Abstract
BACKGROUND: Fundamental care-encompassing relational, psychosocial, and physical needs as outlined in the Fundamentals of Care Framework-is a multifaceted yet essential component of nurses' scope of practice. Despite its significance, fundamental care remains underrepresented in research within home-based care. Consequently, limited knowledge exists regarding how nurses address older people's fundamental care needs, the practical applicability of the Framework, and the influence of contextual modulators. AIM: To explore nurses' scope of practice, fundamental care, and contextual modulators in relation to older people with complex health care needs in home-based care. DESIGN: Exploratory design. SETTING: Four home-care sites in Western Sweden. METHODS: Structured direct observations were conducted using a protocol informed by the Fundamentals of Care Framework and concepts relevant to nurses' scope of practice. Quantitative data were analysed using descriptive statistics and contextualised by qualitative field notes. RESULT: A total of 3042 care activities were recorded across 230 observations involving 46 nurses (registered and non-registered). On average, participants performed 13.23 activities per observation, often addressing multiple dimensions of the Fundamentals of Care Framework. Physical needs typically served as the entry point for care, which frequently expanded to include relational and psychosocial aspects. Registered nurses' involvement in clinical decision-making-structured around the five phases of the nursing process-was primarily concentrated on assessment and implementation. Non-registered nurses also engaged in decision-making and independently initiated activities. Nurses' scope of practice appeared to be related to several contextual modulators, including interruptions and a lack of supportive work environments. CONCLUSION AND IMPLICATIONS: We are among the first to explore nurses' scope of practice in home-based care using the Fundamentals of Care Framework as a conceptual foundation. We have underscored the complexity and multifaceted nature of nurses' scope of practice, including clinical decision-making, the activities' functional and performance levels, and the presence of contextual modulators. Task-shifting from registered nurses to non-registered nurses was evident in clinical decision-making. We suggest that future Models of Care grounded in the Framework and tailored to the specific contextual conditions of home-based care may support nurses in delivering high-quality fundamental care.