Reforming Care, Reframing Nursing: A Critical Policy Analysis of Home Care Nursing in Denmark

This study critically examines how home care nursing is constructed as a policy problem in the 2024 Danish Health Reform. Drawing on Bacchi's "What is the Problem Represented to be?" (WPR) framework, we analyze the reform document to uncover the discursive mechanisms through which home care nursing is problematized, framed, and governed. The analysis identifies four dominant problem representations: unequal access to care, fragmented patient trajectories, insufficient municipal competencies, and an overreliance on hospital-based services. These representations legitimize the centralization of healthcare governance and the transfer of specialized nursing tasks from municipalities to regions. In this framing, home care nursing is discursively positioned as "general" and less complex, despite its central role in coordinating care and managing chronic conditions. Silences regarding working conditions, patient experiences, and structural determinants of health further marginalize nursing expertise. The reform's framing produces discursive, subjectification, and lived effects that risk undermining care continuity and professional recognition. We argue that the reform reflects a technocratic logic that privileges specialization and structural reorganization, while neglecting the relational and contextual dimensions of nursing practice. This study contributes to critical nursing inquiry by highlighting the need for inclusive policy processes that recognize the complexity of home care nursing and the value of frontline professional knowledge.