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.

译文

目的:本研究的目的是通过探索挪威公共家庭护理中护士和患者的信念和实践,对新公共管理时代的护士与患者之间的关系有更深入的了解。
背景:挪威家庭护理服务的组织基于新的公共管理意识形态,这导致了僵化的正规化和面向任务的护理实践,可能会危害个人护理。护士与病人的关系对病人的健康和福祉有若干积极影响,但是组织界限和时间压力会影响关系的质量。
设计:重点人种志。
方法:采用参与者观察和半结构化访谈的方法收集了2015年11月至2016年7月在挪威两个城市的六个不同家庭护理区域中的10名护士和8名患者的数据。数据分析基于Roper和Shapiras框架。
研究结果表明,在确定亲密程度和情感参与程度的广泛差异的同时,护士与患者之间的关系在当代家庭护理中仍然具有重要意义。组织边界,时间限制,高工作量以及护士“能力与患者”复杂疾病之间的不和谐,以降低护士与患者关系的重要性并影响护士发展和进化的条件的方式影响实践。面对护士认为功能欠佳的系统,他们根据自己的专业评估来管理实践,研究结果表明文化模式以护士和患者优先维护护士与患者之间的关系的方式进行。
结论:尽管受到新公共管理的影响,基于传统护理价值观的家庭护理文化仍在继续,但随着时间的推移,向新公共管理文化的过渡可能会影响护理人员与病人之间的关系质量和意义。

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