How Reflective Workshops Helped Home Care Nurses Rethink Support for Older Adults

A quiet revolution is unfolding in Swedish home care, and it does not involve robots, sensors, or futuristic gadgets. Instead, it hinges on something far more human: structured reflection. A new qualitative study published in the Scandinavian Journal of Occupational Therapy explores how three assistant nurses, each with more than two decades of experience, transformed their understanding of what it means to support older adults when they were embedded in a theory-driven reablement program called ASSIST 1.0. The findings suggest that when frontline care staff are given the time, space, and professional mentorship to reflect on their daily work, abstract theoretical concepts can be internalized and translated into genuinely person-centred practice.

Reablement itself represents a paradigm shift in how societies care for their aging populations. Rather than doing things for older adults, a traditional model that can inadvertently erode independence, reablement emphasizes doing things with them. It is a multi-professional, goal-oriented intervention designed to strengthen older people’s participation in the activities of daily life that matter most to them. Yet despite more than 200 publications on the topic, researchers have repeatedly noted that reablement programs often lack explicit theoretical grounding, leaving practitioners without a coherent framework for understanding why certain approaches work. ASSIST 1.0 was designed to close that gap.

The program, developed and piloted in Sweden, weaves together five complementary theoretical strands. The Canadian Model of Occupational Performance and Engagement and the Do-Live-Well framework, both rooted in occupational therapy, clarify what meaningful occupation looks like and how engaging in valued everyday activities connects to health and well-being. Bandura’s social learning theory and the concept of self-efficacy illuminate how confidence and motivation can be built through mastery experiences, observational learning, and verbal encouragement. Finally, situated learning and reflective practice inform the pedagogical engine of the program: bi-weekly workshops in which an experienced occupational therapist guided the assistant nurses through discussions of their real client cases, encouraging them to question routines, examine assumptions, and co-create solutions.

The structure of ASSIST 1.0 was deliberately pragmatic. Delivered within a Swedish Supported Discharge Home Care Service, an intensive, time-limited intervention for older adults immediately following hospital discharge, the program ran for one year. Its three core components were goal-setting using the Canadian Occupational Performance Measure, a structured interview tool that helps clients identify and prioritize the occupations they find challenging; the provision of occupation-based, person-centred support by the assistant nurses themselves; and the workshop series with mentoring from the occupational therapist. Older adults were followed for ten weeks and assessed at baseline and at two subsequent points, while the assistant nurses received fifteen workshops over the year, excluding holiday periods.

To understand how the nurses experienced this novel way of working, the researchers conducted nine semi-structured interviews, three with each participant, at the start of the program, six months in, and at its conclusion. The transcripts, totaling 215 pages, were analyzed using reflexive thematic analysis under a constructivist-relativist lens, an approach that treats meaning as co-created between participants’ accounts and researchers’ interpretations. From this analysis emerged one overarching theme, supported learning and reflecting enhances understanding of reablement, along with three subthemes that trace the nurses’ intellectual and practical journey.

The first subtheme captured how regular reflection with an occupational therapist opened new professional perspectives. The nurses, who had never before participated in structured reflective workshops or worked alongside a dedicated occupational therapist, described the sessions as a resource that prevented professional stagnation. One participant, given the pseudonym Eli, reflected that even after decades in the field, one must continually learn and relearn, because the worst thing a professional can do is become stuck in their role. Another, Kim, described the therapist as a bridge to knowledge they did not possess, prompting them to question whether their usual routines were actually right for each client. Intriguingly, even when workshop topics repeated, the nurses found that new client situations generated fresh insights, an effect the authors link directly to theories of reflective practice, in which revisiting familiar material in new contexts deepens understanding.

The second subtheme revealed perhaps the most striking shift: a move away from organizationally driven goals toward genuinely person-centred goal-setting. Before ASSIST 1.0, the nurses worked with broad, generic goals written by welfare officers at hospital discharge, such as becoming more independent, and then improvised their own specific objectives based on observation, without ever asking the older adults what mattered to them. Watching the occupational therapist use the Canadian Occupational Performance Measure to ask open-ended questions, such as which occupations were essential in a person’s everyday life, proved revelatory. The nurses began adopting the same approach, sitting down with clients to agree on goals together. One nurse noted that this made the work more concrete, while another described how their questioning expanded beyond self-care to include leisure pursuits that give life richer meaning. By the program’s end, all three reported applying these strategies even with older adults outside the program.

The third subtheme showed how everyday examples made reablement tangible. Rather than receiving formal lectures on theory, the nurses encountered theoretical principles through real cases. Kim described a pivotal realization that reablement is not necessarily about exercise or hard physical training but about the small things of ordinary life, even something as humble as putting butter on a sandwich. Eli found that witnessing each step of the goal-setting process made it easier to understand which small components of an activity mattered, and that enabling older adults to manage those components on their own, at moments of their choosing, strengthened autonomy and competence. This reframing of support, from assisting with tasks to enabling participation, resonates with Bandura’s account of self-efficacy, in which encouragement and regular check-ins reinforce motivation and mastery.

The study’s authors are careful to situate these findings within their limitations. The sample comprised only three assistant nurses in a single Swedish urban setting, all aged 45 to 55 with over twenty years of experience, and the occupational therapist came from the research team rather than the local healthcare organization, a trade-off that ensured consistency but may have limited contextual adaptation. The six-month intervals between interviews may also have blurred memories of specific practice changes. Moreover, the researchers themselves are occupational therapists and developers of the ASSIST program, a position they addressed through explicit reflexivity and transparent discussion of how their perspectives shaped the analysis. These caveats mean the themes are context-specific and cannot be assumed to replicate elsewhere.

Nevertheless, the implications are significant for anyone concerned with the sustainability of elder care. The findings align with a growing body of implementation research showing that theoretical knowledge alone is insufficient; practical experience combined with reflective supervision is what fosters meaningful change. Process evaluations of other reablement training programs have identified team-based learning, practical examples, and managerial support as key facilitators, while time constraints and staff shortages remain persistent barriers. The ASSIST 1.0 experience suggests a potential model for integrating theoretical frameworks into collaborative learning sessions without formal instruction, allowing frontline staff to absorb person-centred, occupation-focused principles through situated practice. For lasting impact, the authors argue, such training must be reinforced by organizational structures that promote continuous learning and mentoring. In an era when populations are aging rapidly and home care workforces are strained, the message is both simple and radical: the most powerful technology in reablement may be the structured conversation in which a care worker is asked to think aloud about why they do what they do, and to imagine doing it differently, with the older adult, rather than for them.

Subject of Research: Theory-based reablement training and reflective practice among assistant nurses supporting older adults in home care

Article Title: Assistant nurses’ reflections on ASSIST 1.0: Theory-inspired support in reablement

Article References: Assander, S., Guidetti, S., & Bergström, A. (2025). Assistant nurses’ reflections on ASSIST 1.0: Theory-inspired support in reablement. Scandinavian Journal of Occupational Therapy, 32(1), Article 2570537. https://doi.org/10.1080/11038128.2025.2570537

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2570537

Keywords: reablement, home care, occupational therapy, assistant nurses, reflective practice, person-centred care, goal-setting, self-efficacy, situated learning, older adults, ASSIST 1.0, qualitative research