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Aspects of municipal culture in care for the elderly: a hermeneutic documentary analysis of reports of abuse
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Care culture is an important contextual factor in care practice. Care culture refers to a process of creating meaning out of tradition, horizon and bildung. The care culture is often taken into consideration in situations which go beyond the everyday routine, such as cases of mistreatment. In Sweden, health care professionals are obliged  to document and report any suspected bad conditions.

Aim: To understand aspects of the municipality’s care culture for the elderly, in the light of reports of suspected mistreatment.

Design and methods: A hermeneutic documentary analysis was conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. The hermeneutic analysis followed a four-stage process: selecting and reading the text, setting out the context, closing the hermeneutic circle, and finally creating a conceptual bridge towards a critical understanding from a phenomenological lifeworld perspective, which is the theoretical basis for this study.

Findings: It was found that care of the elderly in the municipality was based on a social culture which placed residents' needs at the centre. Following routines were considered important in preventing mistreatment, and were intended to ensure that all patients were treated fairly and equally. Care was described as task-oriented and often lacking in interpersonal relations. From a phenomenological lifeworld perspective, it was shown that in the municipality’s care of the elderly there was a focus on elderly people’s freedom at the expense of the vulnerability aspects of well being.

Conclusion: Raising awareness of the values underlying care could help to understand care practice. Change is only possible when we reflect on the existing perspectives underpinning the care culture, and integrate them into a broader framework for caring. This will provide the basis moving towards a caring culture based on the meaning and values that promote humanistic care.

Keyword [en]
Care culture, Caring, Document analysis, Elderly care, Hermeneutic, Municipal
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-72229OAI: oai:DiVA.org:liu-72229DiVA: diva2:458600
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2011-11-23Bibliographically approved
In thesis
1. Tradition och horisont: vårdkulturens betydelse för vårdens praxis
Open this publication in new window or tab >>Tradition och horisont: vårdkulturens betydelse för vårdens praxis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aim of this thesis was to illuminate and understand aspects of care culture as a meaning–making process that influences the care praxis. In health care there is increasing recognition of the impacts on organizational culture of health-related matters. Although the factors studied affect care and nursing care, there has been little research from a caring science perspective. Care culture is understood from a hermeneutic perspective as a meaning-making process related to tradition, horizon and “bildung”. These three concepts give care a meaning cohesion that helps caregivers to orient themselves and acquire a care praxis.

Study I was an interview study with seventeen nurses working on different wards. Study II was a focus group study, and included three focus groups with 24 nurses and a secondary qualitative analysis of interviews from study I. Both studies I and II used a phenomenological-hermeneutic approach. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study IV was a case study involving 12 individual interviews and one focus group interview that included four participants. All participants were working at various levels in the municipal organization and were directly or indirectly connected to a mistreatment situation. This research also included a two-day field study and a document study. The individual interviews and focus group interviews were analyzed using a phenomenological hermeneutic approach.

The findings show that care culture can be experienced as positive and enabling of good care but also as defective and an obstacle to good care. Three different care cultures were identified: a service, a social and a motherhood culture. All cultures showed traces of caring values, but from a caring theory perspective, none of them fully demonstrated understanding of the notion of existential caring revealed as the integration of freedom and vulnerability. By studying the underlying traditions and the caregivers’ horizon, the care culture can be illuminated and understood through its expression in praxis. From gaining a comprehensive understanding, a caring ideal could open up and reflect the care culture´s boundaries. This means that ideals can have different interpretations depending on the conditions the care praxis is based on. The gap between care theory and praxis can therefore be understood to mean that the care culture does not use Bildung as a process of alienation and appropriation, resulting in no transformation of the prevailing tradition.

Care culture could be distinguished from three different perspectives. They are referred to in this thesis as the prevailing, the visionary and the critical perspective. Developing a hermeneutic concept of culture, understood as the care culture´s critical perspective, could serve as an opportunity for a reinterpretation of nursing theory´s meta-paradigm concept of environment.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1273
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72231 (URN)978-91-7393-027-7 (ISBN)
Public defence
2011-11-29, K1, Kåkenhus, Campus Norrköping, Linköpings universitet, Norrköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2015-01-19Bibliographically approved

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