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Dependency in autonomous caring: – night nurses’ working conditions for caring in nursing
Mälardalen University, School of Health, Care and Social Welfare.ORCID iD: 0000-0002-9821-9945
Ersta Sköndal högskola.
Mälardalen University, School of Health, Care and Social Welfare.ORCID iD: 0000-0002-3307-6779
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, 312-320 p.Article in journal (Refereed) Published
Abstract [en]

Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

Place, publisher, year, edition, pages
2010. Vol. 24, no 2, 312-320 p.
Keyword [en]
night nursing;caring;caring in nursing;care of older people;municipal nursing;thematic content analysis
National Category
Nursing
Research subject
Care Sciences within Health and Welfare
Identifiers
URN: urn:nbn:se:mdh:diva-15096DOI: 10.1111/j.1471-6712.2009.00722.xISI: 000277713500015Scopus ID: 2-s2.0-77953986384OAI: oai:DiVA.org:mdh-15096DiVA: diva2:543303
Available from: 2012-08-07 Created: 2012-08-07 Last updated: 2014-06-23Bibliographically 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
Keyword
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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