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Reflection in night nursing: a phenomenographic study of municipal night duty registered nurses' conceptions of reflection
Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-9821-9945
Mälardalen University, School of Health, Care and Social Welfare.ORCID iD: 0000-0002-3307-6779
Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, p. 1460-1469Article in journal (Refereed) Published
Abstract [en]

Aim. The aim of the study was to describe nurses' conception of reflection in their working situation. Background. To be a municipal night duty registered nurse in Sweden means to shoulder nursing care responsibility for numerous units with older people in need of care. Two night nurses share nursing care responsibility for up to 1300 people. In nursing research, reflection is an often-mentioned phenomenon discussed with advantages and benefits within the 'traditional fields' of nursing (hospital context). A question to ask is, how do night nurses having an untraditional amount of nursing care responsibility conceptualise and experience reflection in their working situation? Design. A phenomenographic methodology was used. Methods. Data were collected by interviewing all nurses (n = 7) in a medium-sized municipality bordering a metropolitan area of Sweden. Results. The nurses' conceptions of reflection are categorised as 'Field of applications' (an instrument for interpreting, a strategy for handling the working situation and an approach to learning) and 'Field of prerequisites' (presence facilitates reflection; flexibility implies reflection; courage in thought and activity increases reflection). Conclusion. The findings reveal that reflection in the nurses' working situation is more than an instrument for learning, understanding and encouragement for change and improvement. Reflection is conceptualised as an instrument for interpreting nursing care situations, which requires courage and is facilitated by presence and flexibility. Reflection is also conceptualised as an approach to handling, managing and coping with a sometimes impossible working situation that includes nursing responsibility for hundreds of older people and can sometimes entail difficulties and stress. Relevance to clinical practice. The findings showed that reflection has a broader use than had earlier been described. Deliberate use of reflection could mean improved nursing practice. This guides nursing managers to pay attention to the phenomenon as an instrument for nursing care improvement.

Place, publisher, year, edition, pages
2009. Vol. 18, no 10, p. 1460-1469
Keywords [en]
municipal older care, nurses, nursing, night nursing, phenomenography, reflection
National Category
Nursing
Identifiers
URN: urn:nbn:se:mdh:diva-5731DOI: 10.1111/j.1365-2702.2008.02438.xISI: 000265035200010PubMedID: 19077027Scopus ID: 2-s2.0-64549136292OAI: oai:DiVA.org:mdh-5731DiVA, id: diva2:211708
Available from: 2009-04-17 Created: 2009-04-17 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Närhet på distans: Nattsjuksköterskors vårdande i kommunal äldreomsorg
Open this publication in new window or tab >>Närhet på distans: Nattsjuksköterskors vårdande i kommunal äldreomsorg
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Registered nurses’ [RNs] experiences of caring in nursing, working  conditions for caring and reflection in municipal night care was explored to create expanded knowledge and understanding of care for older people. As a consequence of the Ädelreform and development in hospital health care a displacement from clinical health care to municipal care of older people has taken place. Night RNs’ work in the complex municipal care of older people implies single handed work in a consultative function. The RNs are distanced from the care receivers; it is care staff who mainly perform bed side caring. Municipal RNs’ care for older people during nights means trusting their own knowledge and reflective ability, in having nursing responsibility for large groups of old care recipients.   

 

This thesis takes point of departure in a qualitative research approach, with four empirical studies. These have been accomplished in a medium sized municipality in the middle parts of Sweden. The aims of the part studies were: to elucidate municipal night nurses’ experiences of the meaning of caring in nursing (I), to explore Swedish municipal night nurses’ experiences of their working conditions for caring in nursing (II), to examine the caring for care staff offered by municipal night nurses, in the setting of old care recipients people enrolled in the municipal social care system (III) and to describe nurses’ conception of reflection in their working situation (IV). Data were collected with interviews (I, II, IV), diary notes (II) and participative observations (III). The data were analyzed with phenomenological hermeneutics (I), thematic content analysis (II, III) and phenomenography (IV).

 

The results reveal that night RNs caring in nursing means the paradoxes: being close at a distance, being responsible without control and being independently dependent. Caring in nursing means a caring stance in prioritizing and taking responsibility for care recipients and care of care staff (I). Night RNs’ caring is dependent on the organization and care staff, and is complex by the fact that the RNs are not care staff leaders. The RNs’ autonomy prerequisite the ability to handle their work, which mainly means mediated caring communicated by telephone (II). The night RNs’ care of care staff means an informal nursing leadership. With their medical competence and authority the RNs occupy a superior caring leader function in nursing (III). Reflection is conceptualized as an instrument to handle the working situation and requires capacity of presence, flexibility and courage. To reflect is experienced to use knowledge, ethics and also personal values, in considering, estimating and assessing caring situations and actions (IV).

 

The conclusion of the studies (I-V) is that the night RNs’ caring is dependent on the prerequisites described in the dimensions of the organization, self-understanding and vocational and professional relations. The RNs must be able to reflect and handle the situation of caring at a distance, without loosing the vocational fundamental condition of caring, though the consultant function implies that they seldom encounter the care recipients. Increased quality, development and creating possibilities for dignity in care for older people means the RNs must participate more in bed side caring. The RNs should also be caring leaders and be given the opportunity for adequate specialist training in gerontology nursing.

Place, publisher, year, edition, pages
Karolinska Institutet, 2009
Series
Doktorsavhandlingar, NVS Karolinska Institutet
Keywords
Night nurses, caring, nursing, night nursing, phenomenological hermeneutics, thematic content analysis, phenomenography
National Category
Nursing
Research subject
vårdvetenskap
Identifiers
urn:nbn:se:mdh:diva-15098 (URN)978-91-7409-579-1 (ISBN)
Public defence
2009-11-20, Hörsal 1 röd,, Alfred Nobels Allé 23,, Huddinge, 13:49 (Swedish)
Opponent
Supervisors
Note
Medicine doktorsexamenAvailable from: 2012-08-20 Created: 2012-08-07 Last updated: 2015-02-04Bibliographically approved

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Gustafsson, ChristineAsp, Margareta

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