Calibrating the compass of care Nurses' experience of everyday coping in the complex home care setting

Abstract

Abstract Background Public home care services are a significant part of the healthcare system in Norway. The increase in patient numbers has put pressure on the service to meet legal requirements while maintaining economic sustainability and service quality. Concepts such as everyday coping, rooted in the principles of occupational and physical therapy, have been introduced as a shifting mindset to transform caregiving into self-reliance. Despite a distinct shifting mindset, there is little knowledge about how concepts of everyday coping influence nurses’ role in home care. The aim of this study was to gain knowledge about how nurses’ experience of everyday coping in home health care influences nurses’ role in caring for patients. Methods An interpretive approach was chosen following Graneheim and Lundman’s qualitative content analysis. The data were collected through individual semistructured interviews. Eight nurses with different seniority levels and varied work experience were recruited as respondents for this study. The respondents represented two different home care service institutions in rural northern Norway. Results “Calibrating the compass of care” emerged as an overarching metaphor to describe nurses’ experiences of how the concept of everyday coping in home health care influences nurses’ role in caring for patients based on three themes: 1) labyrinth landscape with resource-constrained settings; 2) navigating ethical crossroads; and 3) navigating nursing instincts through formal mandates. Conclusions Despite the intentions to maintain quality of service in home care services through an approach to everyday coping and self-reliance for patients, nurses experience implications for their caregiving. Nurses find the resource-constrained situation demanding when patients introduce their unique needs. Furthermore, they face dilemmas and challenges that intersect with patients’ expectations and their professional responsibilities. For instance, they balance the desire to promote patient independence with the need to provide essential care, especially for elderly and frail individuals. Finally, the nurses express the challenges they experience in following formal procedures while respecting the patient’s autonomy. The results of this study show that changes in Norwegian home care may have been implemented without a clear understanding of the consequences for the core values of nursing care.