Lilienthal Anneliese, Farias Lisette, Boström Anne-Marie, Patomella Ann-Helen, Asaba Eric
Department of Neurobiology, Care Science and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.
Department of Neurobiology, Care Science and Society (NVS), Division for Nursing, Karolinska Institutet, Stockholm, Sweden.
J Multidiscip Healthc. 2025 Jan 16;18:209-221. doi: 10.2147/JMDH.S496365. eCollection 2025.
The care of older persons is facing several challenges, especially as care tasks are becoming increasingly rationalized with less opportunity for relational engagement between nurse assistants and older persons. Evidence suggests this engagement is needed to promote well-being and satisfaction among the older persons with whom they work. The aim of this study was to explore how care, in the context of worker perspectives, is understood and experienced in home or residential care facilities.
Focus-group interviews were conducted with experienced nursing assistants (n = 14) working in urban municipalities in Sweden. Data were analyzed using reflexive thematic analysis.
The main theme: "This work is more than a checklist of tasks, it's like simultaneous mind puzzles", exposes the shortcomings of a "task and time" oriented care system while expecting individualized relational care practices. Three subthemes emerged: "It's about responsibility, not remuneration", "Knowing them is part of the job" and "We do a lot that is not our job". Participants expressed working responsibly day-to-day to find solutions to meet the needs of older persons. Tensions experienced between task and relational care orientations align to variation in understandings of care. These subthemes highlight that their work requires being context-sensitive to adapt in the moment, much like trying to solve mind puzzles.
Increased rationalization of care, while expecting focus on relational aspects, sets nursing assistants in a challenging position. This paradox negatively affects the health of nursing assistants by creating unsustainable work. Without recognition of the required cognitive engagement in problem solving that is part of their work, the challenges of retention, sick leave and burnout are unlikely to be addressed. To ensure coordinated continuative care for older persons, nursing assistants need time and agency to enact relational practices that facilitate doing their work's dynamic care puzzles.
老年人护理面临着诸多挑战，尤其是随着护理任务日益合理化，护士助理与老年人之间建立关系的机会越来越少。有证据表明，这种互动对于提高他们所照顾的老年人的幸福感和满意度是必要的。本研究的目的是探讨在家庭或寄宿护理机构中，从工作人员的角度来看，护理是如何被理解和体验的。
对瑞典城市市政当局中经验丰富的护理助理（n = 14）进行了焦点小组访谈。使用反思性主题分析法对数据进行了分析。
主要主题“这项工作不仅仅是一份任务清单，更像是同时进行的智力拼图游戏”揭示了以“任务和时间”为导向的护理系统的缺点，同时期望有个性化的关系护理实践。出现了三个子主题：“这关乎责任，而非报酬”、“了解他们是工作的一部分”以及“我们做了很多本职工作之外的事情”。参与者表示，他们每天都负责地工作，以找到满足老年人需求的解决方案。任务导向型护理和关系导向型护理之间的紧张关系与对护理理解的差异相一致。这些子主题强调，他们的工作需要时刻保持情境敏感性以做出调整，这很像试图解开智力拼图游戏。
在期望关注关系层面的同时，护理工作的日益合理化使护理助理处于具有挑战性的境地。这种矛盾通过创造不可持续的工作对护理助理的健康产生负面影响。如果不认识到解决问题所需的认知投入是他们工作的一部分，那么留住员工、病假和职业倦怠等挑战就不太可能得到解决。为确保为老年人提供协调一致的持续护理，护理助理需要时间和自主权来实施有助于解决其工作中动态护理难题的关系实践。
