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Concern is growing about inequality in cancer treatment, and a call has been made for more knowledge of the underlying causes of this inequality. Studies show that patients with low socioeconomic status in general face a greater risk of inequality than patients with a high socioeconomic status.The aim of the present study was to uncover how institutional factors may exacerbate inequality in cancer treatment for patients with low socioeconomic status exemplified by patients with head and neck cancer, most of whom have low socioeconomic status.Inspired by Fairclough, we undertook a critical discourse analysis investigating the treatment pathway of patients with head and neck cancer on the basis of policy papers.These papers, which we conceived as formative instruments, harboured a discourse of efficiency and a discourse of participation, together carving out an effective cancer treatment pathway provided patients act in line with the recommendations.The discourses of efficiency and participation are not unfamiliar in health care, and prior research shows that they may pose difficulties for patients with low socioeconomic status.The discoursal framing of head and neck cancer treatment may exacerbate inequality because most patients with a low socioeconomic status fail to comprehend and act in accordance with these discourses.

Objective To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS). Background The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services. Materials and methods Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria. Results Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS. Conclusion This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

BACKGROUND: Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region.OBJECTIVE: The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences.DESIGN AND METHODS: This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country.RESULTS: The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies.CONCLUSION: The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country.TWEETABLE ABSTRACT: "APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Background: Older adult patients who receive homecare services are entitled to free oral healthcare services in Norway. However, there is no guarantee that they would receive such care due to the disintegration of coordination between homecare and dental care services. The oral health care services are organised at the county level while the homecare service at the municipality level. The two organizational levels are governed by different policies, legislations, and funding systems that make collaboration between the healthcare providers at the two levels challenging.Aim: This study aimed to explore the homecare service personnel’s perspective on the existing collaboration and coordination with the oral healthcare services.Methods: Four focus group interviews in three municipalities with different population andorganisation models were conducted. The participants were recruited by their manager and those who consented to participate consisted of registered nurses, auxiliary nurses, auxiliary nursing students and assistants. In the analysis of the interviews, a deductive approach, based on the integrated care model ""rainbow model"", was applied. The model provided a framework to organise the interviews and gather knowledge of the challenges faced by the health personnel for integrating continuity and safe oral health across the two service levels. Result: The health personnel had experienced organizational, professional and ethical dilemmas in the process of providing oral health care to patients. They expressed that there is limited systematic collaboration between homecare services and oral healthcare services in today’s practise. Some of them had experienced that a dental hygienist sometimes assisted the older adults. However, the main finding was that they had insufficient routines for the allocation of responsibilities for initiating, informing, planning and following-up the oral health for individual patients. Thus, it had implication for the health personnel’s feeling of their professional responsibility for addressing the individual patient’s oral health need. The homecare services is in a position to detect changes in the older adults’ oral health. However, the fact that the health services are provided in the homes of the elderly often creates ethical dilemmas between the patients’ wishes and the opinions from professional assessments. Conclusion: The older adults living at home need coordinated healthcare services, of which oral health is an important part. The homecare services need to circumvent organisational and professional barriers and establish a repertoire to manage challenges and dilemmas that occur in their efforts to provide quality oral healthcare services.Implications for applicability, sustainability, and limitations: For ensuring sustainability in integrated oral health services, the result will be used as one of the components in the development of generic and validated guidelines that would be ready for large-scale implementation. However, a limitation is that the oral health personnel’s’ perspective on coordination has not yet been examined in this study which will be addressed in next study.

IntroductionThe population of older persons is growing worldwide. Caring for older patients in their homes is becoming the preferred model of health care delivery. However, the model results in increased need for coordinated and integrated forms of care provision as older adults have often complex health problems. Although oral diseases are the most common of the chronic diseases for older adults, oral health care has been neglected in health care services. This is mostly, due to knowledge gaps, disintegrated and fragmented healthcare services and blurred responsibility between different levels of care. It is urgent to include oral health in the integrated care perspective for older adultsreceiving home care services to avoid unnecessary health deterioration, increased care dependency and utilization of health care services. Therefore, the aim of CORAL is to provide a generic scientific-based integrated care model for connecting home health care and oral health services.MethodsCORAL is constructed in 3 stages by following the UK Medical Research Council’s framework for complex intervention:1) Acquisition of knowledge about oral- health and health care service delivery for older adults in home care services; 2) Development of an inter-professional and inter-service collaboration model for connecting the oral health service with the home care service based on the acquired knowledge and a co-creation approach; 3) Evaluation of the implementation process and effectiveness on cost and service utilisation.Results and discussionsTo provide an integrated care model for connecting home health care and oral health services, it is important to acquire knowledge regarding the oral health status of older adults living at home and regarding home care nurses’ experience with promoting oral health in older adults. Thus, we have conducted a scoping review on the oral health status and oral health-related quality of life among older adults receiving home care services and a scoping review on the oral health care-related beliefs among home care professionals and their attitudes toward promoting oral health in older adults receiving home care services. The reviews have given us an international insight and the knowledge acquired from these studies will be used in developing the model by a co-creation process.ConclusionsCORAL will provide the answers to some of the demographic, structural, organisational, economical and societal challenges. The outcome will contribute to the connection of home care services and Henni: CORAL – Connecting ORAL health-and home care service for patients receiving home care in Norwayoral health services for older adults. It will facilitate knowledge-based and sustainable services and politics. This will reduce costs, increase patient safety and improve quality and efficiency of care.Lessons learnedCOVID-19 has made it challenging to carry out research activities involving patients and healthcare professionals. We have learned that we must adapt and use alternative methods when necessary.LimitationsThe CORAL model will be strongly based on Norwegian conditions, which means that other countries wishing to implement the model may have to make country specific or regional adaptations.Suggestions for future research Our aim for further research is to apply for more funding to implement the CORAL model nationwide in Norway as a continuation of the CORAL-project

