Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway.
Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
BMC Nurs. 2012 Jun 7;11:7. doi: 10.1186/1472-6955-11-7.
Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents' rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations.
For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study.
Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity.
New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.
西方国家政府已经启动改革，以提高养老院居民的护理质量。这些改革大多涵盖了法规和国家质量指标的使用。在挪威的背景下，这些法规包含两页易于阅读和理解的文本。它们特别侧重于居民在养老院规划日常生活的权利。然而，研究文献表明，新法规的实施，特别是如果这些法规旨在改变护理实践，极具挑战性。本研究的目的是进一步探索和描述护理实践，以更深入地了解为什么实施新法规如此困难。
为了进行这项定性研究，选择了民族志设计来探索和描述护理实践。在两个养老院进行了实地工作。共有 45 名护士和护理助理参与了参与者观察，10 人在实地研究结束时接受了访谈。
研究结果表明，工作人员对新的质量法规知之甚少，他们的工作质量受到植根于护理实践的其他因素的指导。进一步的分析表明，工作人员似乎致力于日常工作，而且他们似乎总是知道该做什么。日常工作和总是知道该做什么相互加强和增强彼此，共同形成了一种强大的力量，使日常护理成为一种理所当然的活动。
新法规的实施具有挑战性，因为护理实践已经如此根深蒂固。要改进实践，需要在日常行动和思维中进行系统和深入的实际变革。
