New quality regulations versus established nursing home practice: a qualitative study

Abstract

BackgroundWestern governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents’ rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations.MethodsFor this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study.ResultsFindings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity.ConclusionNew regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.

Continuity and Change in Norwegian Nursing Homes, in the Context of Norwegian Welfare State Ambitions

“…Studies with a more limited time span of Norwegian NHs by other authors and carried out after the introduction of recent reforms, also in different ways point to the old-fashioned qualities of the organisation and care work of the NHs (see e.g. Hauge 2004;Larsen 1999;Sandvoll et al 2012). Some of these continuities hamper efforts toward creating more home-like and meaningful environments for the frail elderly, as demonstrated in this article.…”

Ageing Intensifies the Care Needs of Adults Living with Parkinson ’s Disease and their Carers

“…However, in a residential facility, it may be impractical to manage the daily medications for a large number of residents in a timely way. In addition to the issue of the timing of medications, people with PD may have other needs that require a flexibility that routinised care regimes (Sandvoll, Kristoffersen, and Hauge, 2012: 3) in nursing homes cannot logistically provide or afford. Giles and Lewin (2008b) report that providers argue for different types of respite such as overnight respite in the home.…”

Sykepleieres erfaringer med samhandlingsreformen ved korttidsavdelinger på sykehjem

“…Våre funn tyder på at når sykepleierne opplever at de ikke kan gi god omsorg til pasienten, kan det svekke jobbtilfredsheten. En slik utvikling har man sett ved endringer i helsevesenet både i Norge og i utlandet, hvor sykepleierne rapporterer at opplevd mangel på muligheter til å gjøre en god jobb fører til at mange opplever misnøye og vanskeligheter med implementering av nye rutiner (Corey-Lisle et al 1999;Fläckman et al 2009;Parry-Jones et al 1998;Sandvoll et al 2012). Dette kan føre til frustrasjon når sykepleiernes kompetanse og profesjonsnorm innebaerer at de utøver sitt yrke på bakgrunn av omsorg og et ideal om at man skal vaere der for pasientene (Breivik og Obstfelder 2012).…”