INTRODUCTION: Older people receiving healthcare in long-term care contexts (eg, home healthcare, sheltered housing and nursing home contexts) are especially vulnerable to developing frailty and functional decline. Considering the negative effects associated with these conditions and the possibility of preventing them from progressing, it is vital that nurses possess a broad knowledge base related to them. Particularly as prevention related to these conditions lies well within their remit. Such knowledge could guide the development of effective models of care, ensuring continuity and, hence, quality of care. Our objective will be to review published literature on existing models of care targeting frailty and/or functional decline and how these conditions are described by older people themselves, significant others and nurses in relation to long-term care. METHODS AND ANALYSIS: The scoping review will be conducted in accordance with Arksey and O’Malley’s methodological framework. Recent methodological developments will be considered. PubMed, CINAHL and PsycINFO will be searched. Eligibility criteria will be peer-reviewed papers and written in English. All types of study designs will be eligible and included papers will be quality and ethically assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Protocol checklist for protocols and the PRISMA for Scoping Reviews checklist were followed in this paper. ETHICS AND DISSEMINATION: As the study outlined in this protocol is a scoping review, no ethics approval was needed for this protocol nor for the upcoming study. The findings will be published in an open-access, peer-reviewed journal. Additionally, the findings will guide a research project following the Medical Research Council’s framework for developing and evaluating complex interventions. Thus, supporting us in developing a model of care related to the detection and prevention of frailty and/or functional decline among older people in a long-term care context. 

BackgroundNursing practice in long-term care, must support the delivery of safe and evidence-based care, especially for older people with functional ability limitations and frailty, with the competency, knowledge and structured working modes such practice requires. Understanding, detecting and preventing these conditions is important in a context where care is given to a significant number of older people with complex care needs. Our aim was to map published literature on how functional ability limitations and frailty among older people (65 and above) in home-and facility-based care (i.e. long-term care) were described by key stakeholders, and to identify models of care (MoCs) targeting these conditions.MethodsWe followed Arksey and O'Malley's methodological steps and the PRISMA-ScR reporting guidelines. The PubMed, CINAHL and PsycInfo databases were used to identify papers published between June 2002 and June 2022. The search was updated in May 2024. A descriptive analysis was conducted where the identified patterns were organised and categorised with the support of the Pattern, Advances, Gaps, Evidence for practice and research Recommendations framework (PAGER).ResultsA total of 18,875 unique records were identified. Of these, 26 papers were included. The findings implied a discrepancy between the older people's subjective- and the nurses' more objective, 'matter-of-fact' perspective. The older people described both conditions in terms of identity loss and an emotional struggle to remain independent. They also highlighted the importance of positive connotations in relation to their efforts to adapt and accommodate the situation to the conditions. Nursing practice targeting the conditions were predominantly described as being reactive, based on their experiences and guided by 'intuition'. The identified MoCs mainly targeted functional ability limitations while focusing on educating nurses.ConclusionA point of saturation seems to have been reached regarding research focusing on older people's descriptions of frailty in home-based care. The same cannot be said about older people's or nurses' descriptions concerning functional ability limitations or MoCs. Intervention studies focusing on nursing practice and the development of MoCs that target these conditions preferably in a home-based care context could substantially benefit the development of knowledge within nursing and nursing practice.Trial registration: Open Science Frameworkhttps://doi.org/10.17605/OSF.IO/FNHSA.

