Factors supporting resilient performance and mental well-being among health care professionals in home care settings: a qualitative study

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It is therefore crucial to understand what helps HCPs to stay in their roles and perform under pressure. This study aimed to explore the factors that support resilient performance and mental well-being among HCPs in home care settings. Methods This study used a qualitative exploratory design with a thematic analysis approach. Seven focus group interviews were conducted with 34 participants working in three home care settings in three Norwegian municipalities. Data were collected through semi-structured interviews using an interview guide that focused on actual work situations, resilience in healthcare, patient safety, mental well-being, leadership support, and engagement in care services. Results Four themes were extracted: collaborative culture , describing collective problem-solving, team unity and collegiality; leadership support practices , highlighting the leadership accessibility, supportive, and attentive to the professional and emotional needs of HCPs; organization of work, roles and procedures , highlighting the structured routines, tools and technologies, as well as individual coping and adaptation strategies , describing HCPs' flexibility and task prioritization in handling unpredictable situations. Conclusion A dynamic interplay of both individual factors and organizational elements shaped the ability of HCPs in home care settings to cope with and adapt to the challenges and stressors they encounter in their work. Our research contributes to the growing understanding of the importance of actively promoting collaborative team cultures, accessible leadership, clear organizational structures, and supportive coping strategies in developing resilient and sustainable home care services. Elderly care Health care Professionals Homecare Resilience Resilience in Healthcare Resilient performance RiH theory S4R Support4Resilience Background Over the past few decades, home-based care has become a rapidly growing part of healthcare in Norway and many other Western countries ( 1 – 3 ). This is mainly due to a growing elderly population living with chronic and often complex health conditions ( 4 , 5 ). In addition, the heightened focus on user-centered care, the advancement of new support technologies, and widespread efforts to enhance responsiveness, continuity, efficiency, and equity in healthcare systems are all contributing to the growth ( 5 , 6 ). Projections suggest that the number of care-dependent older people will increase alongside noncommunicable diseases as the leading cause of chronic illness and disability ( 6 ). In Norway, individuals aged 80 and older are projected to account for 16% of the Norwegian population by 2100 ( 7 ), while in the EU, this age group is expected to reach 15.3% by the same year ( 8 ). Furthermore, home care environments are becoming increasingly complex and demanding, requiring HCPs working in these environments to assume a wide variety of roles, supporting patients not only in clinical and curative care but also in supportive, rehabilitative, palliative, and comforting care ( 2 , 9 , 10 ). The HCPs are expected to carry out these responsibilities in unpredictable and often resource-limited conditions. The increasing demand for home care services, combined with the rising complexity, has exacerbated the shortage of qualified HCPs. In Norway, estimates suggest a shortage of around 13,000 registered nurses by 2030 ( 11 ). The gap in the EU is estimated at 4.1 million by the same year ( 8 , 12 ). High turnover rates further worsened this shortage, resulting in healthcare professionals facing psychological stressors such as workload, time pressure, and physically demanding tasks ( 4 ). These factors present substantial challenges to the mental well-being of the HCPs as well as their ability to deliver high-quality care. Hence, it is essential to develop and implement strategies that strengthen the capacity and sustainability of HCPs in homecare settings, providing them with sound working conditions and enhancing their mental well-being. An important step towards this goal is understanding what helps HCPs to stay in their roles and continue delivering quality care under demanding and complex conditions. Resilience in Healthcare (RiH) has been operationalized through the concept of Resilience Engineering (RE), which focuses on promoting the capacity of healthcare systems and professionals to adapt, respond, and maintain high-quality care under varying and often challenging conditions ( 13 ). In this context, resilient performance refers to the outcome of achieving four resilience capabilities within the system: anticipating disruptions, monitoring the system, responding to demands, and learning from experience ( 14 ). Although these abilities have been studied mostly from the hospital perspective ( 15 , 16 ), there is limited research on how these capabilities manifest in home care settings, which are complex, variable, and less controlled than in institutional environments ( 2 , 9 , 10 , 17 ). Moreover, although resilience in healthcare has been widely studied, most research has focused on individual resilience, particularly among hospital staff during acute events such as the COVID-19 pandemic ( 18 – 24 ). These studies have shown that resilience levels can be influenced by sociodemographic variables, such as gender, age, and marital status. However, resilience in healthcare encompasses not only individual traits but also organizational and team-based traits, which can vary across different care contexts ( 25 ). In home care, where HCPs must manage complex care needs with a high degree of autonomy ( 2 , 26 ), there is a pressing need to explore what supports resilience specifically in this setting. This study aims to close this gap by applying the RiH perspective to explore the factors that support resilient performance, their dynamics, and how they influence the mental well-being of HCPs in Norwegian home care contexts. The following research question guided this study: What factors contribute to resilient performance and mental well-being among HCPs, and how do these factors interact with one another? Contextualizing the study The Support4 Resilience project This study is part of the larger Horizon Europe-funded Support4 Resilience (S4R) project 2024–2028 (Project ID: 101136291) ( 27 ). Focusing on elderly care provision across various healthcare settings, including public and private nursing homes, home care services, and hospital-to-home care, the S4R project aims to develop a research-based, innovative platform known as the S4R toolbox. This toolbox is designed to help healthcare leaders phase out ineffective practices, thereby freeing up time and resources for more effective approaches. It also promotes greater autonomy among healthcare professionals and supports learning from positive outcomes. The toolbox provides a range of cost-effective tools, both individual and collaborative, to help implement effective resilience and mental well-being strategies. Involving 14 partners from seven countries, Australia, Finland, Italy, the Netherlands, Norway, Romania, and Spain, the project entails cross-country data collection, toolbox development, implementation, process evaluation, cost-effectiveness and effectiveness evaluations, theory development, and policy recommendations. This article is part of the initial investigations of the S4R project. By exploring the factors that contribute to resilient performance and mental well-being among HCPs from the Norwegian home care context, it aims to provide a foundation for developing the S4R toolbox. The home care setting in Norway: Work organization and daily practices The Norwegian healthcare system is publicly funded and governed at the national, regional, and local levels ( 28 ). The Ministry of Health and Care Services (MoHCS) oversees national-level policy, while provision is decentralized to Regional Health Authorities (RHAs) and municipalities ( 29 ). RHAs are responsible for specialist care, whereas municipalities organize and finance primary care, including home care, the front line of the Norwegian healthcare system ( 29 , 30 ). The way home care is organized and practiced vary across countries ( 31 ). In Norway, home care is predominantly publicly owned, managed, and delivered by the country’s 357 municipalities, which, as of 2025, have a population ranging from approximately 5,000 to 500,000 ( 32 ). Although service provisions should be adapted to individual needs based on individual assessments, the tasks include providing medical assistance, nursing care, practical support to maintain daily life activities, rehabilitation, and end-of-life care at patients’ homes ( 33 ). While basic home care services are, in principle, free of charge, users share the cost for additional services, such as practical assistance (e.g., home cleaning) and access to senior citizen centers, if needed ( 34 ). While organizational models vary between municipalities, home care is generally team-based, with defined roles, planning systems, and digital care plans. HCPs typically rotate shifts, including weekends, with most providing care in patients’ homes, and traveling from one residence to another, while some members work in institutional facilities. Generally, a home care team begins their shifts by reviewing patient lists, sharing care information, and distributing work assignments in a scheduled meeting. The daily assignments in home care settings include basic care responsibilities (hygiene, dressing, and meals) and advanced care responsibilities (medication administration, wound care, catheterization, and ostomy care). Nurses constitute the core workforce of homecare (including elderly care) services in Norway, with most holding bachelor’s degrees and some serving in advanced practice roles at the master's level. As of 2023, approximately 25% of the 122,000 registered nurses work in elderly care ( 35 , 36 ).In addition to nurses, healthcare assistants (in Norwegian: Helsefagarbeidere ) receive training equivalent to a two-year postsecondary vocational degree and comprise approximately 91,000 workers in the same year ( 35 ). To meet service needs, untrained or in-training assistants are also employed temporarily. Methodology Study Design A qualitative exploratory design ( 37 ), was used in this study. Seven focus group interviews were conducted across three home care settings in three Norwegian municipalities. Given the study’s aim, focus group interviews are well-suited for collecting rich experiential data ( 38 ) to gain insight into the factors that enable HCPs to manage challenges, sustain high-quality care, and support their mental well-being in everyday home care practices. Research Setting and Recruitment of Research Participants The three municipalities are all located in the eastern part of Norway. They encompass urban centers and rural areas, varying in size from less than 1,000 km² to over 1,000 km². Their populations range from fewer than 10,000 to more than 20,000 inhabitants (see Table 1 ). Table 1 Characteristics of the recruited municipalities ( 39 ). Municipality (M) Urban Suburban Rural Area(km²) Population size M1 X > 1000 20000–50000 M2 X < 1000 20000–50000 M3 X < 1000 < 10000 Site recruitment was conducted through the municipalities. Municipal leaders were initially contacted, and they facilitated access by reaching out to the leaders of home care services. In total, 34 HCPs were recruited, including registered nurses (n = 16), healthcare assistants (n = 17), and one care assistant (see Table 2 ). Data collection A semi-structured interview guide, comprising 23 questions organized into seven topic areas, was developed specifically for this study in collaboration with the Support4Resilience (S4R) consortium. The guide was initially developed in English (see Supplementary File 1) and was later translated into Norwegian, the participants' native language, to ensure clarity and facilitate better understanding ( 40 ). The interview guide covered the following topics: general information about the participants' professional background, education, and training; actual work situations (Work as done); resilience in healthcare; patient safety; mental well-being; leadership support; and Informal caregivers’ engagement in care services. No questions were asked regarding person- or patient-sensitive issues. Two researchers conducted focus group interviews in November 2024 in pre-arranged meeting places of the home care settings. One of the researchers is an associate professor of care research with substantial knowledge of quantitative and qualitative research methods. The other is a PhD candidate with a solid understanding of qualitative research methodology. The researchers had no prior contact with the study participants. Each focus group interview session lasted approximately 90 minutes and was audio-recorded via the Nettskjema Dektafon mobile app, a data collection tool that enables the ethical and secure storage of qualitative data ( 41 ). Prior to each interview session, participants received both written and oral information about the study aim, and written informed consent was obtained from all participants. This study employed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist as a reporting framework ( 42 ). Characteristics of the participants Table 2 shows that the majority of participants were women (n = 31), including nurse assistants (n = 17) and nurses (n = 14). Three participants, all nurse assistants, were men. Nearly all the participants (n = 33) held permanent positions. Table 2 Characteristics of the participants N = 34 Gender Women 31 Men 3 Professional background Nurses 16 Healthcare assistants ( Helsefagarbeidere ) 17 care assistant 1 Years of work Below 5 years 9 6 to 10 years 11 11 to 20 years 8 21 years and above 6 Work situation Permanent 33 Vicar (temporary) 1 Table 3 shows that of the 34 participants, the majority were from Municipality 1 (24 participants), who held various roles, including nurses (n = 8), healthcare assistants (n = 15), and a care assistant. Municipalities 2 and 3 each had 5 participants. All participants in Municipality 2 were nurses, whereas those in Municipality 3 included both nurses (n = 3) and healthcare assistants (n = 2). Table 3 Number of study participants in each municipality Municipality (M) Nurse Healthcare assistant care assistant Total M1 8 15 1 24 M2 5 0 0 5 M3 3 2 0 5 Total 16 17 1 34 Data analysis The first author transcribed the interviews verbatim ( 43 ) and imported the transcripts into NVivo 1.61 ( 44 ) for analysis. The data analysis for this study was conducted according to Braun and Clarke’s six-step framework for thematic analysis ( 45 ) (see Table 4 ). Table 4 Brown and Clark's six-step framework is followed in the data analysis