Background: The main aim of the current study is to provide updated knowledge on hospital nurses’ assessments of quality of care transitions in older patients in Norway. A secondary aim is to analyse to what extent these assessments are associated with perceived information practices. Methods: Nation-wide cross-sectional web-based survey conducted in 2017 including hospital nurses involved in the discharge of older (≥ 65 years) patients (N=1,785). Four items were used to measure different aspects of quality of transitional care in older patients. Information practices were operationalised as Medical information; Follow-up Information, Cross-sectoral contact. Analyses of variance (ANOVA) were used to analyse associations. Results: Seven out of ten respondents perceived that the older patient feels safe in the transition. Six out of ten respondents perceived that the patient was well informed about the availability of community services, and six out of ten perceived that the patient was well informed about the timing of discharge. Only a little over half of the nurses agreed or strongly agreed with the statement that the patient knows where to turn in case of complications. More positive assessments of quality of care transitions were associated with better perceived information practice (i.e. Follow-up) Almost 50 % of the nurses wanted more contact with community nurses. A stronger perceived need for more contact was negatively associated with all four aspects of quality of care transitions. Conclusion: Our findings suggest a need for more telephone contact and face to face contact over and above the digital/electronic contacts between hospital- and community care nurses to improve quality of care transitions in older patients. The study is part of the CrossCare-Old project, A cross-sectoral approach to high quality health care transitions for older adults, which is funded by the Research Council of Norway (RCN, project no. 256644).

Background An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describes graduate students’ experiences of working practice based in interprofessional teams with complex patients’ care needs in nursing homes. Method Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data. Results Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified. Conclusions IPE in nursing homes facilitated the students’ scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students’ curricula. This could ensure that IPE is experienced more efficient by the students.

Standardized care plans have the potential to enhance the quality of nursing records in terms of content and completeness, thereby better supporting workflow, easing the documentation process, facilitating continuity of care, and permitting systematic data gathering to build evidence from practice. Despite these potential benefits, there may be challenges associated with the successful adoption and use of standardized care plans in municipal healthcare information practices. Using a participatory approach, two workshops were conducted with nurses and nursing leaders (n = 11) in two Norwegian municipalities, with the objective of identifying success criteria for the adoption and integration of standardized care plans into practice. Three themes were found to describe the identified success criteria: (1) “facilitating system level support for nurses' workflow”; (2) “engaged individuals creating a culture for using standardized care plans”; and (3) “developing system level safety nets.” The findings suggest success criteria that could be useful to address to facilitate the integration of standardized care plans in municipal healthcare information practice and provide useful knowledge for those working with implementation and further development of standardized care plans.

Background: There is little research regarding how everyday life is affected by colon cancer treatment. Few studies exist that exclusively examine patients with Dukes C colon cancer. Most studies include other types of bowel cancer and different stages. Objectives: The aims of this study were to explore and describe how colon cancer survivors experience everyday life in general and sexuality in particular after treatment of Dukes C colon cancer. Methods: The study is exploratory and descriptive and uses semistructured interviews to collect data. Nine participants were interviewed regarding their everyday lives up until 2 years after concluded treatment. The analysis was done using Graneheim and Lundman’s method of content-analysis. Results: Bodily changes are a consequence of colon cancer. Exhaustion, colon problems, and visible bodily changes are some of the challenges that survivors are faced with. Socializing with friends was different, and work had to be facilitated. Social networks proved to be a good support, and spouses were considered to be the most important source of social support. Sexual challenges were experienced by men and women alike Conclusion: Participants experience changes in day-to-day life after cancer treatment. Social networks and the participants’ own coping strategies are key to shaping everyday life after treatment. Implication for Practice: It is crucial that healthcare professionals have a holistic view of patients. Both partners and physical activity were identified as an integral part of coping. Seniors are often less active, and some have lost their spouses, it is therefore especially important to examine this demographic. A survey before and after treatment can help optimize rehabilitation. © Lippincott, Williams & Wilkins. This is the authors' accepted and refereed manuscript to the article.

