Exploring home-based care nurses’ mindset for nursing practices: a phenomenological study

Abstract

Background Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. Methods This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. Results The analysis revealed three main patterns that characterise nursing practices in home care: ‘To be vigilant’, ‘To be an all-rounder’, and ‘To act with independence’. The content and distinction of these patterns are discussed through a theoretical framework of ‘clinical mindlines’. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. Conclusion Nurses’ vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses’ practical knowledge and the importance of mindlines.

Barriers to clinical nurse participation in the internet-based home visiting program: a qualitative study

“…We also found it difficult to ensure nurse autonomy in the complex and less regulated setting of home care [ 33 ]. The need for nurses to respect the autonomy and lifestyle of patients and their families and the inability to strictly require patients to do what is medically correct according to professional judgment [ 34 ] is seen as a moral pressure on nurses [ 35 ]. Under this pressure, nurses will be very prone to empathize with their patients.…”

“…Not only are more challenging services required in the new program, there is far less team and equipment support than in the past. However, over time, nurses are relying less on specialists and trying to become all-rounders [ 34 ]. However, this conclusion is predicated on the premise that nurses need to experience all elements of practice required for patient needs [ 43 ].…”

Innovative services in home health nursing: a scoping review protocol

“…In the absence of an appropriate and flexible organisational protocol, nurses are unable to identify and address current problems, individual goals and health promotion activities based on a standard approach over each home visit. 8 22 One of the existing infrastructure gaps is the lack of appropriate use of innovative technologies and intelligent systems, which are constantly being developed. 23 24 …”

“… 34 Although there is a significant need for education and training of nurses in the field of innovations and its approaches, 32 comprehensive guidelines for the provision of innovative services, especially in the field of home care, are limited. 8 23 It is worth noting that this gap in comprehensive guidelines for innovative services has not been addressed in Iran either. Most of the existing studies have focused on the implementation of specific treatments or e-health innovations, 35–38 and there are still areas that are neglected and require further clarification.…”

“…6 As one of the essential aspects of healthcare system, home health nursing (HHN) is capable of addressing future health challenges. 8 HHN services construct a comprehensive care system provided by highly skilled nurses, working under the supervision of doctors, to patients/clients at their home. HHC includes a wide range of services, ranging from basic to advanced services in three levels of prevention.…”