– The employees are more loyal to the patient than to the system. For them, it is most important to provide good care, says Cecilie Knagenhjelm Hertzberg.
She is a researcher at the Center for Medical Ethics at the University of Oslo, and has researched home nursing in three municipalities.
During the work on the study, she followed nurses and healthcare workers at work for several months. Then she discovered that the staff did more for the patients than they really should.
Forskning.no wrote about the study first.
Violates decisions and rules
Those who will receive help from home nursing care will receive a decision stating what help they will receive.
Based on the decision, lists are made of which tasks the employees have, and how much time they should spend on each task, explains the researcher.
In addition, the employees must follow rules that apply everywhere in the health service, such as not accepting gifts from patients, and not accepting money or bank cards to shop for them.
In all three municipalities the researcher studied, the employees broke these rules and decisions.
Even if, for example, the employees were only supposed to help put on support stockings, they did other tasks such as take out of the dishwasher, empty the trash or offer the patient a shower.
Several also helped buy food for patients who could not do it themselves. Some patients also could not afford food.
– There was a lot of social distress, loneliness and isolation. This is a hidden part of our society, says Hertzberg.
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Bought food from own pocket
The researcher discovered this by chance when she herself had to make breakfast for one of the patients she was visiting. The fridge was empty, it was Friday, and the next food delivery was due over the weekend.
– I got some cash from him. But I thought if it wasn’t enough, I’ll just pay the rest. Then I felt it myself and understood that the employees were also shopping for their patients, she says.
When she brought up the topic with the employees, it emerged that several people were happy to pay for groceries out of their own pockets. Sometimes they got the money back, sometimes not.
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Risked own safety
In the study, she also saw that the employees risked their own health and safety when providing care.
– They enter homes that are not equipped for health care. There were patients who did not want to use aids such as raising and lowering beds, because they did not want the home to look like a hospital, says the researcher.
At other times, the employees could find themselves in situations that were downright dangerous.
– There were patients who were very mentally ill, drug addicts, sexual harassment or patients in criminal environments. And they went alone to these people.
Some had learned various techniques to ensure their own safety. Like not having scissors in your pocket, avoiding ponytails in your hair and parking the car in the right direction, so that they could drive off as quickly as possible.
– Not a dilemma
Although they broke rules and compromised their own health and safety, the employees had no doubt that what they were doing was right.
– It’s not really a dilemma for them. For them, it’s about providing good care. Compromising with that can probably be experienced as very difficult, the researcher believes.
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Rigid decisions resulted in poorer well-being
In two of the municipalities the researcher studied, the municipality’s decision was seen as indicative. