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Caring and Uncaring Encounters between Assistant Nurses and Immigrants with Dementia Symptoms in Two Group Homes in Sweden-an Observational Study.

https://arctichealth.org/en/permalink/ahliterature301157
Source
J Cross Cult Gerontol. 2018 Sep; 33(3):299-317
Publication Type
Journal Article
Observational Study
Date
Sep-2018
Author
Mirkka Söderman
Sirpa Rosendahl
Christina Sällström
Author Affiliation
School of Health, Care and Social Welfare, Mälardalen University, Box 325, SE-63105, Eskilstuna, Sweden. mirkka.soderman@mdh.se.
Source
J Cross Cult Gerontol. 2018 Sep; 33(3):299-317
Date
Sep-2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel - ethnology
Communication
Communication Barriers
Cultural Competency
Dementia - diagnosis - nursing - psychology
Emigrants and Immigrants - psychology - statistics & numerical data
Female
Finland
Geriatric Nursing
Group Homes - organization & administration
Homes for the Aged
Humans
Interviews as Topic
Male
Middle Aged
Professional-Patient Relations
Qualitative Research
Sweden
Abstract
The total number of people with dementia symptoms is expected to double every 20 years and there will also be an increase in the number of older immigrants in several countries. There are considerable deficiencies in the present knowledge of how to conduct well-functioning health care for immigrants with dementia symptoms. The aim of this study was to explore caring and uncaring encounters between assistant nurses and immigrants in two group homes for persons with dementia symptoms in Sweden: a Finnish-speaking as well as a Swedish-speaking context. In addition, this study aims to describe how caring and uncaring encounters are manifested in these two contexts according to Halldórsdóttir's theory of "Caring and Uncaring encounters".
Descriptive field notes from 30 separate observations were analyzed using qualitative deductive content analysis.
The main category "caring encounters" focused on reaching out to initiate connection through communication, removing masks of anonymity by acknowledging the unique person, acknowledgment of connection by being personal. Reaching a level of truthfulness by being present and showing respect, raising the level of solidarity by equality and true negotiation of care, based on the residents' needs. The main category, uncaring encounters, focused on disinterest in and insensitivity towards the other, coldness in the connection and lack of humanity in care situations. The observations showed that caring encounters occurred more in the Finnish-speaking context and uncaring encounters more often in the Swedish context.
Encounters could be caring, uncaring, and carried out using a person-centered approach. Communication and relationships could be facilitated using the same language but also through learning to interpret residents' needs and desires.
PubMed ID
29931458 View in PubMed
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Gaming the system to care for patients: a focused ethnography in Norwegian public home care.

https://arctichealth.org/en/permalink/ahliterature299084
Source
BMC Health Serv Res. 2019 Feb 14; 19(1):121
Publication Type
Journal Article
Observational Study
Date
Feb-14-2019
Author
Maria Strandås
Steen Wackerhausen
Terese Bondas
Author Affiliation
Nord University, Universitetsalleén 11, 8049, Bodø, Norway. maria.strandas@nord.no.
Source
BMC Health Serv Res. 2019 Feb 14; 19(1):121
Date
Feb-14-2019
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Adult
Aged
Aged, 80 and over
Anthropology, Cultural
Attitude of Health Personnel
Female
Home Care Services - organization & administration
Humans
Male
Middle Aged
Norway
Nurse-Patient Relations
Nursing Care - organization & administration
Organizational Culture
Perception
Abstract
With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care.
The focused ethnographic design is based on Roper and Shapira's framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities.
Findings indicate cultural patterns regarding nurses' somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses' actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients' health and ensure wellbeing - individualized care, nurse-patient relationships and caring - which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses' perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses' work, and avoid placing demands on nurses. Findings were categorized into three main areas: "Rigid organizational systems complicating nursing care at the expense of caring for patients", "Having the patient's health and wellbeing at heart" and "Compensating for a flawed system".
Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of "gaming the system" for caring purposes, in order to ensure the best possible care for patients.
PubMed ID
30764824 View in PubMed
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