process. Phase Description Data familiarization Transcripts were transcribed, read multiple times, and reviewed with notes for deep understanding. Generating Initial Codes Codes were created systematically for each case to capture key features. Searching for Themes Codes were grouped based on meaningful patterns and relationships. Reviewing Themes Themes and subthemes were refined through cross-case analysis. Defining and Naming Themes Four themes and eight subthemes were finalized through consensus among the authors. Producing the Report A clear, structured report was written to present the findings. The first author conducted initial data coding, followed by regular debriefing sessions with co-authors to review, validate, and refine the emerging themes, thereby facilitating a more nuanced interpretation of the data and mitigating potential biases ( 46 ). Dependability was enhanced through auditing and documenting analytical decisions and coding changes ( 47 ). While member checking was not formally conducted, triangulation across interview data and observational notes helped reinforce the credibility of the findings ( 48 ). Results This study explored the factors that HCPs in home care settings perceive as supporting resilient performance and mental well-being. Using the thematic analysis approach, we identified four main themes and eight subthemes (see Table 5 ). Table 5 Overview of themes (n = 4) and subthemes (n = 8) Main themes Sub-themes 1. Collaborative Culture: Working and Learning Together 1. Sharing knowledge and workloads 2. Team unity and Collegiality 2. Leadership Support Practices 1. Open, accessible, and engaging Leadership 2. Working independently: Demanding and Rewarding 3. Organization of work, Roles and Procedures 1. Documentation as a communication tool 2. Support systems, Technologies, and Tools 4. Individual Coping and Adaptive Strategies 1. Adaptability in the face of unpredictable challenges 2. Reducing stress through task prioritization Theme 1. Collaborative Culture: Working and learning together The theme Collaborative Culture captures aspects related to the HCPs’ perceptions of collective problem-solving, shared learning within their roles, and the overall workplace atmosphere in home care settings. Although home care work often involved physically working alone, participants emphasized that they rarely felt isolated. HCPs reported a strong sense of team collaboration and continuous informal and formal learning, which were cultivated through daily interactions. A shared responsibility for patient care was noted as a defining feature of both structured and spontaneous collaboration in home care work. Sharing knowledge and workloads Participants perceived that a strong collaborative culture contributed to both professional development and care quality, even in settings where HCPs primarily worked independently. Participants reported that despite each HCP having individual tasks for the shift, the nature of their work always made them feel part of a team, both by sharing practical knowledge and by supporting each other with workloads: " Even though we work alone with our lists, we are not alone—we are part of a team. We work together, and we are good at helping each other. If someone finishes early, we start calling around and offering help, picking up visits from others' lists.” (M1, P3) When performing their daily activities, HCPs needed to remain responsive to unexpected patient needs, exchange expertise, and provide both emotional and practical support as needed. In this context, both planned and unplanned interactions, such as shift handovers, mid-shift check-ins, and informal conversations, were seen as valuable opportunities for mutual learning and growth. Informal learning often occurred spontaneously as HCPs shared experiences, reflected on challenging cases, and passed along practical knowledge throughout their day. Breaks and shared lunch times also became arenas for peer exchange. While some participants noted efforts to limit work-related conversations during lunch, many acknowledged that discussions about patient care and professional challenges naturally continued around the lunch table. Participants described learning as embedded in day-to-day routines, with experienced staff mentoring others and providing guidance on complex or unfamiliar tasks. In addition to addressing challenges as they arose, this culture of peer support and ongoing learning was perceived to enable HCPs to share experiences, clarify uncertainties, and enhance their competence. “… unexpected things always come up, so we must discuss them continuously” (M3, P5), “If we are unsure about something, like lifting or transferring patients, we might do a midshaft check-in, where we provide some training.” (M1, P4) Additionally, collaboration extended beyond the immediate care team. Interdisciplinary collaboration with occupational and physical therapists was described as providing HCPs with valuable insights into managing physically demanding tasks, such as lifting and moving patients. By conducting joint patient visits and assessing patient needs together, they offered practical tips that participants felt enhanced both patient care and their workday, especially when tasks became physically challenging. Team unity and collegiality Participants frequently described their workplace as open and supportive compared to other workplaces they were familiar with. The positive team atmosphere was perceived to foster collegiality, making the workday more enjoyable. It was often noted that it was acceptable to feel uncertain about something; when in doubt, one could simply ask, and support was readily available. This openness fostered strong interpersonal relationships and encouraged a collaborative culture. New employees highlighted that, despite being newcomers, it is entirely acceptable to ask questions and seek help from their colleagues. The presence of experienced staff members appeared to reinforce this environment, creating continuity and trust that helped sustain a healthy team culture. “ What works well here is that we have unity and good collegiality. This is important because people like to feel safe around each other .” (M2, P4) Theme 2. Leadership Support Practices This theme encompasses participants' perceptions of leadership in terms of accessibility, supportiveness, and responsiveness to their professional and emotional needs. Open communication, mutual trust, and a supportive leadership presence were recognized as key elements that contributed to day-to-day functioning and to psychological safety, autonomy, and professional growth among the HCPs. Accessible and engaging leadership Several participants used phrases such as ‘the leader is visible’ and ‘the door is always open’ to describe the perceived engagement and responsiveness of leadership in the daily activities of the home care setting. Most noted that they could approach their leaders without needing an appointment, provided that the leader was not preoccupied with other tasks or busy on the phone. Many appreciated the ability to approach their department leaders informally when they met them at work. This accessibility and responsiveness were perceived to allow HCPs to raise concerns, ask questions, and seek guidance without facing barriers. The participants also favored an open approach that included anonymous ‘post-it’ notes as an alternative for those who were less comfortable with direct communication. Participants valued this as a simple, non-intimidating way to communicate with their leaders. One participant (M1, P5) described this approach in detail: “I actually feel that I am being heard and that I can talk with ease, without being judged for the mistakes I make.” (M1, P5) Participants frequently linked supportive and present leadership to fostering a positive work environment and promoting teamwork in the home care settings. Leaders were praised for their swift responses (especially during high-pressure situations), which participants felt built trust and confidence. A participant recalled, " There was an incident, and [the leader] handled it incredibly well, it happened in the blink of an eye, and she gained my trust that way " (M1, P3). Leaders' involvement in frontline tasks was viewed as a crucial aspect of engaging leadership, particularly during periods of increased workload. This became especially evident during busy times, such as the summer holiday season, when staff shortages due to vacations placed additional strain on home care teams. Participants emphasized that leaders who adopted a hands-on approach and actively supported staff in the field not only helped alleviate the immediate workload but also appeared to foster a stronger sense of team cohesion. Working independently: demanding and rewarding Most participants valued autonomy in their work, describing it as both rewarding and demanding because they were responsible for making independent decisions. On the one hand, it allowed them to customize their decisions based on patient needs and develop confidence through independent problem-solving. On the other hand, this autonomy came with pressure, as HCPs were solely responsible for their assessments and actions. Over time, this independence was perceived to contribute to a sense of competence and adaptability, as reflected in the following statement: " When no one is around to ask, I have to make the decision myself. It is scary at first, but it makes me stronger and more confident in my decisions.” (M3, P4) This suggests that while leadership inaccessibility could pose challenges, it also reinforced participants' sense of autonomy and their ability to develop resilience in their roles. Other participants noted that the system clarified decision-making boundaries, which was described as fostering a sense of security and psychological safety. This clarity was seen to help HCPs reduce uncertainty and contributed to a sense of psychological safety, as they knew when to act independently and when to seek support. “We also have a good system in place; I clearly understand which decisions I can make on my own and which ones need to be referred to either the head nurse or the leader.” (M3, P1) Theme 3. Organization of work, roles, and procedures This theme explores how structured organizational routines, clearly defined roles, and the effective use of technological tools and documentation were perceived by participants to contribute to the delivery of high-quality, consistent care. Participants explained that organizational clarity regarding roles, responsibilities, procedures, and expectations in home care settings enabled more predictable workflows, reduced uncertainty, minimized stress, and supported a more stable work environment. Documentation as a communication tool HCPs stressed that accurate and up-to-date documentation is more than just an administrative requirement in home care; rather, it was viewed as a critical component of patient safety, care coordination, and the overall patient experience. Documentation was described as an essential component of internal communication, vital for tracking care processes, recording clinical interactions, and ensuring the continuity of care. Clear and thorough record-keeping was particularly valued in situations requiring coordinated responses, such as initiating new clinical procedures or patient-specific interventions. This was seen to facilitate ongoing evaluation and knowledge sharing among the HCPs. “ Documentation is always important; everything we write and do is subject to follow-up and evaluation. ” (M1, P3) Participants reported that routine reviews of patient records were essential to ensuring continuity and accountability, particularly during shift change or when staff returned from time off. Writing detailed notes was viewed as an expected responsibility, crucial for maintaining awareness of recent developments and preventing information gaps in patients’ care histories. Documentation was also regarded as a critical tool for accountability, particularly when patients responded to questions or concerns from their family members. “[…] when the leader receives questions about a patient, she can check the report, see what has happened and who wrote what, and then explain the details.” (M1, P1) Support Systems, Technologies, and Tools Participants outlined how they use various systems and tools to provide structure and enable continuity of care. This includes task distribution systems, alarms, electronic messaging systems, medication dosing systems, and standardized procedures. Collectively, these systems and tools were described as helping staff stay organized, anticipate tasks, and maintain consistent workflows, even during periods of high demand. Technological tools, including medication dispensers, sensor-based alarms, smart cameras for safe and secure follow-up, door and bed alarms, and emergency call systems, were reported to be used daily to increase patient safety and workflow efficiency. However, not all systems were equally effective across contexts. For example, the limited accessibility of the procedure portal while in the field due to a lack of remote access was seen to limit its usefulness during home visits. In addition to digital tools, participants utilized analog methods, such as reminder notes and checklists, which they frequently reviewed at the beginning of each day to stay organized and prioritize tasks. Participants indicated that while tools and routines were essential for the smooth operation of home care, assigning dedicated staff to manage operational tasks was considered crucial for ensuring care continuity and efficiency. The shift from rotating responsibilities to a more stable staffing arrangement was perceived as enhancing both the efficiency and continuity of care services in home care settings. “Initially, we rotated responsibilities, she would sit one day, I would sit next, and someone else the third. Now, there is more consistency: one person handles everything full time on weekdays, including electronic messages, phone calls, hospital messages, and ongoing communication. ” (M1, P3) The results also revealed that a new task distribution system, which defined clear areas of responsibility for each person, had been introduced to clarify roles and responsibilities. While this system was generally viewed as a positive development, promoting structure, accountability, and more efficient workflows, participants’ experiences varied. Some participants believed it improved coordination and reduced ambiguity in daily tasks, while others felt it limited flexibility or created challenges when tasks overlapped or required teamwork across role boundaries. Theme 4. Individual coping and adaptive strategies This theme encompasses aspects of the personal and professional competencies that HCPs utilize to maintain their mental well-being and performance under pressure. When faced with unpredictable challenges that