# 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.

## Key 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.