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Hansen MF, Martinsen B, Galvin K, Thomasen BP, Norlyk A. Collecting pieces for the 'puzzle': Nurses' intraprofessional collaboration in the hospital-to-home transition of older patients. Scand J Caring Sci 2024. [PMID: 38778752 DOI: 10.1111/scs.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/21/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND AIM Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital-to-home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross-sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross-sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. METHOD The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. FINDINGS The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word-limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. CONCLUSION Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter-productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible.
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Affiliation(s)
- Mette Frier Hansen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark
| | - Bente Martinsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Kathleen Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Agder University Grimstad, Grimstad, Norway
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Pedersen AKB, Skinner MS, Sogstad M. Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study. Health Serv Insights 2024; 17:11786329241238883. [PMID: 38495895 PMCID: PMC10943711 DOI: 10.1177/11786329241238883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.
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Affiliation(s)
- Ann Katrin Blø Pedersen
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Sundlisæter Skinner
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Maren Sogstad
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
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Voie KS, Wiles J, Mæhre KS, Kristiansen M, Helgesen AK, Blix BH. The timescapes of older adults living alone and receiving home care: An interview study. J Aging Stud 2024; 68:101212. [PMID: 38458730 DOI: 10.1016/j.jaging.2024.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.
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Affiliation(s)
- Kristin S Voie
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Kjersti Sunde Mæhre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Margrethe Kristiansen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Health, Welfare and Organisation, Østfold University College, Halden 1757, Norway.
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Bergen 5063, Norway.
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Opara UC, Petrucka P. A Critical Comparison of Focused Ethnography and Interpretive Phenomenology in Nursing Research. Glob Qual Nurs Res 2024; 11:23333936241238097. [PMID: 38495317 PMCID: PMC10943724 DOI: 10.1177/23333936241238097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Choosing an appropriate qualitative methodology in nursing research is a researcher's first step before beginning a study. Such a step is critical as the selected qualitative methodology should be congruent with the research questions, study assumptions, data gathering and analysis to promote the utility of such research in enhancing nursing knowledge. In this paper, we compare focused ethnography by Roper and Shapira and interpretive phenomenology by Benner. Though these methodologies are naturalistic and appear similar, both have different methodological underpinnings. The historical, ontological, epistemological, and axiological philosophy guiding each methodology are described. In addition, the methodological underpinnings of both methodologies and a justification for use in nursing research are provided. This paper will assist future researchers who aim to employ these methodologies in nursing research.
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Hertzberg CK, Heggestad AKT, Magelssen M. Blurred lines: Ethical challenges related to autonomy in home-based care. Nurs Ethics 2023:9697330231215951. [PMID: 38117689 DOI: 10.1177/09697330231215951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Home-based care workers mainly work alone in the patient's home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. AIM The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. RESEARCH DESIGN The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. PARTICIPANTS AND RESEARCH CONTEXT The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. ETHICAL CONSIDERATIONS The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. FINDINGS A main challenge was that staff found it difficult to respect the patient's autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff's threshold for considering the use of coercion appeared to be high. CONCLUSIONS Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems.
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van der Steen MP. Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands. BMC Health Serv Res 2023; 23:1349. [PMID: 38049813 PMCID: PMC10694910 DOI: 10.1186/s12913-023-10351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. METHODS A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. RESULTS The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. CONCLUSION Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.
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Grillo R, Brozoski MA, Naclério-Homem MDG. The importance of written informed consent in facial cosmetic surgery litigation. J Craniomaxillofac Surg 2023; 51:403-406. [PMID: 37591743 DOI: 10.1016/j.jcms.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/30/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
It is the aim of the study to discuss litigation related to facial cosmetic surgery with a particular focus on written consent, in order to prevent unfortunate outcomes for the surgeon and patient alike. A 10-year online search for facial cosmetic surgery litigation in Brazil was conducted from 2012 to 2022. Statistical analyzes were performed using RStudio, and the results were considered significant with a 95% confidence interval. A total of 992 litigations were identified through the search. Of these, 122 articles met our inclusion criteria. The number of legal disputes on this subject has been increasing for years. Female patients are more prone to litigation. Financial damage ranged from $75 to $500,000 (mean: $59,536). Many of the lawsuits that had appropriate written consent have had a favorable outcome for the defendant. The primary specialty was the most common plastic surgery (67%), followed by maxillofacial surgery (9%). Surgeons engaged in facial cosmetic surgery should protect themselves legally from litigation. Written consent significantly reduces both litigation losses and financial damage. Some details on the preparation of this consent form have been discussed.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
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Gebhard D, Herz M. How to Address the Health of Home Care Workers: A Systematic Review of the Last Two Decades. J Appl Gerontol 2023; 42:689-703. [PMID: 36440715 PMCID: PMC9996797 DOI: 10.1177/07334648221141084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Making home care a healthy workplace is a societal concern but research on specific interventions is still scarce. The aim of this systematic review was to provide an initial overview of interventions addressing home care workers' health. All (quasi-) experimental studies, presenting any intervention among home care employees, and reporting any outcome related to occupational health, safety, or well-being were included. PsycArticles, Medline, PubMed, and Web of Science were searched from January 2000 to February 2022. From 16,345 publications, 18 studies with 2432 participants were included and assessed with the Joanna Briggs Institute Critical Appraisal Tools. Organizational and training/educational approaches were found in five studies each, a behavioral approach in one, and seven studies presented a combined approach. Due to methodological limitations and the heterogeneity of interventions, the existing studies are insufficient to inform new programs, but emphasize the need for tailored approaches, integrated concepts, and participatory intervention development.