test their emotional regulation and high workloads, participants reported employing a variety of adaptive strategies, including staying calm and flexible, prioritizing tasks, navigating complexity, protecting team functioning, and continuing to deliver care. Adaptability in the face of unpredictable challenges Adaptability was identified as a core professional competency essential for maintaining performance in the face of unexpected situations, complex patient needs, and limited resources. Participants highlighted that flexibility was crucial at both the individual and team levels, allowing HCPs to support one another and perform professionally despite unpredictable conditions. Working alone, especially during staff shortages or on weekends, required HCPs to assess unfamiliar scenarios and respond independently and quickly. For example, unfamiliar equipment, such as infusion pumps, necessitated on-the-spot problem-solving and self-directed learning. This ability to adapt was perceived as essential for sustaining professional performance in challenging situations. Staying calm and regulating one’s pace were described as essential stress management strategies that HCPs employed to prevent stress from escalating within the team. As one respondent reported: “ … We are good at de-escalating stress… If one person starts panicking, it can spread quickly, but we know how to manage that. It is almost like a skill—keeping things calm and handling the unexpected.” (M1, P1) This flexibility also applied to caring for patients with complex mental health needs, requiring real-time adjustments in approach and communication. Reducing stress through task prioritization HCPs shared that they prioritized tasks based on their critical nature during high-pressure shifts. While participants acknowledged the importance of person-centered care, they also need to focus on more critical tasks, such as administering medication or providing personal hygiene assistance, at the expense of less critical interventions, including vitamin administration or nonessential visits, to manage workloads and reduce stress. When the schedule was tight, HCPs adjusted their schedule, often postponing more time-consuming tasks until later in the day, when their workload allowed for more flexibility. In other cases, HCPs substituted physical visits with check-in calls, especially when patient needs were not urgent. “…there are many times and places we go just to perform a check-in, just to have a conversation, but that is not really why we are here. We are here to provide the necessary healthcare. And that, in a way, comes at the expense of those who may need it to live at home and get help, care, food, and the essential things. ” (M1, P5) Though most agreed that decisions were necessary to ensure quality care for those in more critical need, several noted the emotional complexity of prioritization and the discomfort of facing criticism for delays or changes in plans. “It can be challenging to face criticism for our priorities, especially when some complain while others accept waiting a bit longer without saying anything. This is part of our everyday work.” (M1, P2) Discussion The overall aim of this study was to explore the factors that HCPs in home care settings experience supporting their resilient performance and mental well-being. Guided by the RiH theory, which focuses on maintaining stability while adapting to both expected and unexpected challenges within the healthcare system ( 49 ), we identified four key interrelated factors: Collaborative Culture, Leadership Support Practices, Organization of work, roles and procedures, and Individual Coping and Adapting Strategies (see Table 5 ). Organizational and Contextual Factors The HCPs in this study suggest that a strong collaborative culture is one of the key factors helping them face daily challenges and support each other emotionally in their work. The solidarity among HCPs improves not only individual resilience but also serves the team in navigating the multifaceted challenges of critical care with a shared sense of purpose ( 50 ). This finding is consistent with earlier research, which shows that social cohesion, open communication, and trust-based teamwork reduce occupational stress, build resilience, and support HCPs' mental well-being, which are fundamental for adaptive capacity ( 4 , 51 – 53 ). While many of these dynamics have been studied in the context of the COVID-19 pandemic, the underlying principles of team cohesion and adaptive capacity remain highly relevant to the day-to-day work of home care. The nature of home care is often unpredictable, with professionals working in decentralized settings and frequently managing complex situations independently. This context continues to demand strong collaboration and flexibility. To strengthen our understanding of how these dynamics function specifically in home care, more research is needed that is situated directly within this practice setting. In this study, both planned and spontaneous interactions throughout the workday, such as quick check-ins, case-related discussions, and impromptu problem-solving, were found to play important roles in maintaining team cohesion. Participants described that these exchanges created space for peer learning, mutual feedback, and emotional support, all of which helped foster psychological safety and supported timely adaptation when unexpected challenges arose. Consistent with our findings, previous findings have shown that strong communication and team-based collaboration can reduce burnout, enhance psychological resilience, and lead to improved care quality ( 2 , 54 – 58 ). Participants in our study described collaborations with colleagues and seeking help to solve problems and complete tasks as a normal part of their routine, and were encouraged to do so as part of their daily work. This reflects a key feature of adaptive capacity of resilient healthcare, where teams adapt by dynamically reallocating resources in response to changing demands ( 25 ). This finding aligns with the resilience framework by Lyng et al (2022) ( 54 ), which identifies behaviors such as seeking help and mutual engagement among team members as highly beneficial for improving their practices. As such, involvement, one of the ten capacities for resilience in healthcare, plays a central role in sustaining the functionality and responsiveness of healthcare teams ( 54 , 59 ). Our result also underscores the value of ‘slack’ in organizational routines ( 60 ), where time spent on discussing and addressing work tasks enabled learning, emotional processing, and real-time coordination among HCPs. In a home care environment, where HCPs often work autonomously with little or no immediate support, these seemingly minor moments for peer interaction play a crucial role in supporting the resilient and adaptive performance of HCPs. Accessible and supportive leadership practices were also identified as a significant influence on team resilience ( 61 ). When leaders were approachable, responsive, and actively engaged in frontline tasks during periods of high demand, this was interpreted by the participants as a sign of solidarity and shared responsibility. Participants also noted that these leadership practices helped foster trust and psychological safety within the team, conditions that are essential for resilient performance in high-pressure care environments. This finding aligns with previous research, which demonstrates that leadership practices rooted in openness and support can have a significant impact on team functioning and the capacity to adapt during challenging situations ( 50 , 62 – 64 ). Similarly, in their research on teamwork in healthcare during COVID 19, Anjara et al ( 50 ) found that frontline engagement by clinical leaders marked by shared tasks, collective leadership, and psychological safety supported stronger teamwork and organizational citizenship behaviors. In addition, our study found that workplace autonomy functions as a dual dynamic, both empowering and potentially stressful, depending on the clarity of role boundaries. This finding reflects the distinctive nature of home care, where professionals often work in patients' residences, with less direct supervision than in institutional settings ( 4 ), which may be a source of stress and uncertainty. However, in our study, HCPs reported feeling more confident and secure in their roles when their areas of authority and responsibility were clearly defined. Having this kind of clarity supported their sense of autonomy, which often encouraged professional growth and flexibility. At the same time, participants noted that when guidance or organizational support was lacking, this independence could also lead to uncertainty and added stress. These findings align with earlier research, which has shown that the unpredictable and autonomous nature of home care nurses' work necessitates them to make independent decisions, which can be both empowering and stressful ( 65 ). In this study, the way work was organized, along with clearly defined roles and routines, emerged as a crucial factor in supporting the resilient performance of HCPs. The use of tools and technologies, such as medication dispensers, alarm systems, emergency call systems, and digital monitoring devices, was viewed as essential for enhancing patient safety and also contributed to a more efficient and consistent delivery of care. Additionally, these tools and technologies reduce the need for frequent in-person visits to patients' homes while maintaining surveillance and response capabilities. Similarly, previous studies have shown that the use of technological tools enhances medication adherence, facilitates timely responses to emergencies, and supports staff performance by reducing the need for constant physical presence while maintaining high standards of care and surveillance ( 53 , 66 – 68 ). The need for mobile access to clinical decision-making tools, such as electronic patient portals and real-time documentation systems, was found to enhance efficiency and support informed decisions, both in the field and in on-site primary care settings ( 69 ). Investment in such tools may help decrease unnecessary cognitive and emotional workload, which is essential for maintaining mental well-being ( 54 ). Factors that Support Mental Well-being HCPs in home care settings employ various personal strategies to maintain their well-being and sustain performance despite the prevailing variability and uncertainty inherent in home care work. Adaptability emerged as a core competence across participants' narratives and was described as a distinct technical skill by itself. Participants highlighted the importance of responding flexibly to unpredictable situations, such as unfamiliar clinical scenarios or high-pressure encounters. The ability to independently “figure things out”, especially during weekend shifts when immediate support was often unavailable, was seen as essential for managing the complexity of home-based care. This finding aligns with prior qualitative research on home health nurses, which indicates that autonomy, problem-solving, and adaptability are essential to their daily practice, particularly in situations that require swift judgment and carry significant responsibility ( 70 ). This form of situational responsiveness reflects what can be described as contextual resilience —an ability to draw on tacit knowledge, learn quickly in the moment, and trust one’s own judgment to navigate gaps in resources or information ( 71 ). Previous studies have indicated that adaptive capacity in healthcare encompasses coping, aligning, reframing, and innovating, which are essential for responding dynamically to challenges in home-based care environments ( 72 , 73 ). In addition to personal flexibility, our study revealed the importance of collective stress regulation. Team members actively worked to de-escalate situations when one colleague became overwhelmed. This highlights an important social dimension of resilience in which emotional awareness and relational support help maintain a calm and stable work environment. These interactions reflect team-level adaptive capacity, often grounded in psychological safety and a shared sense of responsibility ( 53 ). The findings indicate that although HCPs are expected to manage their emotional responses individually, they operate within a relational context where colleagues routinely step in to offer support. This interplay between personal coping and collective responsiveness suggests that resilience is not solely an individual attribute; rather, it is a dynamic interplay between personal coping and collective responsiveness. Rather, it emerges as a dynamic, shared process reinforced through daily interactions, peer support, and collaborative learning ( 74 , 75 ). This reciprocal responsiveness contributes to psychological safety and shared responsibility, which are elements central to adaptive team functioning ( 76 ). The participants also described regulating their work speed as a method to handle stress. Flexibility in time management allowed HCPs to maintain control over their workflow even when this required shorter breaks or longer work hours. Despite operational constraints, HCPs maintain their commitment to person-centered, holistic care while regularly adjusting their work priorities to meet the individual needs of their patients. This finding aligns with that of Norlyk et al. (2019) ( 70 ), who observed that home care nurses constantly balance efficiency demands with a strong professional ethos of individualized care, often stretching time to preserve care quality. In our study, essential care tasks, including medication administration and insulin delivery, as well as hygiene support, received priority over less essential services, such as housekeeping and routine check-ins. HCPs viewed these decisions as necessary adjustments to maintain essential care operations during constraints, such as during staff shortages. This finding aligns with broader research indicating that during periods of limited staffing or high workload, healthcare workers implicitly ration care, focusing on acute and safety-critical tasks while deferring fewer essential activities ( 77 ). However, this prioritization process was emotionally complex, particularly when these decisions resulted in patient dissatisfaction or criticism. This may suggest that individual coping involves not only stress regulation but also the maintenance of ethical integrity in challenging environments. This finding aligns with previous research in nursing practice, which suggests that deferring less critical services can lead to moral distress, particularly when patients express dissatisfaction or feel neglected ( 78 ). Another study on moral distress in home-care nursing found that prioritizing tasks under resource constraints often triggered ethical tension and emotional strain ( 79 ). Our study