Sykepleie=kompetanse i hjemmesykepleien – på rett sted til rett tid?

Abstract

Nursing competence in home care nursing-in the right place at the right time? Background: Following the implementation of the Coordination reform, there has been concern about levels of competence in community health services. There have been few empirical studies on the reform and on how concerns regarding competence are dealt with. Objective: The aim of our study is to develop a greater understanding regarding the need for competence in home care following the implementation of the Reform. Method: Two focus group interviews with 11 nurses and two individual interviews with municipal managers, all employed in the same municipality. Result: Even if discharged patients were more sick and in need for more help than before, the nurses found that they were still able to take care of patients in an effective manner. The nurses' competence was found to be adequate, though not sufficient. Cooperation between nurses and lower-skilled staff was described as a challenge. The way home care was organised resulted in some frustration among the nurses, who felt that their competence was not being utilised in the right place at the right time. There seemed to be a diversity of opinion among participants when it came to understanding the aims and challenges that home care nursing is facing. Conclusion: Competence in home care nursing needs to be developed and strengthened. This means an increased budget, more skilled employees, and organisational routines that make cooperation easier and the use of nurses' competence more targeted. To develop a shared understanding of the Coordination Reform and its aims and challenges among all staff should be an integral part of the agenda for managers.

Rutiner for å vurdere ernærings=status i hjemme=sykepleien

“…However, the literature review indicates that there have been no major changes in routines linked to nutrition in recent years (3-9, 11), even though a qualitative study among community nurses showed that the patients they received from hospitals were 'sicker' than was the case prior to the introduction of the Coordination Reform (38). Nevertheless, the results must be interpreted with caution.…”

“…The health care personnel in our survey mentioned time as being the key obstacle to achieving good routines for assessing nutrition. A qualitative survey showed that nurses in the community nursing services considered that their expertise was not being utilised correctly (38).…”

Hjemmesykepleien i samhandling med spesialisthelsetjenesten

“…Kommunenes nye ansvar handler derfor i stor grad om behandlingsrelaterte oppgaver og ivaretakelse av pasienter i en svaert sårbar fase (13, 16,17,20). Dette innebaerer et økt press på kommunale tjenester og hjemmesykepleien spesielt, saerlig i de kommunene som har for få korttidsplasser (16,18). Organiseringen i en bestiller-utfører-modell ser også ut til å begrense mulighetene for å ivareta eldre pasienters pleie-og omsorgsbehov (15).…”

8 Mellomlederes vurdering av kompetansebehov i sykepleie etter samhandlingsreformen

“…En studie av kompetansebehov i hjemmesykepleien etter innføring av samhandlingsreformen viste at det var ingen merkbar endring i kompetansekrevende oppgaver (Norheim og Thoresen 2015). Studien ble gjennomført i 2013 i en mellomstor by som har et lokalsykehus.…”

“…Sykepleierne mente at de så langt hadde tilstrekkelig kompetanse til å ta hånd om de nye oppgavene. Det ble konkludert med at utviklingen tilsier at hjemmesykepleien vil møte krav om å hånd-tere flere nye avanserte kliniske behandlingsoppgaver (Norheim og Thoresen 2015). Det er gjennomført en litteraturstudie av forventninger til den kommunale helse-og omsorgstjeneste og tilgjengelig kompetanse (Bing-Jonsson mfl.…”