”Vi berre gjer det”: Beskrivingar av skjult pleiepraksis i sjukeheim

Abstract

Nursing home practice is often described as complex, even though it might be regarded as consisting of common, everyday activities. Research indicates that nursing staff consider assisting nursing home patients to be difficult and demanding work. At the same time, new regulations are issued for improving quality in nursing homes. Further, nursing staff acts according to a practical sense, and when asked to describe the rules under which they act, they are unable to do so. Research is required to understand the patterns of care that are unspoken and taken for granted. The aim of this project was to uncover, explore and describe some characteristics of the implicit aspects of care practice in nursing homes.

An ethnographic design was selected for this study in order to allow an in-depth understanding of nursing practice in nursing homes. Data were collected in two nursing homes and were comprised of observations of the staff providing care in two nursing homes, document analyses and interviews. The findings show that the nursing staff always seemed to know what to do, and that they knew the residents well. Findings 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 established nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines in their daily work. In addition, the staff had to deal daily with several unexpected events, and always seemed to know what to do. Further unexpected events are described and explored. A seemingly ordinary but unexpected event develops in to a chaotic situation. This was unusual, but with further investigation and in the light of theory, the study illustrates the complexity of nursing home practice. The findings also showed that close contact with some residents’ behaviours could evoke difficult emotions in the staff, such as irritation and aversion. However, it was difficult for the staff to admit to these feelings. In spite of this, nursing staff seemed to believe that they simply had to manage their responses and offer good care to all residents. The nursing staff had developed a habitus of caring, and their own statement “we just do it” is a suitable description of how these implicit parts are just being done.

Theoretical frameworks contributed to making sense of the data and gaining a new understanding of these unarticulated issues in nursing home practice. Bourdieu’s concept of habitus was useful when trying to understand how the staff seemed automatically to know what to do. Habitus regulates actions without being a product of rules; it makes a group of people act as though “collectively orchestrated without the action of a conductor”. Further, Douglas’ concept of “dirt as a matter out of place” was used in trying to gain an understanding of the nursing staff’s reactions to pollution. According to Douglas, dirt is systematically classified and involves the rejection of inappropriate elements.

The aim of this project was to uncover, explore and describe some characteristics of the implicit aspects of care practice in nursing homes. The nursing staff’s own statement, “we just do it”, is a suitable description of how these implicit parts, existing of both knowledge and experience, are just being done. The nursing staff performs the care automatically, and at the same time they deal with dirt and unpleasant tasks, because they are committed to the residents. In the thesis, this is called habitus of caring. The nursing staff has developed a habitus of caring which consists of; knowing the residents, commitment to routines, unexpected events, dirt, as well as unpleasant behaviours that evoke difficult emotions. By exploring and describing the practice, in light of the concept of habitus from Bourdieu and “dirt as a matter out of place” from Douglas, the analyses have contributed to extend our understanding of some unarticulated aspects of nursing home practice.