indicates that individual coping and adaptation strategies, such as task prioritization and peer support, are essential. However, they must function within a supportive organizational framework that emphasizes role clarity. The combination of individual strategies and systemic support approaches is essential for enhancing both workplace resilience and the mental well-being of HCPs in home care settings ( 80 ). The findings of this research have important implications for both leaders and frontline practitioners in home care settings. To promote resilient performance and support the mental well-being of HCPs, leadership should prioritize consistent engagement with staff, cultivate a collaborative team environment, and establish clear roles and responsibility boundaries. In addition, ensuring access to practical digital tools and recognizing the everyday importance of peer support are essential strategies for sustaining adaptive capacity in the dynamic context of home care. Strengths and limitations The qualitative design was suitable for the research question, likely enabling an in-depth exploration of HCPs’ experiences and perceptions related to the factors contributing to positive outcomes in their everyday practices ( 81 ). Using focus group interviews likely enriched the data by capturing more nuanced insights through the dynamics and interactions of the group ( 82 ). The interview guide was developed in collaboration with the S4R consortium, incorporating diverse expert perspectives, which likely enhanced its content validity ( 83 ). The involvement of municipal leaders in participant recruitment may have helped foster trust among participants, contributing to the richness and reliability of the data ( 84 , 85 ). Moreover, the inclusion of registered nurses, healthcare assistants, and one untrained care assistant provided a heterogeneous pool of participants, enabling the capture of diverse perspectives on the factors that support resilient performance and mental well-being. The study’s adherence to the COREQ checklist ( 42 ) likely ensured transparency and methodological rigor in design, data collection, and reporting. However, some important limitations exist in this research that need to be considered for a thorough interpretation of the findings. Although the qualitative approach used likely allowed for in-depth exploration of the study's aim, it may also introduce potential subjectivity in data interpretation ( 81 ). The recruitment method through leadership might have included more engaged and accessible participants, which may introduce selection bias ( 86 , 87 ). Furthermore, while the study was conducted in three home care settings located in three municipalities in the eastern part of Norway, the majority of participants came from a single site, potentially skewing the data toward that context. Nonetheless, given their specific nature, we have described the contextual conditions to enable others to assess the relevance of our results for their healthcare systems. Additionally, only one care assistant and three male participants were included, which may limit the applicability of the findings. Although females are generally overrepresented in healthcare, making the participants representative of the actual workforce composition in this context, it still limits broader applicability. Lastly, while the interview guide was carefully translated into Norwegian, the possibility of subtle interpretative differences cannot be ruled out ( 88 ). The group dynamics during the interview process might be another concern. In a mixed group of nurses and healthcare assistants, discussions were often dominated by nurses. This dynamic might have influenced the diversity and depth of the data collected. Conclusion In this study, we investigated the factors that support resilient performance and mental well-being among HCPs working in Norwegian home care settings. Key themes: a collaborative culture, supportive and accessible leadership practices, clearly structured work organizations, including roles and procedures , as well as individual coping and adaptation strategies , help HCPs cope with daily demands, reducing stress levels while improving their job satisfaction. As home care continues to face challenges with workforce sustainability and poor mental well-being among its staff, our research provides valuable insights into how these elements can be used to develop and implement strategies that support individual and organizational resilience, thereby ensuring sound working conditions and enhancing the mental well-being and retention of HCPs. The research demonstrates that home care settings require a comprehensive approach that combines organizational elements with individual factors to promote resilient performance and mental well-being. Abbreviations HCPs Health Care Professionals RiH Resilience in Healthcare S4R Support4Resilience Declarations This study was approved by the Norwegian Agency for Shared Services in Education and Research (Sikt). All participants provided informed consent before participation. Ethics declarations and Consent This study did not require sensitive health-related data. Hence, ethics approval was not sought from the Regional Ethics Committees for Medical and Health Research (RECs). However, the study adhered to relevant ethical principles, including the Declaration of Helsinki (89). Ethics approval was also obtained from the Norwegian Agency for Shared Services in Education and Research (Sikt). Approval from Sikt ensures that the collection of data and data storage in the project adhere to ethical conduct, rules, and legislation. Informed consent was obtained from all participants of the study. The policies and guidelines of the General Data Protection Regulation (GDPR), Sikt, and the University of Stavanger (UiS) were strictly followed in the study's data collection and storage process. Consent for Publication Not applicable Data availability statement The interview data used for this study can be made available from the corresponding author upon reasonable request, provided that permission is obtained from the study participants. Competing interests Author Siri Wiig is the associate editor of BMC Health Services Research. The author team declares no competing interests. Funding The Faculty of Health Sciences, University of Stavanger, funded the PhD Scholarship. In addition, this study is part of the larger Horizon Europe-funded Support4Resilience (S4R) project 2024-2028 (Project ID: 101136291). However, the Faculty, the University, and the European Union had no role in the research process or publication of the manuscript. Authors’ contributions TTK and RS conducted the data collection. TTK conducted the analysis and transcribed the interviews with input from the co-authors. TTK wrote the first draft of the manuscript, and all the authors critically reviewed and revised the subsequent drafts. All the authors read and approved the final version. Acknowledgments We want to acknowledge the HCPs in home care settings who participated in this study, as well as the leaders in these settings who facilitated the interview process. Corresponding author Corresponding author: Teklay T. Kidanemariam, [email protected] References Chang M, Michelet M, Skirbekk V, Langballe EM, Hopstock LA, Sund ER, et al. Trends in the use of home care services among Norwegians 70 + and projections towards 2050: The HUNT study 1995–2017. Scand J Caring Sci. 2023;37(3):752–65. Idsøe-Jakobsen I, Dombestein H, Brønnick KK, Wiig S. 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Sampling in interview-based qualitative research: A theoretical and practical guide. Qualitative Res Psychol. 2014;11(1):25–41. Schumann M, Dennis A, Leduc JM, Peters H. Translating cross-language qualitative data in health professions education research: Is there an iceberg below the waterline? Med Educ. 2024;59(6):589. Association WM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1InterviewGuide.pdf Cite Share Download PDF Status: Published Journal Publication published 02 Jan, 2026 Read the published version in BMC Health Services Research → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6966052","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515947309,"identity":"b30464af-5dc4-49b8-a9ba-1c68d9e13f6d","order_by":0,"name":"Teklay Tesfay Kidanemariam","email":"data:image/png;base64,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","orcid":"","institution":"University of Stavanger","correspondingAuthor":true,"prefix":"","firstName":"Teklay","middleName":"Tesfay","lastName":"Kidanemariam","suffix":""},{"id":515947310,"identity":"5c43d0fb-ec0f-4523-a450-eb0fceb99d0b","order_by":1,"name":"Maren Kristine Raknes Sogstad","email":"","orcid":"","institution":"The Norwegian University of Science and Technology, NTNU in Gjøvik","correspondingAuthor":false,"prefix":"","firstName":"Maren","middleName":"Kristine Raknes","lastName":"Sogstad","suffix":""},{"id":515947311,"identity":"c3fa9d27-3652-4872-92db-36f646371826","order_by":2,"name":"Siri Wiig","email":"","orcid":"","institution":"University of Stavanger","correspondingAuthor":false,"prefix":"","firstName":"Siri","middleName":"","lastName":"Wiig","suffix":""},{"id":515947312,"identity":"d4b5740c-ed1c-471f-91b1-2e6c6b3b0553","order_by":3,"name":"Cecilie Haraldseid-Driftland","email":"","orcid":"","institution":"University of Stavanger","correspondingAuthor":false,"prefix":"","firstName":"Cecilie","middleName":"","lastName":"Haraldseid-Driftland","suffix":""}],"badges":[],"createdAt":"2025-06-24 13:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6966052/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6966052/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13917-w","type":"published","date":"2026-01-02T15:58:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99545520,"identity":"33898a20-8a88-47b8-8196-f07ee9fc1156","added_by":"auto","created_at":"2026-01-05 16:08:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1175023,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6966052/v1/7ea691f3-2141-49ff-955b-3360fb6d302a.pdf"},{"id":91609553,"identity":"4edea621-2e8e-4b2c-9279-fb88c313acf2","added_by":"auto","created_at":"2025-09-18 09:42:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":274898,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1InterviewGuide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6966052/v1/b0dddd6ed032dd27f702027a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors supporting resilient performance and mental well-being among health care professionals in home care settings: a qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eOver the past few decades, home-based care has become a rapidly growing part of healthcare in Norway and many other Western countries (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This is mainly due to a growing elderly population living with chronic and often complex health conditions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In addition, the heightened focus on user-centered care, the advancement of new support technologies, and widespread efforts to enhance responsiveness, continuity, efficiency, and equity in healthcare systems are all contributing to the growth (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eProjections suggest that the number of care-dependent older people will increase alongside noncommunicable diseases as the leading cause of chronic illness and disability (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Norway, individuals aged 80 and older are projected to account for 16% of the Norwegian population by 2100 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), while in the EU, this age group is expected to reach 15.3% by the same year (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, home care environments are becoming increasingly complex and demanding, requiring HCPs working in these environments to assume a wide variety of roles, supporting patients not only in clinical and curative care but also in supportive, rehabilitative, palliative, and comforting care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The HCPs are expected to carry out these responsibilities in unpredictable and often resource-limited conditions.\u003c/p\u003e\u003cp\u003eThe increasing demand for home care services, combined with the rising complexity, has exacerbated the shortage of qualified HCPs. In Norway, estimates suggest a shortage of around 13,000 registered nurses by 2030 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The gap in the EU is estimated at 4.1\u0026nbsp;million by the same year (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). High turnover rates further worsened this shortage, resulting in healthcare professionals facing psychological stressors such as workload, time pressure, and physically demanding tasks (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These factors present substantial challenges to the mental well-being of the HCPs as well as their ability to deliver high-quality care. Hence, it is essential to develop and implement strategies that strengthen the capacity and sustainability of HCPs in homecare settings, providing them with sound working conditions and enhancing their mental well-being. An important step towards this goal is understanding what helps HCPs to stay in their roles and continue delivering quality care under demanding and complex conditions.\u003c/p\u003e\u003cp\u003eResilience in Healthcare (RiH) has been operationalized through the concept of Resilience Engineering (RE), which focuses on promoting the capacity of healthcare systems and professionals to adapt, respond, and maintain high-quality care under varying and often challenging conditions (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In this context, resilient performance refers to the outcome of achieving four resilience capabilities within the system: anticipating disruptions, monitoring the system, responding to demands, and learning from experience (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Although these abilities have been studied mostly from the hospital perspective (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), there is limited research on how these capabilities manifest in home care settings, which are complex, variable, and less controlled than in institutional environments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, although resilience in healthcare has been widely studied, most research has focused on individual resilience, particularly among hospital staff during acute events such as the COVID-19 pandemic (\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). These studies have shown that resilience levels can be influenced by sociodemographic variables, such as gender, age, and marital status. However, resilience in healthcare encompasses not only individual traits but also organizational and team-based traits, which can vary across different care contexts (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In home care, where HCPs must manage complex care needs with a high degree of autonomy (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), there is a pressing need to explore what supports resilience specifically in this setting.