Healthcare personnel’s clinical decision-making competence in care for acutely ill older adults in home care: a cross-sectional study

TL;DR

This study examines healthcare workers' ability to make clinical decisions for older adults in home care, finding that many lack the necessary skills to detect and respond to acute illnesses.

Contribution

The study provides new insights into clinical decision-making competence gaps among Norwegian home care personnel caring for acutely ill older adults.

Findings

A large proportion of healthcare personnel scored below the desirable cut-off for clinical decision-making competence.

Healthcare workers showed particular difficulty in identifying diffuse symptoms and determining appropriate care levels.

Higher education and use of the ABCDE approach were associated with better decision-making competence.

Abstract

With the increasingly aging population and a larger proportion of older adults living at home, healthcare personnel require well-developed clinical assessment skills and decision-making competence to detect and follow up on acute illnesses in older adults. A lack of such competence can threaten patient safety and must be identified. This study aimed to describe the level of clinical decision-making competence in Norwegian home care when healthcare personnel are caring for acutely ill older adults, and to explore whether selected background factors are associated with competence levels.

A cross-sectional study was conducted among healthcare personnel in home care. Data were collected from 177 nurses, healthcare workers, and assistants using the Ms. Olsen competence test, which measures clinical decision-making. Descriptive statistics were computed, including the sum score of clinical competence, along with multiple regression analyses to examine associations with selected background variables.

Clinical decision-making competence was below the desirable cut-off for a large proportion of respondents across all groups, with 23.6% of nurses, 12.0% of healthcare workers, and 7.9% of assistants scoring above the cut-off. There was a particularly low score for correctly identifying diffuse symptoms. The results indicated uncertainty regarding which level of care to contact when a older adult’s health deteriorated. Factors associated with decision-making competence included the level of health education (p < 0.001) and the use of the ABCDE approach (p < 0.003).

Clinical decision-making competence in Norwegian home care has room for improvement. There seems to be a need to enhance the competence of healthcare personnel to ensure that older adults receive the right help at the appropriate level of care. Uncertainty about what actions to take indicates a need for clearer guidelines regarding interventions in response to changes in conditions.

The online version contains supplementary material available at 10.1186/s12912-026-04380-x.