Exploring the needs and possible solutions to improve the formal assessment of district nurses in home care: A qualitative study

Abstract

Title: Exploring the needs and possible solutions to improve the formal assessments of district nurses in home care: a qualitative study. Background: Home care differs widely across Europe in financing and care allocation. In the Netherlands, district nurses are authorised in care allocation, called formal assessment. In formal assessments, the district nurse determines the care demand based on the needs of the patient. However, practice variation occurs in formal assessments, meaning there are differences in care allocation for comparable patients. Practice variation reduces quality of care. Since district nurses perform formals assessments, it is important to gain insight into the needs and possible solutions of district nurses to improve the quality of formal assessments. Aim: The aim was to explore the needs and possible solutions of district nurses to improve the quality of the formal assessment to determine the care needs of patients in home care. Method: An explorative study was conducted. District nurses were purposefully sampled. Semi-structured interviews were conducted in March and April 2020. Data was thematically analysed according to Braun and Clarke. Results: Two main themes emerged after interviewing district nurses (n=12): district nurses needs for quality and uniformity improvement, and district nurses’ preconditions for quality and uniformity improvement. District nurses perceived learning from and with each other and education as important needs for district nurses to improve the quality and uniformity of formal assessments. District nurses defined preconditions to improve the quality of formal assessments by: retaining autonomy, more time, and structure and facilities. Conclusion: This study provided insight regarding the needs and possible solutions of district nurses to improve the quality of formal assessments in home care. District nurses needs to reduce practice variation could be further explored considering that practice variation plays an important role in the quality of formal assessments.