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Affiliation(s)
- Doris Gebhard
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
| | - Michael Herz
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
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Gebhard D, Wimmer M. The Hidden Script of Work-Related Burdens in Home Care - A Cross Over Mixed Analysis of Audio Diaries. J Appl Gerontol 2023; 42:704-716. [PMID: 36280591 PMCID: PMC9996799 DOI: 10.1177/07334648221130747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The lived experiences of work-related burdens in the daily working routines of home care workers are insufficiently investigated. Therefore, the aim of this study is to examine the types, frequencies, and distributions of work-related burdens and to explore their co-occurrence. Qualitative data was collected via audio diaries and analyzed applying a crossover mixed analysis using content as well as network analysis. In all, 23 home care workers (mean age = 46.70 ± 10.40; 91.30% female) produced 242 diary entries. Participants reported work-related burdens 580 times with 77 different types, predominately in relation to work organization (50.5%). Network analysis reveals a complex picture, which shows the strong relation between time pressure and travel between homes, and identifies additional tasks as the central node in the network of burdens. A holistic understanding of setting-specific burdens provides an important starting point for measures of workplace health promotion.
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Affiliation(s)
- Doris Gebhard
- Department of Sport and Health Sciences, 9184Technical University of Munich, Munich, Germany
| | - Magdalena Wimmer
- Department of Sport and Health Sciences, 9184Technical University of Munich, Munich, Germany
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10
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Norlyk A, Burau V, Ledderer LK, Martinsen B. Who cares?-The unrecognised contribution of homecare nurses to care trajectories. Scand J Caring Sci 2023; 37:282-290. [PMID: 36085599 DOI: 10.1111/scs.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Organisation of patients' trajectories is a critical element of nursing practice. However, nursing practice is mainly expressed in terms of direct patient care, while the practices through which care is organised have received little attention, are poorly acknowledged and lack formal recognition. AIM To examine the management of care trajectories as provided by homecare nurses. DESIGN We conducted focus group interviews with 29 Danish homecare nurses. The analysis drew on the evidence based and theoretically informed framework care trajectory management. Care trajectory management is conceptualised as comprising of three organisational components: (1) Trajectory awareness, (2) Trajectory working knowledge and (3) Trajectory articulation. FINDINGS The organising work of homecare nursing is both complex and unpredictable requiring advanced organisational, collaborative and clinical competences to secure concerted actions in alignment with the needs of the individual patient. Without having any formal obligation homecare nurses took on the responsibility for the coordination of the different activities of the professional actors, and for securing concerted actions. Care trajectory management as provided by homecare nurses reflected a high degree of commitment for patients and illustrated that this type of organising work was driven by the values of the humanistic ethos of nursing. CONCLUSION The study highlights the strength of the invisible and ongoing organising work of homecare nurses. Care trajectory management in homecare reflects the moral foundation of nursing. Consequently, the professional logic of nursing reflected as direct patient care alone is too narrow. We need to acknowledge the organising work of patients' trajectories as a core task equal to direct patient care. Our study highlights the need for articulating the organising work of homecare nurses and for presenting problematic organisational structures to policymakers and managers. If not, the important organisational work of homecare nurses is at the risk of remaining invisible.
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Affiliation(s)
- Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,Faculty of Health and Sport Sciences, Agder University, Grimstad, Norway
| | - Viola Burau
- Department of Political Science, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Loni Kraus Ledderer
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bente Martinsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
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11
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Jakobsen LM, Lind R. ´You are not yourself anymore´: The place of the ethical demand in a practical home care context. Scand J Caring Sci 2023; 37:79-87. [PMID: 35348235 DOI: 10.1111/scs.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
THE STUDY'S RATIONALE The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its person-oriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. AIMS AND OBJECTIVES This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. METHODOLOGICAL DESIGN The article is based on an empirical narrative in the form of an individual qualitative research interview. FINDINGS The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. CONCLUSION The system of New Public Management sets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize or strengthen the old person´s dignity.
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Affiliation(s)
- Lena M Jakobsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromso, Norway
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12
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Brenne BA, Hedlund M, Ingstad K. Exploring home-based care nurses' mindset for nursing practices: a phenomenological study. BMC Nurs 2022; 21:291. [PMID: 36316738 PMCID: PMC9623960 DOI: 10.1186/s12912-022-01068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. Methods This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. Results The analysis revealed three main patterns that characterise nursing practices in home care: ‘To be vigilant’, ‘To be an all-rounder’, and ‘To act with independence’. The content and distinction of these patterns are discussed through a theoretical framework of ‘clinical mindlines’. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. Conclusion Nurses’ vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses’ practical knowledge and the importance of mindlines.
