Mid Sweden University

Background: The Swedish healthcare organisation for older persons has shifted its focus towards home care. Receiving care at home offers comfort and security, allowing older persons to remain in familiar surroundings. The care encounter in home care is the core of everyday care practice. However, what happens during these care encounters is often unknown due to its private nature and is sparsely researched. Aim: The overall aim of this doctoral thesis was to explore, describe, and gain a deeper understanding of the lived experiences of care encounters in home care, as perceived by older persons and home care nurses, to generate knowledge for nursing practice. Method: The design is qualitative, and data has been collected through interviews at both descriptive (I, III) and in-depth narrative levels (II, IV). Participants were purposefully sampled to ensure a diverse range of perspectives and experiences relevant to the research aim. The interview text has been analysed through Qualitative content analysis (I, III), Hermeneutic interpretation (II), and Phenomenological hermeneutic interpretation (IV). Findings: While older persons appreciated the convenience of receiving care at home, the findings revealed challenges such as nursing routines conflicting with everyday life routines (I, II), unclear communication, and being dependent on support (I). Although receiving vital support, older persons strove to uphold independence (II) but were subordinate to their home care nurses which posed a challenge in this regard (I, II). Home care nurses encountered a wide range of patient needs, which spanned from medical requirements to emotional support (III). Each of their patients brought unique challenges and circumstances, necessitating home care nurses to flexibly adjust their approaches (IV). However, they struggled with balancing their expectations and desires related to the quality and extent of care they intended to provide to their patients,  against what was realistically achievable given the constraints of time, legislative requirements, and organisational demands (III, IV). Conclusion: An examination of the findings alongside the overall aim of this doctoral thesis, relevant literature, and Kari Martinsen’s philosophy of caring, reveal the complexity of care encounters in this context. For example, the quality of these care encounters varies based on the assigned home care nurse, affecting the equality and effectiveness of care. Older persons lacked involvement in their care decisions, impacting the person-centred approach. Dependency on home care nurses complicates matters, as it can lead to a loss of autonomy and dignity. Additionally, tight schedules limit home care nurses’ time with each of their patients, reducing opportunities for meaningful interactions. The unique nature of care at home blurs personal and professional boundaries. Providing relational, moral, and practical care enhances dignity and empowerment for older persons. Effective implementation of this approach requires adequate time and resources for home care nurses.