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Nurses go visiting: ethics and gender in home-based nursing care
Umeå University, Faculty of Medicine, Department of Nursing.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to explore how nursing is constructed in home-based nursing care from the viewpoint of patients and nurses who are receiving or giving care. Since nursing both constructs and is in turn constructed by the context in which it serves, language plays a central part in those constructions and in this thesis. The thesis has been guided by social constructionism, meaning that the positions the patients and the nurses inhabits have been considered as social phenomenon constructed in discursive processes.

There are two ideas that guided this thesis. One idea was that home-based nursing care promotes the association of caring abilities in relation to nursing, women and the private sphere. Another idea was that the place where the care was carried out has ethical implications.

Data was collected from interviews with 10 home-based nurses (study I) working in community in the western part of Sweden and 10 patients cared for in their home by these nurses (study II). Nurses and patients were interviewed about their experiences of giving respectively receiving home-based nursing care. The interviews were transcribed verbatim and analyzed with a discourse analytic method in study I and II. The findings in study I show that the nurses described their subject positions as "guests" and "professionals" and that they have to make a choice between these positions, as it is impossible to perform both positions at the same time. Dependent on the situation, both an ethics of care and an ethics of justice were applied by the nurses, that is, to perform according to the subject positions of "guest" or "professional."

In study II, the patients describe their own subject position as "safeguard" and the nurses‟ positions as "substitutes". These subject positions provided the opportunities, and the obstacles, for the patients‟ possibilities to receive care in their home which included which kind of strategies, habits and activities the patients described and what tasks and how they considered or expected the nurses to perform. These findings are discussed within a theoretical framework, i.e. a gendered dichotomy of the private spheres versus the public spheres. Inherent in this framework is a discussion of the findings related to the habits that are essential in the nurses‟ and the patients‟ constructions of subject positions.

In study III, metaphors used by home-based nurses‟ were explored as a means to discover values and norms held by nurses working in home-based nursing care. Ten interviews with nurses working in home-based nursing care (the same interviews as in study I) were analyzed and interpreted with a metaphor analytic method. In the analysis metaphoric linguistic expressions (MLE) were explored and patterns of MLEs formed two entailments. After exploring MLEs and entailments on an explicit surface level the analysis went to a broader underlying dimension of conceptual metaphors identifying the overall metaphor: "Home-based nursing care is an endless journey". The metaphor "Home-based nursing care is an endless journey" exposed home-based nursing care in constant motion, thereby requiring nurses to adjust to circumstances. This adjustment required ethical maturity based on experience, knowledge, and creativity. The study III focuses on the importance of further developing reflections over experiences related to everyday ethical issues.

In study IV, the findings from study I were the starting point for a philosophical exploration of the concept "guest" and its relation to other adjacent concepts such as hosts and hospitality. The question to be answered was as follows: In what ways can home-based nurses‟ description of being "guests" in patients‟ home be understood? The exploration was based on Derrida‟s philosophy of unconditional and conditional hospitality, Levinas‟ philosophy of "face" and "the Other" and Arendt‟s philosophy of "go visiting". The findings indicated that the concept "guest" was not appropriate for the nurses to use when describing their position in home-based nursing care, since the concept was problematic for the content and the complexity of home-based nursing care. The findings also showed that exposing concepts as binaries is fruitful since they show relationship between concepts. Just illuminating the concept "guest" did not reveal the power relationship between the "guest" and the "host" and their relationship to hospitality.

The distinction between diverse ethical perspectives could be seen as problematic or as an opportunity. According to this study, the nurses used a plurality of different ethical ideas, such as an ethics of care, an ethics of justice, an ethics of virtue and an "everyday ethics." A possible interpretation could be that this was a sign of a difficulty to maintain distinction between ethical theories in clinical practice. 

Ethical issues in the private sphere are less commonly explored compared to ethical issues in the public sphere, for example in hospital care. As showed in this thesis, the distinction between the private and the public spheres was problematic. It does not describe two spatially separate spheres, but rather it describes functionally dependent activities, interests and relations, such as diverse areas of ethical ideas and "feminine" and "masculine" positions.

Home-based nursing care is a complex area and discourse analysis of the relation between home-based nursing care, subject positions, ethics and gender is more or less lacking. Exploring home-based nursing care outgoing from discourse analytic perspectives and methods is rewarding for nurses‟ practice, education and research as it opens up new perspectives of home-based nursing care.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1426
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-43796ISBN: 978-91-7459-224-5OAI: oai:DiVA.org:umu-43796DiVA: diva2:416076
Public defence
2011-06-01, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-11 Created: 2011-05-10 Last updated: 2016-02-01Bibliographically approved
List of papers
1. Nurses as guests or professionals in home health care
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2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 3, 371-383 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: ;guest' and ;professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.

Keyword
discourse analysis; ethical appeal; guest or professional; home nursing care
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-19048 (URN)10.1177/0969733007088361 (DOI)18388171 (PubMedID)
Available from: 2009-03-03 Created: 2009-03-03 Last updated: 2016-02-01Bibliographically approved
2. Patients as 'safeguard' and nurses as 'substitute' in home health care
Open this publication in new window or tab >>Patients as 'safeguard' and nurses as 'substitute' in home health care
2009 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 2, 219-230 p.Article in journal (Refereed) Published
Abstract [en]

One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as 'safeguard', and the nurses' subject position as 'substitute' for themselves. These subject positions provided the opportunities, and the obstacles, for the patients' possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

Place, publisher, year, edition, pages
Sage Publications, 2009
Keyword
discourse analysis, ethical repercussions, home-based nursing care, safeguard, substitute
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-34602 (URN)10.1177/0969733008100081 (DOI)19237475 (PubMedID)
Available from: 2010-06-09 Created: 2010-06-09 Last updated: 2016-02-01Bibliographically approved
3. Home-based nursing: an endless journey
Open this publication in new window or tab >>Home-based nursing: an endless journey
2011 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 3, 408-417 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore metaphors for discovering values and norms held by nurses in home-based nursing care. Ten interviews were analysed and interpreted in accordance with a metaphor analytical method. In the analysis, metaphoric linguistic expressions and two entailments emerged, grounded in the conceptual metaphor ‘home-based nursing care is an endless journey’, which were created in a cross-domain mapping between the two conceptual domains of home-based nursing care and travel. The metaphor exposed home-based nursing care as being in constant motion, thereby requiring nurses to adjust to circumstances that demand ethical maturity. The study focuses on the importance of developing further theories supporting nurses’ expressions of their experiences of everyday ethical issues.

Place, publisher, year, edition, pages
Sage Publications, 2011
Keyword
everyday ethics, home-based nursing care, journey, metaphor, motion
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-43784 (URN)10.1177/0969733011398098 (DOI)
Available from: 2011-05-09 Created: 2011-05-09 Last updated: 2016-02-01Bibliographically approved
4. Nurses go visiting
Open this publication in new window or tab >>Nurses go visiting
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-43785 (URN)
Available from: 2011-05-09 Created: 2011-05-09 Last updated: 2016-02-01Bibliographically approved

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