![]() The accelerating growth of the homecare–dependent population creates a need for competence development and new approaches for the care of frail older patients. HCPs often work alone and therefore have a fundamental role in detecting deteriorating frail older patients, where observational competence and clinical judgement are vital to providing appropriate patient care. Failure to recognise and respond to clinical deterioration might result in adverse outcomes, and early recognition by measuring vital signs is emphasised. Frailty is an age-related condition characterised by a decline in physiological capacity and increased vulnerability where patients have a higher risk of rapid deterioration and mortality. Homecare services are multifaceted, with an increasing number of frail older patients with extensive care needs and complex requirements. The competence requirements for homecare professionals (HCPs) are becoming increasingly challenging due to changes in healthcare. Depending on the implementation process and the homecare context, professionals enact the activities of the improvement programme differently. This study documents the differences entailed in creating sustainable outcomes of an improvement programme for homecare professionals’ competence in recognising and responding to deteriorating frail older patients. This involved whether routines and planned activities were set to follow up the improvement programme, or whether organisational issues such as leadership focus, resources, and workforce stability supported the programme. ![]() The differences were related to the frequency of vital sign measurements, coping levels, and situational awareness, in which successful outcomes were shaped by implementation issues and contextual setting. Substantial differences were revealed across the two homecare districts in how homecare professionals enacted new knowledge and routines resulting from the competence improvement programme. The analysis revealed five concepts characterising the outcomes of the competence improvement programme: 1) frequency of vital sign measurements, 2) situational awareness, 3) expectations and coping level, 4) activities for sustained improvement, and 5) organisational issues affecting CIP focus. Data were collected in two homecare districts using participant observation, focus group interviews, and individual interviews. This study applied a qualitative mixed-method design. ![]() Therefore, the aim of this study is to describe the outcomes of a competence improvement programme for the systematic observation of frail older patients in homecare. However, the outcomes of such programmes remain unknown. Improvement programmes are essential to fill this knowledge gap. The conclusion is that since PDD characteristics change during a child’s development and they vary among individuals, since diagnostic criteria and tools have not yet been commonly decided among professionals, causes of PDD are still under investigation and treatments have not been defined, systematic observation can contribute to the assessment of children with PDD and make the environment functional to child’s needs.The growth of frail older patients with extensive care needs in homecare creates a need for competence development. This article aims to present the method of systematic observation (value, aim, techniques and the role of observer), as well as to propose other techniques of assessment and diagnosis for children with PDD. However, the assessment of children with pervasive developmental disorders (PDD) should not be confined to the application of one method (Kroustalakis 1994, Polychronopoulou 1995, Vosniadou, 1995). Observation is considered a reliable method for the recognition of behavioural, communicative, cognitive, sensory and motor difficulties.
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