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Närhet på distans: Nattsjuksköterskors vårdande i kommunal äldreomsorg
Karolinska institutet.ORCID iD: 0000-0002-9821-9945
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 [en]
Night nurses, caring, nursing, night nursing, phenomenological hermeneutics, thematic content analysis, phenomenography
National Category
Nursing
Research subject
vårdvetenskap
Identifiers
URN: urn:nbn:se:mdh:diva-15098ISBN: 978-91-7409-579-1 (print)OAI: oai:DiVA.org:mdh-15098DiVA: diva2:543321
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
List of papers
1. Municipal Night Nurses’ Experience of the Meaning of Caring
Open this publication in new window or tab >>Municipal Night Nurses’ Experience of the Meaning of Caring
2009 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 5, 599-612 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to elucidate municipal night registered nurses’ (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs’ experience of caring is interpreted as meanings in paradoxes: ‘being close at distance’, the condition of ‘being responsible with insignificant control’, and ‘being interdependently independent’. The RNs’ experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding tovocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.

Keyword
gerontologisk vårdvetenskap
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-7917 (URN)10.1177/0969733009106652 (DOI)000268845300009 ()19671646 (PubMedID)2-s2.0-70249126570 (Scopus ID)
Available from: 2010-02-09 Created: 2010-02-09 Last updated: 2015-08-05Bibliographically approved
2. Reflection in night nursing: a phenomenographic study of municipal night duty registered nurses' conceptions of reflection
Open this publication in new window or tab >>Reflection in night nursing: a phenomenographic study of municipal night duty registered nurses' conceptions of reflection
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, 1460-1469 p.Article 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.

Keyword
municipal older care, nurses, nursing, night nursing, phenomenography, reflection
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-5731 (URN)10.1111/j.1365-2702.2008.02438.x (DOI)000265035200010 ()19077027 (PubMedID)2-s2.0-64549136292 (Scopus ID)
Available from: 2009-04-17 Created: 2009-04-17 Last updated: 2015-08-05Bibliographically approved
3. Supportive leadership in Swedish community night nursing
Open this publication in new window or tab >>Supportive leadership in Swedish community night nursing
2010 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 7, 822-831 p.Article in journal (Refereed) Published
Abstract [en]

Aim  The aim of the present study was to examine the support night nurses’ give to staff in community night nursing.

Background  Studies have shown that support given to staff is one of night registered nurses’ (RNs’) experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described.

Methods  All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations.

Results  The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership.

Conclusions  Out of ‘concern for the staff’ the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs’ awareness that by giving support to staff this affects the staffs’ caring for older people.

Implications for nursing management  The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

The aim of the present study was to examine the support night nurses give to staff in community night nursing. Studies have shown that support given to staff is one of night registered nurses (RNs) experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described.

All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership.Conclusions Out of concern for the staff  the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs awareness that by giving support to staff this affects the staffs caring for older people. Implications for nursing management The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

Place, publisher, year, edition, pages
Blackwell Publishing, 2010
Keyword
care of older people, night nursing, nursing leadership, observations, support
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-10589 (URN)10.1111/j.1365-2834.2010.01155.x (DOI)000283239100007 ()20946218 (PubMedID)2-s2.0-77958505520 (Scopus ID)
Available from: 2010-10-27 Created: 2010-10-27 Last updated: 2015-08-05Bibliographically approved
4. Dependency in autonomous caring: – night nurses’ working conditions for caring in nursing
Open this publication in new window or tab >>Dependency in autonomous caring: – night nurses’ working conditions for caring in nursing
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.

Keyword
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:nbn:se:mdh:diva-15096 (URN)10.1111/j.1471-6712.2009.00722.x (DOI)000277713500015 ()2-s2.0-77953986384 (Scopus ID)
Available from: 2012-08-07 Created: 2012-08-07 Last updated: 2014-06-23Bibliographically approved

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