Negotiating safety and responsibility in caregiving to children receiving hospital-at-home: A Norwegian study of parents and homecare nurses' experiences.

Healthcare policies in Western countries increasingly emphasise the avoidance of hospitalisation to reduce hospital admissions. Hospital-at-home for children is a treatment offered to children at home that would otherwise require hospitalisation. Norway practices a model where homecare services play a significant role in assisting the hospital when children need home visits beyond the capacity of what the hospital can offer. Although homecare nurses' work has been affected by several changes in recent decades, few have reported on what these changes imply for homecare nurses' work and family caregivers. The aim of this study was to explore how parents and homecare nurses worked and collaborated in home visits to children receiving hospital-at-home, focusing on how they negotiated caregiving. We conducted 16 interviews: six interviews with parents and 10 interviews with homecare nurses. The interviews were analysed thematically. Both parents and homecare nurses described these home visits as challenging, indicating experiences of distrust. Parents had carefully observed homecare nurses, checking whether they knew how to treat the child and perform the clinical procedures. Homecare nurses had invested much energy into being perceived as calm and trustworthy by the parents. We applied the perspective of negotiation to understand the work and collaboration reported by parents and homecare nurses when unsafety or uncertainty was experienced during home visits, revealing the complexity of their roles in dealing with such events. The results showed the reciprocal dependency between the parents and the homecare nurses that enabled them to perform caregiving work in partnership, sharing responsibility. Our findings suggest that the collaboration with hospital-at-home has an impact on the feeling of safety and control for both parties. We question whether there is a danger of too much responsibility being left with the parents when homecare services are involved.