The nurse–patient relationship in the New Public Management era, in public home care: A focused ethnography

Aim The aim of this study was to gain deeper understandings of nurse–patient relationships in the New Public Management era, by exploring beliefs and practices of nurses and patients in Norwegian public home care. Background Organization of Norwegian home care services is based on New Public Management‐ideologies, which have led to a rigidly formalized and task‐oriented nursing practice that may jeopardize individual nursing care. Nurse–patient relationships have several positive effects on patients’ health and well‐being, but organizational boundaries and time pressure affect the quality of relationships. Design Focused ethnography. Methods Data were collected between November 2015–July 2016 using participant observation and semi‐structured interviews with 10 nurses and eight patients in six different home care areas, in two Norwegian municipalities. Data analysis was based on Roper and Shapiras framework. Findings Findings demonstrate the continued importance of nurse–patient relationships in contemporary home care, while identifying extensive variations in the degree of closeness and emotional involvement. Organizational boundaries, time constraints, high workload, and disharmony between nurses “competence and patients” complex illnesses, influence practice in ways that reduce the significance of nurse–patient relationships and affect conditions under which they develop and evolve. Facing a system nurses perceive to function suboptimal, they govern practices based on their own professional assessments, and findings indicate cultural patterns in the way both nurses and patients prioritize to safeguard nurse–patient relationships. Conclusion Home care cultures based on traditional nursing values continue, despite New Public Management influences, but a transition into New Public Management culture may, over time, influence the quality of nurse–patient relationships and meanings attributed to them. 目的 本项研究目的在于,通过探索挪威公共家庭护理中护士与患者的信念及实践,深入了解新公共管理时代的护患关系。 背景 组织挪威家庭护理服务是基于新公共管理的思想,这种思想已导致了一种僵化、形式化且以任务为主导的护理惯例,这可能危及个人护理。护患关系对患者的健康及身体素质有一定的积极影响,但组织界线及时间压力会影响这种关系的质量。 设计 重点人种志研究 方法 采用参与者观察与半结构化访谈的方式,对挪威两个城市中,六家不同家庭护理区域的10名护士及八位患者进行访谈,于2015年十一月至2016年六月进行数据收集。 结果 研究结果表明,护患关系在当代家庭护理中仍然很重要,同时也发现亲密程度与情感参与间存在极大差异。组织界限、时间限制、工作量大、以及护士能力和患者复杂疾病间的不协调影响了实践,降低了护患关系的重要性,并影响在这种关系下他们发展进步的条件。面对一个众护士认为运作不理想的系统,他们根据自己的专业评估管理实践;且研究结果表明护士与患者都优先维护护患关系这样的文化模式。 结论 不考虑新公共管理的影响,基于传统护理价值观的家庭护理文化仍在继续,但随着时间的发展,向新公共管理文化的过渡可能影响护患关系质量并赋予其的意义。