Preferences for Tailored Support - Patients' and Health Care Professionals' Experiences Regarding Symptoms and Self-Management Strategies During the First Year After Curatively Intended Prostate Cancer Treatment.

Purpose: There is an increase in the number of men undergoing screening for prostate cancer, and advancements in treatments, which implies current knowledge about symptoms and self-management. This study aims to explore experiences of symptom distress, and self-management strategies during the first year after curatively intended treatment for prostate cancer, as identified by patients and health care professionals. Methods: A qualitative design was used, including data triangulation from individual interviews with patients (n =17) and one focus group interview with healthcare professionals (n =5). Thematic analysis was used. Results: The two main themes were identified: living with the consequences of treatment and navigating a new situation. Living with the consequences of treatment illustrated how losing control of bodily functions such as bladder, bowel, and sexual functions interfered with daily life. A stigma around the disease was described, and a life living in an unfamiliar body challenged ideas of masculinity. The first months after treatment ended was a distressing period related to the abruption in frequent contact with healthcare providers, and concerns about the future. The second theme, navigating a new situation, illustrates that self-management strategies varied, due to individual factors as did the need for tailored information and support provided from healthcare professionals and family, which was highly valued. Information and support were described as complex topics and healthcare professionals emphasized the need for appropriate education for staff to provide proper support to men after ended treatment. Conclusion: Lingering symptoms and concerns were evident during the first year after treatment. Self-management strategies varied, and timely and tailored information and support during the first year were considered highly valued, important, and preferred by patients. Our results indicate that support should be offered immediately after curatively intended treatment.

Men's experiences of receiving a prostate cancer diagnosis after opportunistic screening-A qualitative descriptive secondary analysis.

BACKGROUND: Prostate cancer is one of the most common types of cancer in men and could occur without symptoms. Screening has been debated but remains controversial and, in most countries, organized population-based screening does not exist. The aim of this study was to describe men's experiences of receiving a prostate cancer diagnosis after opportunistic screening. METHODS: This study is a secondary analysis from interviews with 17 men (aged 56-80 years) who had undergone curative treatment for prostate cancer. Data were collected in an urban region of Sweden through interviews conducted face to face or by telephone. An inductive content analysis was used with Consolidated criteria for Reporting Qualitative research as a reporting checklist. RESULTS: Two main categories were identified. Screening is a lifesaver enclosed by ethical dilemmas reflects how men considered screening as a lifesaving test. Testing was surrounded by injustice and an eagerness to encourage other men to undergo screening. Facing challenges during diagnosis reflects the men's experiences of being in an unknown field yet expected to engage in decision-making concerning appropriate treatment. Receiving the diagnosis rendered mixed emotions about having a cancer disease, that the treatment could cause lifelong symptom distress and the men described being hesitant to talk about their diagnosis. CONCLUSIONS: The findings highlight men's opinions about screening and that the lack of routine screening represents injustice. The men considered this as an ethical question of lifesaving justice, while stakeholders may argue that screening could lead to unnecessary suffering and overtreatment. Men do not always talk openly about their diagnosis, linked to the fact that it concerns intimate areas. It is important to balance the information in relation to shared decision-making regarding treatment. Health care professionals have an ethical responsibility to support and coach the patient in their decision. PATIENT OR PUBLIC CONTRIBUTION: This study was based on interviews with men who had experienced a diagnosis of prostate cancer.

Home care assistants' attitudes and perceptions of caring for people at the end of life in their homes in Sweden.

The ageing population is increasing worldwide, with older people often having multimorbidity and a need for help with activities and personal care. Home Care Assistants (HCAs) are central to the provision of care in the home. They meet older people approaching the end of life and their relatives. Little is known about HCAs attitudes towards caring for a dying person and how aspects such as education, age, earlier care experiences, care education and experience of caring for dying older people affect their attitudes. The aim was to describe HCAs' attitudes towards the care of dying persons living in their ordinary homes. This cross-sectional study used the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) for data collection during December 2017 and January 2018, and descriptive statistics and regression analysis for data analysis. The participants were HCAs (n = 127, 96% of those eligible) in a municipality in central Sweden. An overall positive attitude was reported. About 32% lacked formal HCA education although 93% had experience of interacting with a dying person. Age, HCA education, internal palliative care education, number of years' experience and previous experience of caring for a dying person were independently associated with HCAs' attitudes. In the multivariate regression analysis, age and years of experience were the only significant predictors of HCAs' attitudes towards caring for dying care recipients. Young employees without HCA education and experience of a dying person might be vulnerable in situations involving caring for a dying person. Communicating about death and dying, forming a relationship with the care recipient and the family, and providing care when a person is dying can be challenging. Implications: Young employees without HCA education and experience of interacting with a dying person needs to be prepared for the situation. This needs to be considered by stakeholders and social and healthcare organisations.

Childrens' and young adults' perspectives of having a parent with dementia diagnosis: A scoping review.

BACKGROUND: Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden. DESIGN AND METHODS: Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed. FINDINGS: Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support. CONCLUSIONS: The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.

Like a bridge over troubled water - a qualitative study of professional caregiver singing and music as a way to enable person-centred care for persons with dementia.

