Nord University, Levanger, Norway.
Nord University & NTNU, Trondheim, Norway.
J Adv Nurs. 2024 Feb;80(2):612-627. doi: 10.1111/jan.15828. Epub 2023 Aug 13.
To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway.
A qualitative descriptive study.
Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data.
The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes.
Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion.
The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust.
This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.
探讨挪威购买方-供应方组织模式下的家庭护理服务中护士专业判断力的运作方式。
定性描述性研究。
采用半结构式访谈，对 2020 年 4 月至 11 月在挪威四个地方行政区从事家庭护理的 15 名注册护士进行深入访谈，采用 Braun 和 Clark 的六步分析法对经验数据进行分析。
分析产生了两个主要主题，即“购买方的指示：促进和限制护理”和“专业判断力符合医疗保健的购买方-供应方组织”，有五个相关代码。
由于医疗服务的复杂性和任务数量，护士依赖于组织框架。同时，他们进行了大量的补偿性工作，需要具备灵活性，以便开展工作并采取行动，满足个别患者的意外需求或涉及专业判断力的需求。
购买方-供应方模式既促进又限制了家庭护理中的护理实践和专业责任。由于家庭护理服务的复杂性和涉及的任务种类繁多，因此需要进行良好的组织。在这种情况下，约束因素与灵活性和专业判断力的需求相关。尽管有严格的框架，但护士仍会执行额外的补偿性任务。受“新公共管理”启发的改革，如购买方-供应方分离，减少了护士的工作量；然而，仍然需要行使判断力。本研究的结果可以帮助家庭护理管理者和卫生政策制定者理解管理逻辑和医疗保健逻辑之间的相互作用，从而更恰当地组织医疗保健服务，使护士作为行动者获得更多的信任。
本研究强调了家庭护理护士在努力实现标准化的组织框架中行使判断力的机会。护士行使判断力的能力对患者的个人和整体护理至关重要。同时，需要有一个组织框架，因为护士无法满足患者可能存在的所有需求，否则会使家庭保健服务和护士负担过重。
