忽视的合法化——挪威养老院工作人员的定性研究。
Legitimizing neglect - a qualitative study among nursing home staff in Norway.
机构信息
Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway.
Keck School of Medicine, University of Southern California, Los Angeles, USA.
出版信息
BMC Health Serv Res. 2023 Mar 6;23(1):212. doi: 10.1186/s12913-023-09185-1.
INTRODUCTION
Residents in nursing homes do not always get qualitatively good nursing care, and research shows that residents' basic care needs are sometimes neglected. Neglect in nursing homes is a challenging and complex issue, yet a preventable one. Nursing home staff are at the frontline of detecting and preventing neglect but may also be the ones causing it. It is essential to understand why and how neglect happens in order to recognize, expose, and prevent its occurrence. Our aim was to generate new knowledge on the processes leading to and allowing neglect to continue in Norwegian nursing homes, by studying how nursing home staff perceive and reflect on when nursing home residents are neglected in their daily practice.
METHODS
A qualitative exploratory design was used. The study was based on five focus group discussions (20 participants, total) and ten individual interviews with nursing home staff from 17 different nursing homes in Norway. The interviews were analysed according to Charmaz constructivist grounded theory.
RESULTS
In order to make neglect an acceptable practice, nursing home staff apply different strategies. These strategies were identified as when the staff legitimize neglect by neglecting neglect, when the staff are not recognizing their own behaviour as neglectful, as expressed in their actions and language, and normalizing missed care when resources are lacking and nursing staff are rationing care.
CONCLUSIONS
The gradual shift between judging actions as neglectful or not are made possible when nursing home staff legitimize neglect by not recognizing their practice as neglective, thus neglecting neglect or when they are normalizing missed care. Increased awareness and reflections on these processes may be a way of reducing the risk of and preventing neglect in nursing homes.
简介
养老院的居民并不总能得到高质量的护理，研究表明，居民的基本护理需求有时会被忽视。养老院的忽视是一个具有挑战性和复杂性的问题，但也是可以预防的。养老院的工作人员是发现和预防忽视的第一线人员，但他们也可能是造成忽视的人。了解忽视是如何发生的原因和方式对于识别、揭露和预防忽视的发生至关重要。我们的目的是通过研究养老院工作人员在日常实践中如何感知和反思养老院居民被忽视的情况，来了解导致和允许忽视在挪威养老院继续存在的过程，从而产生关于忽视的新知识。
方法
采用定性探索性设计。该研究基于挪威 17 家不同养老院的 20 名参与者的 5 个焦点小组讨论和 10 个个人访谈。访谈按照 Charmaz 建构主义扎根理论进行分析。
结果
为了使忽视成为一种可接受的做法，养老院工作人员采用了不同的策略。这些策略包括工作人员通过忽视忽视来使忽视合理化，当工作人员的行为和语言没有表现出他们自己的行为是疏忽的，以及在资源匮乏和护理人员配给护理时，将错过的护理正常化。
结论
当养老院工作人员通过不将他们的行为视为疏忽来使忽视合理化，从而忽视忽视，或者当他们将错过的护理正常化时，工作人员可以在判断行为是否疏忽之间做出逐渐的转变。提高对这些过程的认识和反思可能是减少养老院忽视风险和预防忽视的一种方式。
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