\u003c/p\u003e\u003cp\u003eThis study aims to close this gap by applying the RiH perspective to explore the factors that support resilient performance, their dynamics, and how they influence the mental well-being of HCPs in Norwegian home care contexts.\u003c/p\u003e\u003cp\u003eThe following research question guided this study: What factors contribute to resilient performance and mental well-being among HCPs, and how do these factors interact with one another?\u003c/p\u003e\n\u003ch3\u003eContextualizing the study\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eThe Support4 Resilience project\u003c/h2\u003e\u003cp\u003eThis study is part of the larger Horizon Europe-funded Support4 Resilience (S4R) project 2024\u0026ndash;2028 (Project ID: 101136291) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Focusing on elderly care provision across various healthcare settings, including public and private nursing homes, home care services, and hospital-to-home care, the S4R project aims to develop a research-based, innovative platform known as the S4R toolbox. This toolbox is designed to help healthcare leaders phase out ineffective practices, thereby freeing up time and resources for more effective approaches. It also promotes greater autonomy among healthcare professionals and supports learning from positive outcomes. The toolbox provides a range of cost-effective tools, both individual and collaborative, to help implement effective resilience and mental well-being strategies.\u003c/p\u003e\u003cp\u003eInvolving 14 partners from seven countries, Australia, Finland, Italy, the Netherlands, Norway, Romania, and Spain, the project entails cross-country data collection, toolbox development, implementation, process evaluation, cost-effectiveness and effectiveness evaluations, theory development, and policy recommendations.\u003c/p\u003e\u003cp\u003eThis article is part of the initial investigations of the S4R project. By exploring the factors that contribute to resilient performance and mental well-being among HCPs from the Norwegian home care context, it aims to provide a foundation for developing the S4R toolbox.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eThe home care setting in Norway: Work organization and daily practices\u003c/h3\u003e\n\u003cp\u003eThe Norwegian healthcare system is publicly funded and governed at the national, regional, and local levels (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The Ministry of Health and Care Services (MoHCS) oversees national-level policy, while provision is decentralized to Regional Health Authorities (RHAs) and municipalities (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). RHAs are responsible for specialist care, whereas municipalities organize and finance primary care, including home care, the front line of the Norwegian healthcare system (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe way home care is organized and practiced vary across countries (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In Norway, home care is predominantly publicly owned, managed, and delivered by the country\u0026rsquo;s 357 municipalities, which, as of 2025, have a population ranging from approximately 5,000 to 500,000 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough service provisions should be adapted to individual needs based on individual assessments, the tasks include providing medical assistance, nursing care, practical support to maintain daily life activities, rehabilitation, and end-of-life care at patients\u0026rsquo; homes (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). While basic home care services are, in principle, free of charge, users share the cost for additional services, such as practical assistance (e.g., home cleaning) and access to senior citizen centers, if needed (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile organizational models vary between municipalities, home care is generally team-based, with defined roles, planning systems, and digital care plans. HCPs typically rotate shifts, including weekends, with most providing care in patients\u0026rsquo; homes, and traveling from one residence to another, while some members work in institutional facilities.\u003c/p\u003e\u003cp\u003eGenerally, a home care team begins their shifts by reviewing patient lists, sharing care information, and distributing work assignments in a scheduled meeting. The daily assignments in home care settings include basic care responsibilities (hygiene, dressing, and meals) and advanced care responsibilities (medication administration, wound care, catheterization, and ostomy care).\u003c/p\u003e\u003cp\u003eNurses constitute the core workforce of homecare (including elderly care) services in Norway, with most holding bachelor\u0026rsquo;s degrees and some serving in advanced practice roles at the master's level. As of 2023, approximately 25% of the 122,000 registered nurses work in elderly care (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).In addition to nurses, healthcare assistants (in Norwegian: \u003cem\u003eHelsefagarbeidere\u003c/em\u003e) receive training equivalent to a two-year postsecondary vocational degree and comprise approximately 91,000 workers in the same year (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). To meet service needs, untrained or in-training assistants are also employed temporarily.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eA qualitative exploratory design (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), was used in this study. Seven focus group interviews were conducted across three home care settings in three Norwegian municipalities. Given the study\u0026rsquo;s aim, focus group interviews are well-suited for collecting rich experiential data (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) to gain insight into the factors that enable HCPs to manage challenges, sustain high-quality care, and support their mental well-being in everyday home care practices.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Setting and Recruitment of Research Participants\u003c/h3\u003e\n\u003cp\u003eThe three municipalities are all located in the eastern part of Norway. They encompass urban centers and rural areas, varying in size from less than 1,000 km\u0026sup2; to over 1,000 km\u0026sup2;. Their populations range from fewer than 10,000 to more than 20,000 inhabitants (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the recruited municipalities (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMunicipality (M)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSuburban\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArea(km\u0026sup2;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePopulation size\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20000\u0026ndash;50000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20000\u0026ndash;50000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSite recruitment was conducted through the municipalities. Municipal leaders were initially contacted, and they facilitated access by reaching out to the leaders of home care services.\u003c/p\u003e\u003cp\u003eIn total, 34 HCPs were recruited, including registered nurses (n\u0026thinsp;=\u0026thinsp;16), healthcare assistants (n\u0026thinsp;=\u0026thinsp;17), and one care assistant (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eA semi-structured interview guide, comprising 23 questions organized into seven topic areas, was developed specifically for this study in collaboration with the Support4Resilience (S4R) consortium. The guide was initially developed in English (see Supplementary File 1) and was later translated into Norwegian, the participants' native language, to ensure clarity and facilitate better understanding (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe interview guide covered the following topics: general information about the participants' professional background, education, and training; actual work situations (Work as done); resilience in healthcare; patient safety; mental well-being; leadership support; and Informal caregivers\u0026rsquo; engagement in care services. No questions were asked regarding person- or patient-sensitive issues.\u003c/p\u003e\u003cp\u003eTwo researchers conducted focus group interviews in November 2024 in pre-arranged meeting places of the home care settings. One of the researchers is an associate professor of care research with substantial knowledge of quantitative and qualitative research methods. The other is a PhD candidate with a solid understanding of qualitative research methodology. The researchers had no prior contact with the study participants. Each focus group interview session lasted approximately 90 minutes and was audio-recorded via the \u003cem\u003eNettskjema Dektafon\u003c/em\u003e mobile app, a data collection tool that enables the ethical and secure storage of qualitative data (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Prior to each interview session, participants received both written and oral information about the study aim, and written informed consent was obtained from all participants.\u003c/p\u003e\u003cp\u003eThis study employed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist as a reporting framework (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCharacteristics of the participants\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the majority of participants were women (n\u0026thinsp;=\u0026thinsp;31), including nurse assistants (n\u0026thinsp;=\u0026thinsp;17) and nurses (n\u0026thinsp;=\u0026thinsp;14). Three participants, all nurse assistants, were men. Nearly all the participants (n\u0026thinsp;=\u0026thinsp;33) held permanent positions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;34\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eProfessional background\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare assistants (\u003cem\u003eHelsefagarbeidere\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecare assistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYears of work\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelow 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 to 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11 to 20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eWork situation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVicar (temporary)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that of the 34 participants, the majority were from Municipality 1 (24 participants), who held various roles, including nurses (n\u0026thinsp;=\u0026thinsp;8), healthcare assistants (n\u0026thinsp;=\u0026thinsp;15), and a care assistant. Municipalities 2 and 3 each had 5 participants. All participants in Municipality 2 were nurses, whereas those in Municipality 3 included both nurses (n\u0026thinsp;=\u0026thinsp;3) and healthcare assistants (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNumber of study participants in each municipality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMunicipality (M)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealthcare assistant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecare assistant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe first author transcribed the interviews \u003cem\u003everbatim\u003c/em\u003e (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and imported the transcripts into NVivo 1.61 (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) for analysis. The data analysis for this study was conducted according to Braun and Clarke\u0026rsquo;s six-step framework for thematic analysis (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBrown and Clark's six-step framework is followed in the data analysis process.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eData familiarization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTranscripts were transcribed, read multiple times, and reviewed with notes for deep understanding.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGenerating Initial Codes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCodes were created systematically for each case to capture key features.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSearching for Themes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCodes were grouped based on meaningful patterns and relationships.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReviewing Themes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThemes and subthemes were refined through cross-case analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefining and Naming Themes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFour themes\u003c/b\u003e and \u003cb\u003eeight subthemes\u003c/b\u003e were finalized through consensus among the authors.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProducing the Report\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA clear, structured report was written to present the findings.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe first author conducted initial data coding, followed by regular debriefing sessions with co-authors to review, validate, and refine the emerging themes, thereby facilitating a more nuanced interpretation of the data and mitigating potential biases (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Dependability was enhanced through auditing and documenting analytical decisions and coding changes (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). While member checking was not formally conducted, triangulation across interview data and observational notes helped reinforce the credibility of the findings (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study explored the factors that HCPs in home care settings perceive as supporting resilient performance and mental well-being. Using the thematic analysis approach, we identified four main themes and eight subthemes (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOverview of themes (n\u0026thinsp;=\u0026thinsp;4) and subthemes (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Collaborative Culture: Working and Learning Together\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Sharing knowledge and workloads\u003c/p\u003e\u003cp\u003e2. Team unity and Collegiality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Leadership Support Practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Open, accessible, and engaging Leadership\u003c/p\u003e\u003cp\u003e2. Working independently: Demanding and Rewarding\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Organization of work, Roles and Procedures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Documentation as a communication tool\u003c/p\u003e\u003cp\u003e2. Support systems, Technologies, and Tools\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Individual Coping and Adaptive Strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Adaptability in the face of unpredictable challenges\u003c/p\u003e\u003cp\u003e2. Reducing stress through task prioritization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 1. Collaborative Culture: Working and learning together\u003c/h2\u003e\u003cp\u003eThe theme \u003cem\u003eCollaborative Culture\u003c/em\u003e captures aspects related to the HCPs\u0026rsquo; perceptions of collective problem-solving, shared learning within their roles, and the overall workplace atmosphere in home care settings. Although home care work often involved physically working alone, participants emphasized that they rarely felt isolated. HCPs reported a strong sense of team collaboration and continuous informal and formal learning, which were cultivated through daily interactions. A shared responsibility for patient care was noted as a defining feature of both structured and spontaneous collaboration in home care work.