Background and Aim: Nurses' scope of practice is central to healthcare delivery. While scope of practice is well described conceptually, there is limited empirical research capturing how it is enacted in everyday clinical practice. This study aimed to describe scope of practice in home-based care, focusing on care activities, clinical decision-making, professional autonomy and contextual modulators. Design: A multi-method observational design. Setting: Three nursing teams within home healthcare services in a Norwegian municipality—the DECIDE project. Methods: Quantitative and qualitative data were collected through structured observations guided by a conceptual framework. Data were analysed using descriptive statistics and qualitative categorisation. Results: A total of 827 care activities were observed across 239 observations. Care activities most often addressed physical and medical needs, while psychosocial needs were less frequently observed. Registered nurses more often engaged in both direct and indirect care and primarily delivered compensatory care. Clinical decision-making was most frequently observed during assessment, while other phases of the nursing process, particularly evaluation, were less evident. These patterns were consistently associated with contextual modulators observed during care delivery. Conclusions: Nurses' scope of practice in home-based care is enacted through care activities and emerges as a context-sensitive, system-level phenomenon shaped by contextual modulators. Registered nurses frequently performed tasks beyond planned visits, while non-registered nurses concentrated on activities of daily living. Both groups showed limited engagement with the evaluation phase of the nursing process. Implications for the Profession and/or Patient Care: Strengthening clinical leadership, decision-making autonomy, and organisational support may support enactment of scope of practice and improve care quality in home-based settings. Reporting Method: The study followed reporting standards for mixed-methods research and was appraised using the Mixed Methods Appraisal Tool. Patient or Public Contribution: Patient and public involvement was incorporated at the DECIDE project level but not in this observational study. 

Background Nurses' understanding of their scope of practice is essential for coordinating safe and optimal home-based care for older people with complex needs. Contextual modulators, workload pressures, and limited opportunities for clinical leadership may hinder enactment of core aspects of this scope. Uncertainty regarding nurses' scope of practice persists, particularly in home-based care. The aim of this study was to explore how nurses experience their own and each other's scopes of practice, and what characterises their scope of practice in home-based care. Methods A qualitative descriptive design using focused individual interviews was employed with eight registered nurses and eight non-registered nurses from three home-based nursing teams in south-east Norway. Although interviews were conducted individually, data were analysed dyadically using an adapted Framework Method to enable systematic comparison of perspectives. Results Nurses' scope of practice was characterised by ongoing clinical observation, assessment, and response to change, supported by continuity of visits and in-depth knowledge of service users. Activities ranged from household chores and basic care to advanced clinical procedures, with substantial overlap between the nurses. Registered nurses articulated greater analytic depth and system-level accountability. Despite shared conceptual understandings, nurses experienced a parallel scope of practice with divergent responsibilities. Registered nurses assumed primary accountability in acute, complex, and transitional care situations, and tensions were evident regarding responsibility distribution and decision-making. Conclusions Scope of practice in home-based care was dynamic and context-dependent, enacted through an embodied nursing process reflecting rapid, experience-based cognition and analytic decision-making. Although nurses described shared understandings, enactment involved overlapping activities alongside distinct responsibilities. Registered nurses' scope of practice extended beyond direct care to coordination, clinical leadership, and accountability for care completion. These findings highlight risks of implicit responsibility shifting and emphasise the need to clearly define and empirically ground nurses' scope of practice to support safe practice, leadership, workforce sustainability, and future research on continuity, responsibility, and decision-making in complex care settings.

Background: Clinical reasoning in nursing is described as complex, context-dependent, and difficult to articulate. Despite its recognised importance, it is often examined through narrative accounts or inferred from decision outcomes, offering limited insight into how reasoning is articulated and organised in practice. This has limited our understanding of the structure of reasoning, particularly in complex and dynamic settings, and underscores the need for approaches that make this structure explicit and open to systematic analysis. Aim: To explore and describe how registered nurses retrospectively explain and structure their clinical reasoning in relation to observed care situations in home-based care. Methods: A retrospective think-aloud design was used. Nineteen transcripts from registered nurses were analysed using a rule-based modified clinical protocol analysis, with AI-assisted procedures to identify clinical domains, operator configurations, and cross-case structures. Results: Clinical reasoning was consistently organised around recurring patterns of observation and evaluation, often extended into planning in more complex or risk-oriented situations. Reasoning was characterised by non-linear structures combining diagnostic and procedural orientations. Different clinical domains were associated with distinct reasoning structures, including verification-based processes in procedural care and evaluation-planning processes in autonomyand support-focused situations. Conclusion: Registered nurses' clinical reasoning in home-based care can be described as structured, multi-layered, and contextually adaptive, rather than strictly linear. The findings suggest that reasoning can be systematically described across cases, making reasoning structures visible and comparable. Implications: This study offers a basis for describing and discussing clinical reasoning more systematically in nursing education, supervision, and future research.