Expectations and reality of registered nurses working in residential care homes

Sammanfattning: The overall aim of the thesis is to study the expectations of the co-workers on Registered Nurses and to study the Registered Nurses descriptions of their working experiences in order to obtain an understanding of the Registered Nurses’ work situation in residential care homes. The thesis includes four studies and the method is based on a qualitative approach. Studies; I, II and III illuminate the nurse assistants (I), the care managers (II) and the physicians (III) perspectives regarding Registered Nurses responsible for providing nursing care to the older people living in residential care homes. The data analysis was based on a phenomenological hermeneutical method and was used for studies I, II and III. Study IV describes the Registered Nurses’ own experiences of their working situation. Latent content analysis was used for the data analyzing process. A comprehensive interpretation of study I, II and III indicates paradoxes in the meaning of the expectations that can be incompatible for nurses in specific nursing care situations. The first paradox in these expectations is to be autonomous and make independent decisions and at the same time experience limitations in decision-making and leadership. The second paradox was to act as a leader and at the same time be an equal and subordinate. The third paradox was to ensure a holistic view of care and at the same time keep within own area of practice. The meaning of nursing aides, social workers and physicians’ expectations of nurses was the experience of both moral and ethical dilemmas, feelings of frustration and powerlessness in specific nursing care situations. The results in study IV show that nurses’ experience of their work situation was that they were valued and appreciated but also felt that they were depreciated and frustrated. When the nurses experienced that they were appreciated and valued, it confirmed their autonomy in nursing care and they felt that others trusted their competence. When they were allowed to expand social service in order to provide nursing care they also felt appreciated. The nurses’ expectations on themselves and by others included to have knowledge in many areas, ability to be able to interpret and understand the specific situation from the older person’s health and life situation and to be able to work together with other professionals The nurses were expected to alternate in their approach to the older person based on the particular situation, at times providing care in the hospital and other times, in the private home. The nurses experienced frustration when they were not permitted to decide on extended social service, resources and competence that were necessary for nursing care. They experienced a moral dilemma when they did not have a colleague that could take over at the end of their work day. A moral dilemma was also experienced when the nurses felt that they were not able to live up to the expectation of being accessible, which was an expectation expressed by nurse assistants, care managers and physicians. The nurses experienced that colleagues and physicians in other areas were not aware of their work situation. There is a need for an organization with a flexible structure in which the authoritative responsibility is regulated by the needs of the older person and not the professional position. When the older person has multiple nursing care needs and end of life care, the nurse would take leadership with the authority to make decisions concerning resources and competence. The education of nurses would adapt the residential care homes as a new context for nursing care and develop the education and the subject gerontological nursing care for this field.

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