Balancing contradictory requirements in homecare nursing—A discourse analysis

Abstract

Aim To explore prevailing discourses on nursing competence in homecare nursing to boost understanding of practice within this field. Design A qualitative study with a social constructivist perspective. Methods Six focus‐group interviews with homecare nurses in six different municipalities in Norway. Adapting a critical discourse analysis, data were linguistically, thematically and contextually analysed in the light of theories on competence, institutional logic and discourses. Results The analysis found homecare nursing to be a diverse and contradictory practice with ever‐increasing work tasks. Presented as binary oppositions, we identified the following prevailing discourses: individualized care versus organizing work; everyday‐life care versus medical follow‐up; and following rules versus using professional discretion. The binary oppositions represent contradictory requirements that homecare nurses strive to balance. The findings indicate that medical follow‐up and organizational work have become more dominant in homecare nursing, leaving less time and attention paid to relational and everyday‐life care.

Staff's perspectives on the organization of homecare services to people with dementia—A qualitative study

“…People with dementia are described as complex patients, often with multimorbidity combined with cognitive impairment and advanced age. The need for coordination, planning and organization of the homecare service can exceed the capacity the service has to adapt to the individual patient (Fjørtoft et al., 2020). This may explain why homecare services have traditionally been minimally specialized and adapted to people with dementia (Bokberg et al., 2015) and have been described as providing the same type of help to most patients (Bokberg et al., 2015; Larsen et al., 2019; Turjamaa et al., 2014).…”

Home‐care nurses’ distinctive work: A discourse analysis of what takes precedence in changing healthcare services

“…Our findings demonstrate how contradictory values are at stake in today's home‐care nursing. Home‐based healthcare is located within broader political and social changes that are often linked to market‐oriented and medical ideologies, which challenge nursing care that require more time and presence (Aranda & Jones, 2008; Bendix Andersen et al., 2018; Fjørtoft et al., 2020; Glasdam et al., 2020). Nurses hold a crucial position to make these consequences visible to the public and ensure that basic values in nursing are safeguarded for at‐home patients.…”

“…Several studies have highlighted the professional and ethical challenges encountered by performing nursing in a home context (Martinsen, Mortensen, & Norlyk, 2018; Öresland, Määttä, Norberg, Jörgensen, & Lützén, 2008) in addition to the logistics of traveling from home to home (Holm & Angelsen, 2014; Skinner, Yantzi, & Rosenberg, 2009). Home‐care nurses face many expectations and demands, and a massive time restraint is highlighted by many as characteristic of their work (Bendix Andersen, Beedholm, Kolbæk, & Frederiksen, 2018; Fjørtoft, Oksholm, Førland, Delmar, & Alvsvåg, 2020; Pusa, Hägglund, Nilsson, & Sundin, 2015; Turjamaa, Hartikainen, & Pietilä, 2013).…”

“…Home-care nurses face many expectations and demands, and a massive time restraint is highlighted by many as characteristic of their work (Bendix Andersen, Beedholm, Kolbaek, & Frederiksen, 2018;Fjørtoft, Oksholm, Førland, Delmar, & Alvsvåg, 2020;Pusa, Hägglund, Nilsson, & Sundin, 2015;Turjamaa, Hartikainen, & Pietilä, 2013).…”

Forced treatment and care in home-dwelling persons with dementia

“…42,57 Furthermore, the medicalization of tasks in home healthcare leads to increased need for specialized knowledge among nurses. 58 This may result in scenarios where less educated staff provide assistance with ADL. Such staff members may not have knowledge of how to provide person-centered care, or awareness of where the limits of coercion are crossed.…”