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Background: Meeting psychosocial needs is a significant component of quality dementia care. To enable persons with dementia to live at home for as long as possible, a community healthcare service offering care where physical, social, psychological, cultural and spiritual needs are met, is recommended. A comprehensive allocation process is required to allocate individually tailored healthcare services. However, the allocation process for older home-dwelling persons with dementia, specifically for services to safeguard psychosocial needs, remains largely unexplored. Accordingly, this study aims to explore purchasers’ deliberations on psychosocial needs during the process of allocating healthcare services to older home-dwelling persons with dementia. Methods: The study had a descriptive design with a qualitative approach. The primary data source was focus group interviews with purchasers who assess and allocate healthcare services. The interview data were supplemented by a review of administrative decisions made by the purchasers. Data from the focus group interviews were analysed using a descriptive and interpretive approach. Content analysis of the administrative decisions was conducted. Results: The purchasers described the allocation process as challenging. The following four themes reflect the complexity of the allocation process: (i) an unfamiliar and unclear concept; (ii) a hierarchy of needs; (iii) an adjusting allocation process; (iv) a challenging documentation of administrative decisions. Conclusions: The purchasers viewed a comprehensive allocation process as important. However, a web of different interplaying aspects prevented the purchasers from conducting a comprehensive need-led allocation process. Insufficient assessment or allocation threatens the adequate safeguarding of the psychosocial needs of persons with dementia. Having varied and sufficient services to allocate is of great importance, but is not sufficient. Psychosocial needs must be better incorporated as a significant element throughout the entire allocation process. Purchasers’ deliberations on psychosocial needs within the process of allocating healthcare services for older home-dwelling persons with dementia: a qualitative study. The study received an additional research grant from the Norwegian Nurses Organisation (number 13/0033). This funding did not influence the study design; data collection, analysis, or interpretation; or preparation of the manuscript.

Marianne Kumlin,1– 3 Geir Vegar Berg,2,4 Kari Kvigne,1 Ragnhild Hellesø3 1Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences Elverum, Elverum, Norway; 2Innlandet Hospital Trust, Lillehammer, Norway; 3Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 4Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, NorwayCorrespondence: Marianne Kumlin Tel +47 91594685Email marianne.kumlin@inn.noAim: Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain.Methods: This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed.Results: The analyses revealed three central themes in the healthcare professionals’ work to build coherence in the patients’ care trajectory: Working to manage a patient’s illness trajectory during the course of the patient’s life, working to achieve a comprehensive overall picture, and considering multiple options in a “patchwork” terrain.Conclusion: Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person’s journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient’s life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient’s complex care trajectory.Keywords: older, care trajectory, complex healthcare, health personnel, interdisciplinary

BackgroundAn ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describe graduate students’ experiences of working in interprofessional teams with complex patients’ care needs in nursing homes.MethodStudents from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of K in Norway were joined to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, where 21 graduate students participated in four groups. Data were collected during spring 2018 and were inductively analysed according to a thematic analysis method (Systematic Text Condensation) and discussed using four previously proposed types of coordination practices. ResultsThree themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced IPE on complex patients in nursing homes as a comprehensive learning arena.ConclusionsInterprofessional education in nursing homes disclose challenges and possibilities to develop the health care service for elderly patients with complex care needs. It is important to experience complex situations during professional education, even if frustrating, when students have the possibility to discuss difficulties with each other and the faculty. Educators can arrange their IPE activity to foster more collaborative practices and potentially increase learning outcomes.

Background: Inadequate pain care is a significant problem for patients during hospitalization, particularly in Ethiopia. Evidence has shown that work process re-organization improves patient-reported outcomes.This study aimed to compare patients’ experiences before and after re-organizing inpatient pain care Method: A quasi-experimental design on a separate sample was conducted between October 1, 2016, and June 15, 2017. Participants of the study were patients admitted to the four inpatient units (medical, surgical, maternity, and gynaecology) of Jimma Medical Centre. Seven hundred eighty-two (Survey 1: N=256; Survey 2: N=259; Survey 3: N= 267) patients out of 845 patients invited to participate (92.5%) in three consecutive surveys were included in the analysis. A patient survey questionnaire adapted from a Brief Pain Inventory, the American Pain Society Patient Outcome Questionnaire, and Pain Treatment Satisfaction Scale was used. Data were mainly analysed using ANOVA. A significant difference between samples was declared at a P-value of less than 0.05.Results: Patients reported experiences with pain care significantly increased after re-organizing in-hospital pain care. More specifically, although there was a growing misfit between information provided and adequacy, staff responsiveness within 30 minutes, and patient satisfaction with pain management significantly increased. These increments were statistically significant with p Conclusion: Re-organizing in-hospital pain care improves patient-reported pain care experiences by changing both nurses’ technical capacity and the work process at inpatients’ units

Background Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. Methods The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken. Results Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory. Conclusions The patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient’s pace in the decision-making process may lead to a more appropriate level of health care in line with the patient’s preferences and goals. © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data

Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients&rsquo, experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

Background Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals—one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

Aim To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long-term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.