District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice

Craftman, Åsa Gransjön; Strauss, Esther; Rudberg, Susanne; Westerbotn, Margareta

doi:10.1111/j.1365-2702.2012.04262.x

Cited by 22 publications

(36 citation statements)

References 22 publications

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“…The DNs seemed especially dependent on HCAs and seemed to lack structured, planned meetings for collaboration with and supervision of several HCAs. These findings are in agreement with those of a recent study that found that DNs wanted improved collaboration with HCAs, which could be more easily achieved if both professionals were governed by the same authority (Craftman et al 2013). However, because of the current organisation of home care and home health care, it seems reasonable to focus on providing these patients with integrated care.…”

Section: Discussionsupporting

confidence: 90%

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District nurses' perspectives on detecting mental health problems and promoting mental health among community‐dwelling seniors with multimorbidity

Grundberg

Hansson

Hillerås

et al. 2016

Journal of Clinical Nursing

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Aims and objectivesTo describe district nurses' perspectives on detecting mental health problems and promoting mental health among homebound older people with multimorbidity.BackgroundMental health problems among older people with multiple chronic conditions, that is, multimorbidity, are challenging issues. These patients' homes often serve as arenas in which district nurses can promote health. Mental health promotion must be studied in greater depth within primary care because older people with multimorbidity are particularly prone to developing poor mental health, which can go undetected and untreated.DesignA descriptive, qualitative study using semi‐structured interviews and content analysis.MethodsTwenty‐five district nurses completed individual or focus group interviews. Data were analysed using qualitative content analysis.ResultsMost district nurses stated that detecting mental health problems and promoting mental health were important tasks but that they typically focused on more practical home health care tasks. The findings revealed that district nurses focused on assessment, collaboration and social support as means of detecting mental health problems and promoting mental health.ConclusionsThe district nurses described various factors and actions that appeared to be important prerequisites for their involvement in primary mental health care. Nevertheless, there were no established goals for mental health promotion, and district nurses often seemed to depend on their collaboration with other actors. Our findings indicated that district nurses cannot bear the primary responsibility for the early detection of mental health problems and early interventions to promote mental health within this population.Relevance to clinical practiceThe findings of this study indicated that workforce training and collaboration between different care providers are important elements in the future development of this field. Early detection and early treatment of mental health‐related issues should also be stated as explicit objectives in the provision of care to community‐dwelling older people with multimorbidity.

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Section: Discussionsupporting

confidence: 90%

“…These HCAs support patient autonomy by enabling seniors to remain in their homes for as long as possible (Perissinotto et al 2012). DNs often delegate the administration of medicine to the HCAs providing social services in the community (Craftman et al 2013).…”

Section: Introductionmentioning

confidence: 99%

District nurses' perspectives on detecting mental health problems and promoting mental health among community‐dwelling seniors with multimorbidity

Grundberg

Hansson

Hillerås

et al. 2016

Journal of Clinical Nursing

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“…To abstain from delegation which is a core right stipulated by the statute of delegation (NBHW, 1997, 2001) may not be realistic in practice. Abstaining from delegation makes it difficult to continue working as an HCA in social care and means the DNs cannot perform their job timely (Craftman et al ., ). This leaves DNs and HCAs in a hostage situation as both are dependent on each other to fulfil working requirements.…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies show that the heavy workload of DNs pressures them to delegate the administration of medication to HCAs regardless of their skills, and not always in an appropriate manner (Bystedt et al ., ; Craftman et al ., ). The delegation process requires sound judgment, communication skills and a willingness to collaborate on the part of the HCA and the DN (Potter, ).…”

Section: Introductionmentioning

confidence: 97%

“…In Sweden, the municipality and the county council are now facing the challenges of collaborating to meet the rising demands of extended caring and nursing outside the hospital, and an essential element in this is ensuring a safe medication process. Earlier studies in community settings focusing on DNs’ experiences indicate that due to an increased professional burden DNs struggle to meet legal requirements as to whether to delegate medical administration to HCAs, while, at the same time, ensuring patient safety (Craftman et al ., ). In this study, the term HCA is used to denote unregistered staff; various terms are used in the literature and in different countries, for example unlicensed assistive personnel, healthcare assistants and unlicensed caregivers.…”

Section: Introductionmentioning

confidence: 97%

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Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services

Craftman

Hammar

Strauss

et al. 2014

Int J Older People Nursing

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Background Administration of medication to care recipients is delegated to home‐care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home‐care assistants have practical administration skills, but lack formal medical knowledge. Aim The aim of this study was to explore how home‐care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. Methods Four focus groups consisting of 19 home‐care assistants were conducted. Data were analysed using qualitative content analysis. Results According to home‐care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home‐care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. Conclusions Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home‐care recipients. Implications for practice This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients’ best interest and to ensure patient safety.

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Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis

Shore

Maben

Mold

et al. 2022

International Journal of Nursing Studies

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Introduction Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care. Methods The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. Results Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions. Conclusion Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors a...

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District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice

Cited by 22 publications

References 22 publications

District nurses' perspectives on detecting mental health problems and promoting mental health among community‐dwelling seniors with multimorbidity

District nurses' perspectives on detecting mental health problems and promoting mental health among community‐dwelling seniors with multimorbidity

Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services

Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis

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