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Affiliation(s)
- Bodil Aarmo Brenne
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
| | - Marianne Hedlund
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway ,grid.5947.f0000 0001 1516 2393Department of Social Work, NTNU, 7491 Trondheim, Norway
| | - Kari Ingstad
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
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Charosaei F, Rostami S, Esmaeili M, Molavynejad S, Vanaki Z. Challenges in implementation of patient-centred care in cardiac care unit: A qualitative study. Nurs Open 2022; 10:838-849. [PMID: 36057965 PMCID: PMC9834141 DOI: 10.1002/nop2.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/24/2022] [Accepted: 08/22/2022] [Indexed: 01/16/2023] Open
Abstract
AIM This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. DESIGN This study was performed with a descriptive qualitative study approach. METHODS In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. RESULTS After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.
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Affiliation(s)
- Firouzeh Charosaei
- Department of Nursing, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Shahnaz Rostami
- Nursing Care Research Center in Chronic Disease, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Maryam Esmaeili
- Nursing and Midwifery Care Research Center, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Shahram Molavynejad
- Nursing Care Research Center in Chronic Disease, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Zohreh Vanaki
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
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The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073836. [PMID: 35409520 PMCID: PMC8997992 DOI: 10.3390/ijerph19073836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.
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Heyn LG, Brembo EA, Eide H, Hafskjold L, Sundling V. Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter? PATIENT EDUCATION AND COUNSELING 2021; 104:2418-2424. [PMID: 34294490 DOI: 10.1016/j.pec.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons' health and nature of the visit influenced their expressed worries. METHODS In this cross-sectional explorative study, we analysed older persons' expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway. RESULTS Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration. CONCLUSION Findings suggest that home visit type may influence the older persons' expressed worries. The complexity of the older persons' health condition seems to have little impact on the expressed worries. PRACTICE IMPLICATIONS Knowledge about communication in different complexity of visits is important when planning care for older persons.
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Affiliation(s)
- Lena Günterberg Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Linda Hafskjold
- Faculty of Health and Social Sciences, Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Drammen, Norway.
| | - Vibeke Sundling
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway; National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway.
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Solbakken R, Bondas T, Kasén A. Relationships influencing caring in first-line nursing leadership: A visual hermeneutic study. Scand J Caring Sci 2021; 36:957-968. [PMID: 33955011 DOI: 10.1111/scs.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
AIM To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives. DESIGN AND METHOD We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018. RESULTS The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients. CONCLUSION First-line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory. IMPACT In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.
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Affiliation(s)
- Rita Solbakken
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Terese Bondas
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Anne Kasén
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Bach-Mortensen AM, Barlow J. Outsourced austerity or improved services? A systematic review and thematic synthesis of the experiences of social care providers and commissioners in quasi-markets. Soc Sci Med 2021; 276:113844. [PMID: 33773477 DOI: 10.1016/j.socscimed.2021.113844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.
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Affiliation(s)
- Anders Malthe Bach-Mortensen
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK.
| | - Jane Barlow
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK
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Care home residents on the move: the significance of cultural context for physical activity. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x20001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Increased physical activity is widely promoted as beneficial for older people, but previous research indicates this may be difficult to implement in care homes, especially for people with dementia who form an increasing proportion of residents. Care home cultures can mitigate against physical activity for residents, but there is also scope for them to embed personalised physical activity. They are under-researched, but significant in terms of outcomes and quality of life for residents. This paper builds understanding of care home cultures of physical activity through qualitative, empirical research in five care homes. Key findings are that culturally framed views about physical activity, sometimes reflecting stereotypical views of dependency, can be seen in care homes. Managers, staff and residents may be invested in or resistant to physical activity and dominant managerial or societal views may be reflected or contested. The relatively closed boundaries of care homes reinforce sedentariness, and resident involvement in either chosen or enforced physical activity is varied. Interactions demonstrate potential to negotiate physical activity more or less effectively in any given care home. Rigid routines, external regulations and pressure on staffing can be negative, but management commitment has positive potential. In conclusion, the paper identifies that to increase physical activity in a sustainable manner, any intervention needs to address issues of culture change and individual needs and preferences.
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The value of the ethnographic approach to research issues in palliative care. Curr Opin Support Palliat Care 2020; 13:337-343. [PMID: 31689271 DOI: 10.1097/spc.0000000000000460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Qualitative research in the field of palliative care allows for a crucial study of the final stage of life from a social point of view and cultural perspective. This review evaluates the advantages and challenges of applying an ethnographic approach to palliative care research. RECENT FINDINGS Thirteen ethnographic articles on organization or quality of care, decision-making, delirium, death, and the process of dying, were reviewed. Most studies use interviews, participant observation, and field notes as their primary data collection techniques. In ethnographic research, cultural issues, relationships and interactions of a group, the meanings and perceptions of the participants, the communication process, and the use of language in a particular and natural context were analyzed. Data collection and information analysis took an average of 14 months in the included studies. SUMMARY The ethnographic method, applied with rigor, is valuable in the analysis of a real phenomenon if the particular context in which the study developed is well defined. With an ethnographic approach, researchers can uncover cultural nuances that evidence different realities.
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