Purpose: To describe the perspectives of caregivers in terms of using singing and music in their everyday work, and of their effect on care and interaction with the person with dementia.Methods: A qualitative design was used, consisting of group discussions with professional caregivers from three nursing homes in a medium-sized city in a rural area of Sweden.Results: The results demonstrate that caregiver singing and music can be powerful and useful in the care of and in communication with persons with dementia. Music, for example, can be used to facilitate socialization as it opens up for discussion, while caregiver singing was preferable when it came to the facilitation of care situations and interaction.Conclusions: Singing and music can be powerful and useful tools in the care of and in communication with persons with dementia. Regardless of whether singing or music is used, the most important factor is that a person-centred approach is adopted so as to make the music a facilitative tool. Caregiver singing and music are ways to connect with the person with dementia and an understanding of their use can contribute to dementia research. This in turn can increase awareness of the possible ways to strengthen the partnership between caregivers and persons with dementia.

Homeless persons' experiences of health- and social care: A systematic integrative review.

Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health- and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty-two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008-2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health- and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons' access to health- and social care.

Caring for older people with dementia reliving past trauma.

BACKGROUND: The occurrence of behavioural changes and problems, and degree of paranoid thoughts, are significantly higher among people who have experienced extreme trauma such as during the Holocaust. People with dementia and traumatic past experiences may have flashbacks reminding them of these experiences, which is of relevance in caring situations. In nursing homes for people with dementia, nursing assistants are often the group of staff who provide help with personal needs. They have firsthand experience of care and managing the devastating outcomes of inadequate understanding of a person's past experiences. AIM: The aim was to describe nursing assistants' experiences of caring for older people with dementia who have experienced Holocaust trauma. RESEARCH DESIGN: A qualitative descriptive and inductive approach was used, including qualitative interviews and content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Nine nursing assistants from a Jewish nursing home were interviewed. ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethical Review Board, Stockholm. FINDINGS: The theme 'Adapting and following the survivors' expression of their situation' was built on two categories: Knowing the life story enables adjustments in the care and Need for flexibility in managing emotional expressions. DISCUSSION AND CONCLUSION: The world still witnesses genocidal violence and such traumatic experiences will therefore be reflected in different ways when caring for survivors with dementia in the future. Person-centred care and an awareness of the meaning of being a survivor of severe trauma make it possible to avoid negative triggers, and confirm emotions and comfort people during negative flashbacks in caring situations and environments. Nursing assistants' patience and empathy were supported by a wider understanding of the behaviour of people with dementia who have survived trauma.

Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia.

BACKGROUND:: Persons with dementia may have severe physical and psychological symptoms at the end of life. A therapy dog used in their care can provide comfort and relieve their anxiety. The dog handler guides the dog during the interaction with the patient. AIM:: To describe the impact of therapy dogs on people with dementia in the final stages of life from the perspective of the dog handler. METHODS:: Interviews were conducted and analysed using qualitative content analysis. FINDINGS:: The dog provides comfort and relief through its presence and by responding to the physical and emotional expressions of the dying person. CONCLUSIONS:: Interactions with dogs were found to have a positive impact on persons with dementia and eased the symptoms associated with end of life according to the dog handlers.

Newly graduated nurses' experiences of a trainee programme regarding the introduction process and leadership in a hospital setting-A qualitative interview study.

AIM AND OBJECTIVES: This study aimed to describe newly graduated nurses' experiences of introduction processes and leadership within a hospital trainee programme. BACKGROUND: For many, being a newly graduated nurse is associated with stress, influenced by the challenge of the transition to independent nurse, coupled with the loss of mentorship due to nurse turnover and rapidly changing demands. METHODS: A qualitative design with an inductive approach was chosen, and four focus groups were convened. A total of nineteen nurses were included in the study. Data were analysed using qualitative content analysis. COREQ was used as EQUATOR checklist. FINDINGS: The analysis resulted in three themes: Need for an introduction when facing a complex reality, Striving to stand on my own and The importance of having an accessible and multiskilled manager. The transition is a complex, dynamic and demanding process. CONCLUSIONS: The orientation process from student to becoming an independent nurse is a challenging period. A flexible manager and a readily accessible leadership facilitate the newly graduated nurse's striving to become an independent nurse. The study demonstrates that a trainee programme and support are essential in this process. There are indications that today's newly graduated nurses have high expectations of coaching from the manager during the orientation process. RELEVANCE TO CLINICAL PRACTICE: The hospital setting and its organisation are rapidly changing in relation to the increasing number of patients and their health status. In addition, there is a need for newly graduated nurses to secure regrowth, to fill the ranks of experienced nurses leaving the field. Newly graduated nurses increasingly perceive a gap between their training and clinical realities, thus necessitating changes in tutoring and their introduction to the work.

Experiences of home care assistants providing social care to older people: A context in transition.

AIM: The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes. BACKGROUND: With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field. DESIGN: A qualitative inductive design was used. METHODS: A descriptive, qualitative study using focus group interviews and content analysis. FINDINGS: The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting. CONCLUSIONS: Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation. IMPLICATIONS FOR PRACTICE: The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.

Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study.

Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study / Evolução no acessos à informação sobre câncer de mama e seu rastreio no site do Instituto Nacional de Câncer: um estudo exploratório

Abstract Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

Resumo Demoras no diagnóstico do câncer de mama (CM) são comuns no Brasil, talvez devido à ineficácia de estratégias de divulgação sobre os meios para a identificação precoce. Admitida como equivalente ao interesse coletivo sobre CM, analisou-se a evolução de acessos às páginas sobre CM e seu rastreio (RCM) no site do INCA durante 48 meses. Empregou-se analisadores de log files para construir uma série temporal (2006-2009) de médias mensais de acessos às CM e RCM estudadas por análise de variância (ANOVA). Aumentos significativos e "picos de atenção" transitórios nas CM; ampliação nas diferenças CM/RCM, por incrementos crescentes nas CM associados à estabilidade nas RCM. Os resultados são consistentes com relatos anteriores que descrevem expressivo interesse em CM e relativa indiferença ao RCM. No contexto de um estudo exploratório, discute-se: a "fraca cultura de prevenção"; falta de confiança no SUS e nos programas de rastreio; "efeito celebridade" no contexto do framing das mídias; percepção de riscos coletivos ampliada por vulnerabilidades sociais. Os achados sugerem que estratégias de comunicação adaptadas à cultura são essenciais à divulgação dos programas de rastreio. Pesquisas futuras são necessárias para estudar com mais detalhe as construções sociais sobre temas relativos ao CM.

Registered nurses' perceptions of safe care in overcrowded emergency departments.

AIMS AND OBJECTIVES: To explore registered nurses' perceptions of safe practice in care for patients with an extended length of stay in the emergency department. BACKGROUND: Extended length of stay and overcrowding in emergency departments are described internationally as one of the most comprehensive challenges of modern emergency care. An emergency department is not designed, equipped or staffed to provide care for prolonged periods of time. This context, combined with a high workload, poses a risk to patient safety, with additional medical errors and an increased number of adverse events. From this perspective, it is important to extend our knowledge and to describe registered nurses' experiences of safe practice. DESIGN: A qualitative, inductive and descriptive study. METHODS: Qualitative interview study carried out in five emergency departments. Data were analysed using a qualitative content analysis with a latent approach. RESULTS: Patient safety meets obstacles in the clinical environment involving experiencing deficiencies regarding patient safety in the clinical setting and the impact of working procedures and routines. Moreover, nurses are challenged in their professional responsibilities involving balancing essential nursing care and actual workload; it is common to experience emotional reactions based on feelings of loss of control. CONCLUSIONS: From the nurses' perspective, a prolonged stay in the emergency department may lead to negative consequences for both patient safety and care as well as registered nurses' psychosocial experiences. An extended length of stay significantly reduces the level of nursing and caring that registered nurses can perform in the emergency department. RELEVANCE TO CLINICAL PRACTICE: This study indicates that emergency departments should review their procedures to avoid both deviations from normal practice and moral stress among registered nurses. This can contribute to an increased understanding and insight about the challenge of patient safety in an emergency department setting.

Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes.

AIMS AND OBJECTIVE: The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes. BACKGROUND: The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation. DESIGN: A qualitative inductive descriptive study. METHODS: Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee. RESULTS: Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work. CONCLUSIONS: The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care. RELEVANCE TO CLINICAL PRACTICE: The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel.

Time trends in 20 years of medication use in older adults: Findings from three elderly cohorts in Stockholm, Sweden.

New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people. THE PURPOSE OF THE RESEARCH: It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years. MATERIALS AND METHODS: The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition. THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS: Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.

Older people's experience of utilisation and administration of medicines in a health- and social care context.

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

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

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.

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.

AIMS AND OBJECTIVES: To describe district nurses' perceptions of the concept of delegating medication management to unlicensed personnel working in municipal social care. BACKGROUND: The delegation of medical tasks involves responsibility and is regulated by law to avoid damage and injuries and to protect the patient. The delegation of the administration of medication is a multifaceted task. The delegating district nurse is responsible for the outcome and should also follow up the delegated task. DESIGN: A descriptive qualitative study, involving semi-structured interviews and content analysis. METHODS: Twenty district nurses were interviewed. The interviews were audio taped. The data were collected from April 2009-August 2010 and analysed using content analysis. RESULTS: The findings revealed that the statutes of delegation appear to be incompatible with practice, however, mostly due to lack of time. Communication between district nurses and home care aides, as well as tutoring, was regarded as important. The district nurses found it imperative to be available to the home care aides and made an effort to create a trusting atmosphere. CONCLUSIONS: District nurses cannot manage their workload without delegating the administration of medication in the present organisational model of health care and social care. The statutes regarding delegating medicine tasks are also cumbersome and difficult to incorporate for district nurses who are responsible for the delegation. RELEVANCE TO CLINICAL PRACTICE: The findings elucidate the current situation as regards district nurses and the need to delegate the administration of medication. Health care and social care for home-dwelling older patients, as well as statutes, needs to be evaluated and updated to meet and be prepared for the increasing demands of care.