Here it is everything at once: a qualitative study of district nurses' experiences caring for older individuals with multiple chronic health problems in primary care.

Background: Over the next 10-year period in Sweden, the number of people aged 80 and older is will increase by about 50%. The care needs of the population are changing as more people live at home longer with chronic conditions. District nurses in primary care often have the first contact with patients of all ages and are especially involved in care of older individuals with multiple chronic conditions, common mental health problems, and complex care needs. Understanding how district nurses currently see their work with older people with complex multimorbidity is a key step in developing new models of primary care to support older individuals with complex multimorbidity. The aim of this study was to investigate district nurses' experiences of caring for older adults with multiple chronic conditions and how they think care be improved for this group.

Methods: This was a qualitative study of individual and focus group interviews made with fifteen district nurses working at five primary care centers in the Stockholm Region, Sweden. Data was analyzed using reflective thematic analysis.

Results: We generated one central theme, Ready to take responsibility if there is room for complexity and four subthemes: Seeing the complex patient as a coherent and whole person; Competent to take responsibility for patient needs.; Primary care can't say no, so DNs find solutions when cooperation is lacking; DN competencies must be visible, well-defined and have boundaries.

Conclusions: DNs feel competent to identify and address individual needs for older people with multiple chronic conditions and common mental health problems and ready to take responsibility for patient's needs, if they have the time, support and structure needed to address complexity with this patient group.