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSharing knowledge and workloads\u003c/h2\u003e\u003cp\u003eParticipants perceived that a strong collaborative culture contributed to both professional development and care quality, even in settings where HCPs primarily worked independently. Participants reported that despite each HCP having individual tasks for the shift, the nature of their work always made them feel part of a team, both by sharing practical knowledge and by supporting each other with workloads:\u003c/p\u003e\u003cp\u003e\"\u003cem\u003eEven though we work alone with our lists, we are not alone\u0026mdash;we are part of a team. We work together, and we are good at helping each other. If someone finishes early, we start calling around and offering help, picking up visits from others' lists.\u0026rdquo;\u003c/em\u003e (M1, P3)\u003c/p\u003e\u003cp\u003eWhen performing their daily activities, HCPs needed to remain responsive to unexpected patient needs, exchange expertise, and provide both emotional and practical support as needed. In this context, both planned and unplanned interactions, such as shift handovers, mid-shift check-ins, and informal conversations, were seen as valuable opportunities for mutual learning and growth. Informal learning often occurred spontaneously as HCPs shared experiences, reflected on challenging cases, and passed along practical knowledge throughout their day.\u003c/p\u003e\u003cp\u003eBreaks and shared lunch times also became arenas for peer exchange. While some participants noted efforts to limit work-related conversations during lunch, many acknowledged that discussions about patient care and professional challenges naturally continued around the lunch table.\u003c/p\u003e\u003cp\u003e Participants described learning as embedded in day-to-day routines, with experienced staff mentoring others and providing guidance on complex or unfamiliar tasks. In addition to addressing challenges as they arose, this culture of peer support and ongoing learning was perceived to enable HCPs to share experiences, clarify uncertainties, and enhance their competence. \u003cem\u003e\u0026ldquo;\u0026hellip; unexpected things always come up, so we must discuss them continuously\u0026rdquo;\u003c/em\u003e (M3, P5), \u003cem\u003e\u0026ldquo;If we are unsure about something, like lifting or transferring patients, we might do a midshaft check-in, where we provide some training.\u0026rdquo;\u003c/em\u003e (M1, P4)\u003c/p\u003e\u003cp\u003eAdditionally, collaboration extended beyond the immediate care team. Interdisciplinary collaboration with occupational and physical therapists was described as providing HCPs with valuable insights into managing physically demanding tasks, such as lifting and moving patients. By conducting joint patient visits and assessing patient needs together, they offered practical tips that participants felt enhanced both patient care and their workday, especially when tasks became physically challenging.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTeam unity and collegiality\u003c/h2\u003e\u003cp\u003e Participants frequently described their workplace as open and supportive compared to other workplaces they were familiar with. The positive team atmosphere was perceived to foster collegiality, making the workday more enjoyable. It was often noted that it was acceptable to feel uncertain about something; when in doubt, one could simply ask, and support was readily available. This openness fostered strong interpersonal relationships and encouraged a collaborative culture.\u003c/p\u003e\u003cp\u003eNew employees highlighted that, despite being newcomers, it is entirely acceptable to ask questions and seek help from their colleagues. The presence of experienced staff members appeared to reinforce this environment, creating continuity and trust that helped sustain a healthy team culture. \u0026ldquo;\u003cem\u003eWhat works well here is that we have unity and good collegiality. This is important because people like to feel safe around each other\u003c/em\u003e.\u0026rdquo; (M2, P4)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2. Leadership Support Practices\u003c/h2\u003e\u003cp\u003eThis theme encompasses participants' perceptions of leadership in terms of accessibility, supportiveness, and responsiveness to their professional and emotional needs. Open communication, mutual trust, and a supportive leadership presence were recognized as key elements that contributed to day-to-day functioning and to psychological safety, autonomy, and professional growth among the HCPs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eAccessible and engaging leadership\u003c/h2\u003e\u003cp\u003e Several participants used phrases such as \u0026lsquo;the leader is visible\u0026rsquo; and \u0026lsquo;the door is always open\u0026rsquo; to describe the perceived engagement and responsiveness of leadership in the daily activities of the home care setting. Most noted that they could approach their leaders without needing an appointment, provided that the leader was not preoccupied with other tasks or busy on the phone. Many appreciated the ability to approach their department leaders informally when they met them at work. This accessibility and responsiveness were perceived to allow HCPs to raise concerns, ask questions, and seek guidance without facing barriers.\u003c/p\u003e\u003cp\u003e The participants also favored an open approach that included anonymous \u0026lsquo;post-it\u0026rsquo; notes as an alternative for those who were less comfortable with direct communication. Participants valued this as a simple, non-intimidating way to communicate with their leaders. One participant (M1, P5) described this approach in detail: \u003cem\u003e\u0026ldquo;I actually feel that I am being heard and that I can talk with ease, without being judged for the mistakes I make.\u0026rdquo;\u003c/em\u003e (M1, P5)\u003c/p\u003e\u003cp\u003eParticipants frequently linked supportive and present leadership to fostering a positive work environment and promoting teamwork in the home care settings. Leaders were praised for their swift responses (especially during high-pressure situations), which participants felt built trust and confidence.\u003c/p\u003e\u003cp\u003eA participant recalled, \"\u003cem\u003eThere was an incident, and [the leader] handled it incredibly well, it happened in the blink of an eye, and she gained my trust that way\u003c/em\u003e\" (M1, P3).\u003c/p\u003e\u003cp\u003eLeaders' involvement in frontline tasks was viewed as a crucial aspect of engaging leadership, particularly during periods of increased workload. This became especially evident during busy times, such as the summer holiday season, when staff shortages due to vacations placed additional strain on home care teams. Participants emphasized that leaders who adopted a hands-on approach and actively supported staff in the field not only helped alleviate the immediate workload but also appeared to foster a stronger sense of team cohesion.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eWorking independently: demanding and rewarding\u003c/h2\u003e\u003cp\u003eMost participants valued autonomy in their work, describing it as both rewarding and demanding because they were responsible for making independent decisions. On the one hand, it allowed them to customize their decisions based on patient needs and develop confidence through independent problem-solving. On the other hand, this autonomy came with pressure, as HCPs were solely responsible for their assessments and actions.\u003c/p\u003e\u003cp\u003eOver time, this independence was perceived to contribute to a sense of competence and adaptability, as reflected in the following statement: \"\u003cem\u003eWhen no one is around to ask, I have to make the decision myself. It is scary at first, but it makes me stronger and more confident in my decisions.\u0026rdquo;\u003c/em\u003e (M3, P4) This suggests that while leadership inaccessibility could pose challenges, it also reinforced participants' sense of autonomy and their ability to develop resilience in their roles.\u003c/p\u003e\u003cp\u003eOther participants noted that the system clarified decision-making boundaries, which was described as fostering a sense of security and psychological safety. This clarity was seen to help HCPs reduce uncertainty and contributed to a sense of psychological safety, as they knew when to act independently and when to seek support. \u003cem\u003e\u0026ldquo;We also have a good system in place; I clearly understand which decisions I can make on my own and which ones need to be referred to either the head nurse or the leader.\u0026rdquo;\u003c/em\u003e (M3, P1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3. Organization of work, roles, and procedures\u003c/h2\u003e\u003cp\u003eThis theme explores how structured organizational routines, clearly defined roles, and the effective use of technological tools and documentation were perceived by participants to contribute to the delivery of high-quality, consistent care. Participants explained that organizational clarity regarding roles, responsibilities, procedures, and expectations in home care settings enabled more predictable workflows, reduced uncertainty, minimized stress, and supported a more stable work environment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eDocumentation as a communication tool\u003c/h2\u003e\u003cp\u003eHCPs stressed that accurate and up-to-date documentation is more than just an administrative requirement in home care; rather, it was viewed as a critical component of patient safety, care coordination, and the overall patient experience. Documentation was described as an essential component of internal communication, vital for tracking care processes, recording clinical interactions, and ensuring the continuity of care.\u003c/p\u003e\u003cp\u003eClear and thorough record-keeping was particularly valued in situations requiring coordinated responses, such as initiating new clinical procedures or patient-specific interventions. This was seen to facilitate ongoing evaluation and knowledge sharing among the HCPs. \u0026ldquo;\u003cem\u003eDocumentation is always important; everything we write and do is subject to follow-up and evaluation.\u003c/em\u003e\u0026rdquo; (M1, P3)\u003c/p\u003e\u003cp\u003eParticipants reported that routine reviews of patient records were essential to ensuring continuity and accountability, particularly during shift change or when staff returned from time off. Writing detailed notes was viewed as an expected responsibility, crucial for maintaining awareness of recent developments and preventing information gaps in patients\u0026rsquo; care histories. Documentation was also regarded as a critical tool for accountability, particularly when patients responded to questions or concerns from their family members. \u003cem\u003e\u0026ldquo;[\u0026hellip;] when the leader receives questions about a patient, she can check the report, see what has happened and who wrote what, and then explain the details.\u0026rdquo;\u003c/em\u003e (M1, P1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eSupport Systems, Technologies, and Tools\u003c/h2\u003e\u003cp\u003eParticipants outlined how they use various systems and tools to provide structure and enable continuity of care. This includes task distribution systems, alarms, electronic messaging systems, medication dosing systems, and standardized procedures. Collectively, these systems and tools were described as helping staff stay organized, anticipate tasks, and maintain consistent workflows, even during periods of high demand.\u003c/p\u003e\u003cp\u003eTechnological tools, including medication dispensers, sensor-based alarms, smart cameras for safe and secure follow-up, door and bed alarms, and emergency call systems, were reported to be used daily to increase patient safety and workflow efficiency. However, not all systems were equally effective across contexts. For example, the limited accessibility of the procedure portal while in the field due to a lack of remote access was seen to limit its usefulness during home visits.\u003c/p\u003e\u003cp\u003eIn addition to digital tools, participants utilized analog methods, such as reminder notes and checklists, which they frequently reviewed at the beginning of each day to stay organized and prioritize tasks.\u003c/p\u003e\u003cp\u003eParticipants indicated that while tools and routines were essential for the smooth operation of home care, assigning dedicated staff to manage operational tasks was considered crucial for ensuring care continuity and efficiency. The shift from rotating responsibilities to a more stable staffing arrangement was perceived as enhancing both the efficiency and continuity of care services in home care settings. \u003cem\u003e\u0026ldquo;Initially, we rotated responsibilities, she would sit one day, I would sit next, and someone else the third. Now, there is more consistency: one person handles everything full time on weekdays, including electronic messages, phone calls, hospital messages, and ongoing communication.\u003c/em\u003e\u0026rdquo; (M1, P3)\u003c/p\u003e\u003cp\u003eThe results also revealed that a new task distribution system, which defined clear areas of responsibility for each person, had been introduced to clarify roles and responsibilities. While this system was generally viewed as a positive development, promoting structure, accountability, and more efficient workflows, participants\u0026rsquo; experiences varied. Some participants believed it improved coordination and reduced ambiguity in daily tasks, while others felt it limited flexibility or created challenges when tasks overlapped or required teamwork across role boundaries.