Introduction: When older patients are in need of care the desire for help is often related to practical duties, but they also express a preference for support with the emotional difficulties that disease and illness cause. The concept of support in nursing is widely used and in nursing practice it is seldom specified which kind of support that has been performed.

Aim: Aim was to explore and describe which supportive intervention registered nurses use in municipal elderly home care settings and if it is in agreement with the patient’s preferences.

Methods: One retrospective descriptive study (I) were conducted and followed up by three qualitative studies using Grounded Theory as a method (II-IV). Grounded Theory allowed to explore actions/interactions and processes that occur between complex social phenomena. A process is seen as a continuous action in relation to a determinate purpose to reach a goal with a problem or a situation and actors can choose actions to influence the course of events.

Data collection and sampling: I/Using a web based form describing 7053 interventions given to patients 80 years or older during the months of April and October 2004-2008. II/ Observation of 12 registered nurses supportive interventions during the home visit of 36 patients between 80 and 102 years. III/ Interviews with 16 registered nurses. IV/Interviews with 18 patients between 80 and 96 years.

Results: Combined, the four studies show in a substantive theory that supportive interventions were based on patient’s preferences and guided by their emotions. The emotional support resulted in that the patient could experience serenity. Serenity is a state of relief and the moment required for the patient to be able to move forward. Patients lost or reduced ability to process their emotions makes that they get stuck in a state, which fatigue them with additional experience of disease and illness. To get out of their state the patient searched the registered nurse whose mission is to identify their needs in order that they could find relief. The theory also shows the strengths and weaknesses in the process. Emotional support should be developed as a nursing intervention and be integrated as a part of nursing.