University of Stavanger