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4. Individual coping and adaptive strategies\u003c/h2\u003e\u003cp\u003eThis theme encompasses aspects of the personal and professional competencies that HCPs utilize to maintain their mental well-being and performance under pressure. When faced with unpredictable challenges that test their emotional regulation and high workloads, participants reported employing a variety of adaptive strategies, including staying calm and flexible, prioritizing tasks, navigating complexity, protecting team functioning, and continuing to deliver care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eAdaptability in the face of unpredictable challenges\u003c/h2\u003e\u003cp\u003eAdaptability was identified as a core professional competency essential for maintaining performance in the face of unexpected situations, complex patient needs, and limited resources. Participants highlighted that flexibility was crucial at both the individual and team levels, allowing HCPs to support one another and perform professionally despite unpredictable conditions.\u003c/p\u003e\u003cp\u003eWorking alone, especially during staff shortages or on weekends, required HCPs to assess unfamiliar scenarios and respond independently and quickly. For example, unfamiliar equipment, such as infusion pumps, necessitated on-the-spot problem-solving and self-directed learning. This ability to adapt was perceived as essential for sustaining professional performance in challenging situations.\u003c/p\u003e\u003cp\u003eStaying calm and regulating one\u0026rsquo;s pace were described as essential stress management strategies that HCPs employed to prevent stress from escalating within the team. As one respondent reported: \u0026ldquo; \u003cem\u003e\u0026hellip; We are good at de-escalating stress\u0026hellip; If one person starts panicking, it can spread quickly, but we know how to manage that. It is almost like a skill\u0026mdash;keeping things calm and handling the unexpected.\u0026rdquo;\u003c/em\u003e (M1, P1)\u003c/p\u003e\u003cp\u003eThis flexibility also applied to caring for patients with complex mental health needs, requiring real-time adjustments in approach and communication.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eReducing stress through task prioritization\u003c/h2\u003e\u003cp\u003eHCPs shared that they prioritized tasks based on their critical nature during high-pressure shifts. While participants acknowledged the importance of person-centered care, they also need to focus on more critical tasks, such as administering medication or providing personal hygiene assistance, at the expense of less critical interventions, including vitamin administration or nonessential visits, to manage workloads and reduce stress.\u003c/p\u003e\u003cp\u003eWhen the schedule was tight, HCPs adjusted their schedule, often postponing more time-consuming tasks until later in the day, when their workload allowed for more flexibility. In other cases, HCPs substituted physical visits with check-in calls, especially when patient needs were not urgent. \u003cem\u003e\u0026ldquo;\u0026hellip;there are many times and places we go just to perform a check-in, just to have a conversation, but that is not really why we are here. We are here to provide the necessary healthcare. And that, in a way, comes at the expense of those who may need it to live at home and get help, care, food, and the essential things.\u003c/em\u003e\u0026rdquo; (M1, P5)\u003c/p\u003e\u003cp\u003eThough most agreed that decisions were necessary to ensure quality care for those in more critical need, several noted the emotional complexity of prioritization and the discomfort of facing criticism for delays or changes in plans. \u003cem\u003e\u0026ldquo;It can be challenging to face criticism for our priorities, especially when some complain while others accept waiting a bit longer without saying anything. This is part of our everyday work.\u0026rdquo;\u003c/em\u003e (M1, P2)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall aim of this study was to explore the factors that HCPs in home care settings experience supporting their resilient performance and mental well-being.\u003c/p\u003e\u003cp\u003eGuided by the RiH theory, which focuses on maintaining stability while adapting to both expected and unexpected challenges within the healthcare system (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), we identified four key interrelated factors: \u003cem\u003eCollaborative Culture, Leadership Support Practices, Organization of work, roles and procedures, and Individual Coping and Adapting Strategies\u003c/em\u003e (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003eOrganizational and Contextual Factors\u003c/h2\u003e\u003cp\u003eThe HCPs in this study suggest that a strong collaborative culture is one of the key factors helping them face daily challenges and support each other emotionally in their work. The solidarity among HCPs improves not only individual resilience but also serves the team in navigating the multifaceted challenges of critical care with a shared sense of purpose (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). This finding is consistent with earlier research, which shows that social cohesion, open communication, and trust-based teamwork reduce occupational stress, build resilience, and support HCPs' mental well-being, which are fundamental for adaptive capacity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR52\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). While many of these dynamics have been studied in the context of the COVID-19 pandemic, the underlying principles of team cohesion and adaptive capacity remain highly relevant to the day-to-day work of home care. The nature of home care is often unpredictable, with professionals working in decentralized settings and frequently managing complex situations independently. This context continues to demand strong collaboration and flexibility. To strengthen our understanding of how these dynamics function specifically in home care, more research is needed that is situated directly within this practice setting.\u003c/p\u003e\u003cp\u003eIn this study, both planned and spontaneous interactions throughout the workday, such as quick check-ins, case-related discussions, and impromptu problem-solving, were found to play important roles in maintaining team cohesion. Participants described that these exchanges created space for peer learning, mutual feedback, and emotional support, all of which helped foster psychological safety and supported timely adaptation when unexpected challenges arose. Consistent with our findings, previous findings have shown that strong communication and team-based collaboration can reduce burnout, enhance psychological resilience, and lead to improved care quality (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55 CR56 CR57\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants in our study described collaborations with colleagues and seeking help to solve problems and complete tasks as a normal part of their routine, and were encouraged to do so as part of their daily work. This reflects a key feature of adaptive capacity of resilient healthcare, where teams adapt by dynamically reallocating resources in response to changing demands (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This finding aligns with the resilience framework by Lyng et al (2022) (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), which identifies behaviors such as seeking help and mutual engagement among team members as highly beneficial for improving their practices. As such, involvement, one of the ten capacities for resilience in healthcare, plays a central role in sustaining the functionality and responsiveness of healthcare teams (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Our result also underscores the value of \u0026lsquo;slack\u0026rsquo; in organizational routines (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), where time spent on discussing and addressing work tasks enabled learning, emotional processing, and real-time coordination among HCPs. In a home care environment, where HCPs often work autonomously with little or no immediate support, these seemingly minor moments for peer interaction play a crucial role in supporting the resilient and adaptive performance of HCPs.\u003c/p\u003e\u003cp\u003eAccessible and supportive leadership practices were also identified as a significant influence on team resilience (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). When leaders were approachable, responsive, and actively engaged in frontline tasks during periods of high demand, this was interpreted by the participants as a sign of solidarity and shared responsibility. Participants also noted that these leadership practices helped foster trust and psychological safety within the team, conditions that are essential for resilient performance in high-pressure care environments. This finding aligns with previous research, which demonstrates that leadership practices rooted in openness and support can have a significant impact on team functioning and the capacity to adapt during challenging situations (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Similarly, in their research on teamwork in healthcare during COVID 19, Anjara et al (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) found that frontline engagement by clinical leaders marked by shared tasks, collective leadership, and psychological safety supported stronger teamwork and organizational citizenship behaviors.\u003c/p\u003e\u003cp\u003eIn addition, our study found that workplace autonomy functions as a dual dynamic, both empowering and potentially stressful, depending on the clarity of role boundaries. This finding reflects the distinctive nature of home care, where professionals often work in patients' residences, with less direct supervision than in institutional settings (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), which may be a source of stress and uncertainty. However, in our study, HCPs reported feeling more confident and secure in their roles when their areas of authority and responsibility were clearly defined. Having this kind of clarity supported their sense of autonomy, which often encouraged professional growth and flexibility. At the same time, participants noted that when guidance or organizational support was lacking, this independence could also lead to uncertainty and added stress. These findings align with earlier research, which has shown that the unpredictable and autonomous nature of home care nurses' work necessitates them to make independent decisions, which can be both empowering and stressful (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, the way work was organized, along with clearly defined roles and routines, emerged as a crucial factor in supporting the resilient performance of HCPs. The use of tools and technologies, such as medication dispensers, alarm systems, emergency call systems, and digital monitoring devices, was viewed as essential for enhancing patient safety and also contributed to a more efficient and consistent delivery of care.\u003c/p\u003e\u003cp\u003eAdditionally, these tools and technologies reduce the need for frequent in-person visits to patients' homes while maintaining surveillance and response capabilities. Similarly, previous studies have shown that the use of technological tools enhances medication adherence, facilitates timely responses to emergencies, and supports staff performance by reducing the need for constant physical presence while maintaining high standards of care and surveillance (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe need for mobile access to clinical decision-making tools, such as electronic patient portals and real-time documentation systems, was found to enhance efficiency and support informed decisions, both in the field and in on-site primary care settings (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). Investment in such tools may help decrease unnecessary cognitive and emotional workload, which is essential for maintaining mental well-being (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eFactors that Support Mental Well-being\u003c/h2\u003e\u003cp\u003eHCPs in home care settings employ various personal strategies to maintain their well-being and sustain performance despite the prevailing variability and uncertainty inherent in home care work. Adaptability emerged as a core competence across participants' narratives and was described as a distinct technical skill by itself. Participants highlighted the importance of responding flexibly to unpredictable situations, such as unfamiliar clinical scenarios or high-pressure encounters. The ability to independently \u0026ldquo;figure things out\u0026rdquo;, especially during weekend shifts when immediate support was often unavailable, was seen as essential for managing the complexity of home-based care. This finding aligns with prior qualitative research on home health nurses, which indicates that autonomy, problem-solving, and adaptability are essential to their daily practice, particularly in situations that require swift judgment and carry significant responsibility (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis form of situational responsiveness reflects what can be described as \u003cem\u003econtextual resilience\u003c/em\u003e\u0026mdash;an ability to draw on tacit knowledge, learn quickly in the moment, and trust one\u0026rsquo;s own judgment to navigate gaps in resources or information (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Previous studies have indicated that adaptive capacity in healthcare encompasses coping, aligning, reframing, and innovating, which are essential for responding dynamically to challenges in home-based care environments (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to personal flexibility, our study revealed the importance of collective stress regulation. Team members actively worked to de-escalate situations when one colleague became overwhelmed. This highlights an important social dimension of resilience in which emotional awareness and relational support help maintain a calm and stable work environment. These interactions reflect team-level adaptive capacity, often grounded in psychological safety and a shared sense of responsibility (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings indicate that although HCPs are expected to manage their emotional responses individually, they operate within a relational context where colleagues routinely step in to offer support. This interplay between personal coping and collective responsiveness suggests that resilience is not solely an individual attribute; rather, it is a dynamic interplay between personal coping and collective responsiveness. Rather, it emerges as a dynamic, shared process reinforced through daily interactions, peer support, and collaborative learning (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). This reciprocal responsiveness contributes to psychological safety and shared responsibility, which are elements central to adaptive team functioning (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe participants also described regulating their work speed as a method to handle stress. Flexibility in time management allowed HCPs to maintain control over their workflow even when this required shorter breaks or longer work hours. Despite operational constraints, HCPs maintain their commitment to person-centered, holistic care while regularly adjusting their work priorities to meet the individual needs of their patients. This finding aligns with that of Norlyk et al. (2019) (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e), who observed that home care nurses constantly balance efficiency demands with a strong professional ethos of individualized care, often stretching time to preserve care quality.