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Tradition och horisont: vårdkulturens betydelse för vårdens praxis
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
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: urn:nbn:se:liu:diva-72231ISBN: 978-91-7393-027-7 (print)OAI: oai:DiVA.org:liu-72231DiVA: diva2:458611
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
List of papers
1. Care and caring culture as experienced by nurses working in different care environments: A phenomenological-hermeneutic study
Open this publication in new window or tab >>Care and caring culture as experienced by nurses working in different care environments: A phenomenological-hermeneutic study
2009 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, no 5, 689-698 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim is to understand and develop the concept of care and caring Culture and to do so based on the empirical/phenomenological standpoint of nurses lived experiences of working in different environments.

Background: Culture, care and caring are significant concepts mentioned and used in connection with nursing practice. In the nursing literature, the caring culture as a concept is mostly taken for granted, and it is up to the reader to determine what caring culture means.

Method: A phenomenological-hermeneutic method was used to uncover the meaning of lived experiences though interpretation of interviews transcribed as text. Seventeen nurses working oil different wards were interviewed in 2006. A follow-up focus-group discussion was conducted with seven of the nurses I year later for validation of the findings.

Findings: Thematic analyses revealed five themes: you have to adapt to the existing care Culture: seeing the invisible: being Yourself; the strong personalities; the patients must adapt themselves to the circumstances. Adaptation to unwritten routines entails adaptation to the culture and the common value system. On wards described as "homelike", nurses may act in a way that reflects their own values.

Discussion: The care and caring culture can be understood from the perspective of what it means to care and from the perspective of how care provision is accomplished. To attain a caring Culture founded on certain values, for example caritas, love and charity, we must first understand how the organization and personnel understand caring.

Keyword
Care culture, Caring culture, Phenomenological-hermeneutic method, Nursing, Adaptation, Ethos, Ward
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-18031 (URN)10.1016/j.ijnurstu.2008.12.005 (DOI)
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2017-12-13Bibliographically approved
2. The significance of routines in nursing practice
Open this publication in new window or tab >>The significance of routines in nursing practice
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 23-24, 3513-3522 p.Article in journal (Refereed) Published
Abstract [ar]

Aim. The aim of this study was to illuminate the significance of routines in nursing practice.

Background. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action.

Design. A qualitative design using a phenomenological-hermeneutic approach.

Method. Data collection from three focus groups focused on nurses’ experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as ‘qualified nursing pool’ nurses.

Result. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient’s integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it.

Conclusions. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice.

Relevance to clinical practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine.

Place, publisher, year, edition, pages
Wiley, 2011
Keyword
culture, lifeworld, nursing practice, phenomenological-hermeneutic method, routine, ward
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-67272 (URN)10.1111/j.1365-2702.2010.03522.x (DOI)000297864500027 ()
Note
Article first published online: 12 Oct. 2010Available from: 2011-04-07 Created: 2011-04-07 Last updated: 2017-12-11Bibliographically approved
3. Aspects of municipal culture in care for the elderly: a hermeneutic documentary analysis of reports of abuse
Open this publication in new window or tab >>Aspects of municipal culture in care for the elderly: a hermeneutic documentary analysis of reports of abuse
(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
Care culture, Caring, Document analysis, Elderly care, Hermeneutic, Municipal
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72229 (URN)
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2011-11-23Bibliographically approved
4. Care culture as a meaning-making process: a study of a mistreatment investigation
Open this publication in new window or tab >>Care culture as a meaning-making process: a study of a mistreatment investigation
2013 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 9, 1179-1187 p.Article in journal (Refereed) Published
Abstract [en]

Culture might offer significant insights into the circumstances under which mistreatment occurs. Our aim with this study was to understand and explore institutional mistreatment from a care culture perspective. We used a case study with a triangulating methodology. It involved 12 individual interviews, one focus group interview with four people, a 2-day field study, and a document study. The case was a mistreatment situation that had occurred in municipal care, in which residents had been locked in their rooms at night. Two different care cultures were identified that could give a richer contextual understanding of the motives behind the institutional mistreatment. The service culture was need-oriented and emphasized freedom in care provision. The motherhood culture was characterized by protection and safeguarding of the vulnerable residents. Both cultures showed traces of caring values, but when important caring values were absent, this created a seedbed for mistreatment.

Place, publisher, year, edition, pages
Sage Publications, 2013
Keyword
case studies; health care; culture of; hermeneutics; lived experience; phenomenology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72230 (URN)10.1177/1049732312470760 (DOI)000323312000003 ()
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2017-12-08Bibliographically approved

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