Karlsson Inger, Ekman Sirkka-Liisa, Fagerberg Ingegerd
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Scand J Caring Sci. 2009 Jun;23(2):265-73. doi: 10.1111/j.1471-6712.2008.00616.x.
The aim of the study was to describe Registered Nurses' (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to 'be everywhere and to know everything', but at the same time they felt invisible and underestimated. They experienced themselves as 'lonely fixers', having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.
本研究旨在描述注册护士（RN）在老年人养老院工作环境中的经历。对12名注册护士进行了访谈，并采用潜在内容分析法对数据进行分析。数据收集于2006年春季。研究结果显示，这些注册护士经历了一种矛盾的工作环境：既感到被赏识和有价值，同时又感到被低估和沮丧。当他们提供护理服务并给予他人信任和支持时，会感到被赏识和有价值。当社会护理和专业护理之间的界限清晰时，注册护士会体验到积极的工作环境。当他们被期望“无处不在且无所不知”时，他们也会感到沮丧，但同时又觉得自己被忽视和低估。他们将自己视为“孤独的解决者”，即在老年人出院时能够解决实际问题，并期望在没有专业能力和专业团队成员的情况下提供专科护理。总之，注册护士能够明确护理界限非常重要。当这些界限清晰时，护理目标就会明确，注册护士也会变得更加自主、受关注且能被倾听。管理者应该倾听并支持注册护士，持续监督和能力发展是必不可少的要素。在养老院工作的注册护士要满足对他们的所有期望是一项艰巨的任务，这会导致道德困扰、犯错以及因压力引发疾病的风险。