\u003c/p\u003e\u003cp\u003eIn our study, essential care tasks, including medication administration and insulin delivery, as well as hygiene support, received priority over less essential services, such as housekeeping and routine check-ins. HCPs viewed these decisions as necessary adjustments to maintain essential care operations during constraints, such as during staff shortages. This finding aligns with broader research indicating that during periods of limited staffing or high workload, healthcare workers implicitly ration care, focusing on acute and safety-critical tasks while deferring fewer essential activities (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, this prioritization process was emotionally complex, particularly when these decisions resulted in patient dissatisfaction or criticism. This may suggest that individual coping involves not only stress regulation but also the maintenance of ethical integrity in challenging environments. This finding aligns with previous research in nursing practice, which suggests that deferring less critical services can lead to moral distress, particularly when patients express dissatisfaction or feel neglected (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). Another study on moral distress in home-care nursing found that prioritizing tasks under resource constraints often triggered ethical tension and emotional strain (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study indicates that individual coping and adaptation strategies, such as task prioritization and peer support, are essential. However, they must function within a supportive organizational framework that emphasizes role clarity. The combination of individual strategies and systemic support approaches is essential for enhancing both workplace resilience and the mental well-being of HCPs in home care settings (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings of this research have important implications for both leaders and frontline practitioners in home care settings. To promote resilient performance and support the mental well-being of HCPs, leadership should prioritize consistent engagement with staff, cultivate a collaborative team environment, and establish clear roles and responsibility boundaries. In addition, ensuring access to practical digital tools and recognizing the everyday importance of peer support are essential strategies for sustaining adaptive capacity in the dynamic context of home care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eThe qualitative design was suitable for the research question, likely enabling an in-depth exploration of HCPs\u0026rsquo; experiences and perceptions related to the factors contributing to positive outcomes in their everyday practices (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Using focus group interviews likely enriched the data by capturing more nuanced insights through the dynamics and interactions of the group (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). The interview guide was developed in collaboration with the S4R consortium, incorporating diverse expert perspectives, which likely enhanced its content validity (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe involvement of municipal leaders in participant recruitment may have helped foster trust among participants, contributing to the richness and reliability of the data (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Moreover, the inclusion of registered nurses, healthcare assistants, and one untrained care assistant provided a heterogeneous pool of participants, enabling the capture of diverse perspectives on the factors that support resilient performance and mental well-being. The study\u0026rsquo;s adherence to the COREQ checklist (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) likely ensured transparency and methodological rigor in design, data collection, and reporting.\u003c/p\u003e\u003cp\u003eHowever, some important limitations exist in this research that need to be considered for a thorough interpretation of the findings. Although the qualitative approach used likely allowed for in-depth exploration of the study's aim, it may also introduce potential subjectivity in data interpretation (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). The recruitment method through leadership might have included more engaged and accessible participants, which may introduce selection bias (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, while the study was conducted in three home care settings located in three municipalities in the eastern part of Norway, the majority of participants came from a single site, potentially skewing the data toward that context. Nonetheless, given their specific nature, we have described the contextual conditions to enable others to assess the relevance of our results for their healthcare systems.\u003c/p\u003e\u003cp\u003eAdditionally, only one care assistant and three male participants were included, which may limit the applicability of the findings. Although females are generally overrepresented in healthcare, making the participants representative of the actual workforce composition in this context, it still limits broader applicability. Lastly, while the interview guide was carefully translated into Norwegian, the possibility of subtle interpretative differences cannot be ruled out (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe group dynamics during the interview process might be another concern. In a mixed group of nurses and healthcare assistants, discussions were often dominated by nurses. This dynamic might have influenced the diversity and depth of the data collected.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we investigated the factors that support resilient performance and mental well-being among HCPs working in Norwegian home care settings. Key themes: a \u003cem\u003ecollaborative culture, supportive and accessible leadership practices, clearly structured work organizations, including roles and procedures\u003c/em\u003e, as well \u003cem\u003eas individual coping and adaptation strategies\u003c/em\u003e, help HCPs cope with daily demands, reducing stress levels while improving their job satisfaction.\u003c/p\u003e\u003cp\u003eAs home care continues to face challenges with workforce sustainability and poor mental well-being among its staff, our research provides valuable insights into how these elements can be used to develop and implement strategies that support individual and organizational resilience, thereby ensuring sound working conditions and enhancing the mental well-being and retention of HCPs.\u003c/p\u003e\u003cp\u003eThe research demonstrates that home care settings require a comprehensive approach that combines organizational elements with individual factors to promote resilient performance and mental well-being.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHCPs Health Care Professionals\u003c/p\u003e\n\u003cp\u003eRiH Resilience in Healthcare\u003c/p\u003e\n\u003cp\u003eS4R Support4Resilience\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study was approved by the Norwegian Agency for Shared Services in Education and Research (Sikt). All participants provided informed consent before participation.\u003c/p\u003e\u003ch2\u003eEthics declarations and Consent\u003c/h2\u003e\n\u003cp\u003eThis study did not require sensitive health-related data. Hence, ethics approval was not sought from the Regional Ethics Committees for Medical and Health Research (RECs). However, the study adhered to relevant ethical principles, including the Declaration of Helsinki (89).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval was also obtained from the Norwegian Agency for Shared Services in Education and Research (Sikt). Approval from Sikt ensures that the collection of data and data storage in the project adhere to ethical conduct, rules, and legislation. \u0026nbsp; Informed consent was obtained from all participants of the study. The policies and guidelines of the General Data Protection Regulation (GDPR), Sikt, and the University of Stavanger (UiS) were strictly followed in the study\u0026apos;s data collection and storage process.\u003c/p\u003e\n\u003ch2\u003eConsent for Publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eData availability statement\u003c/h2\u003e\n\u003cp\u003eThe interview data used for this study can be made available from the corresponding author upon reasonable request, provided that permission is obtained from the study participants.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eAuthor Siri Wiig is the associate editor of BMC Health Services Research. The author team declares no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe Faculty of Health Sciences, University of Stavanger, funded the PhD Scholarship. In addition, this study is part of the larger Horizon Europe-funded Support4Resilience (S4R) project 2024-2028 (Project ID: 101136291). However, the Faculty, the University, and the European Union had no role in the research process or publication of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eTTK and RS conducted the data collection. TTK conducted the analysis and transcribed the interviews with input from the co-authors. TTK wrote the first draft of the manuscript, and all the authors critically reviewed and revised the subsequent drafts. All the authors read and approved the final version.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eWe want to acknowledge the HCPs in home care settings who participated in this study, as well as the leaders in these settings who facilitated the interview process.\u003c/p\u003e\n\u003ch2\u003eCorresponding author\u003c/h2\u003e\n\u003cp\u003eCorresponding author: Teklay T. Kidanemariam, [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChang M, Michelet M, Skirbekk V, Langballe EM, Hopstock LA, Sund ER, et al. Trends in the use of home care services among Norwegians 70\u0026thinsp;+\u0026thinsp;and projections towards 2050: The HUNT study 1995\u0026ndash;2017. Scand J Caring Sci. 2023;37(3):752\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIds\u0026oslash;e-Jakobsen I, Dombestein H, Br\u0026oslash;nnick KK, Wiig S. 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JAMA. 2013;310(20):2191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Elderly care, Health care Professionals, Homecare, Resilience, Resilience in Healthcare, Resilient performance, RiH theory, S4R, Support4Resilience","lastPublishedDoi":"10.21203/rs.3.rs-6966052/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6966052/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe growing demand for home care services, mainly due to an aging population and increasing complexity of care, has intensified the shortage of qualified health care professionals (HCPs), resulting in increased workloads, emotional strain, a constant need to adapt to changing care demands, and poor mental well-being. It is therefore crucial to understand what helps HCPs to stay in their roles and perform under pressure. This study aimed to explore the factors that support resilient performance and mental well-being among HCPs in home care settings.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study used a qualitative exploratory design with a thematic analysis approach. Seven focus group interviews were conducted with 34 participants working in three home care settings in three Norwegian municipalities. Data were collected through semi-structured interviews using an interview guide that focused on actual work situations, resilience in healthcare, patient safety, mental well-being, leadership support, and engagement in care services.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFour themes were extracted: \u003cem\u003ecollaborative culture\u003c/em\u003e, describing collective problem-solving, team unity and collegiality; \u003cem\u003eleadership support practices\u003c/em\u003e, highlighting the leadership accessibility, supportive, and attentive to the professional and emotional needs of HCPs; \u003cem\u003eorganization of work, roles and procedures\u003c/em\u003e, highlighting the structured routines, tools and technologies, as well as \u003cem\u003eindividual coping and adaptation strategies\u003c/em\u003e, describing HCPs' flexibility and task prioritization in handling unpredictable situations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eA dynamic interplay of both individual factors and organizational elements shaped the ability of HCPs in home care settings to cope with and adapt to the challenges and stressors they encounter in their work. Our research contributes to the growing understanding of the importance of actively promoting collaborative team cultures, accessible leadership, clear organizational structures, and supportive coping strategies in developing resilient and sustainable home care services.\u003c/p\u003e","manuscriptTitle":"Factors supporting resilient performance and mental well-being among health care professionals in home care settings: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-18 09:34:32","doi":"10.21203/rs.3.rs-6966052/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6b4603d-847e-4598-99bf-2179b6addb21","owner":[],"postedDate":"September 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:05:26+00:00","versionOfRecord":{"articleIdentity":"rs-6966052","link":"https://doi.org/10.1186/s12913-025-13917-w","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-01-02 15:58:02","publishedOnDateReadable":"January 2nd, 2026"},"versionCreatedAt":"2025-09-18 09:34:32","video":"","vorDoi":"10.1186/s12913-025-13917-w","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13917-w","workflowStages":[]},"version":"v1","identity":"rs-6966052","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6966052","identity":"rs-6966052","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}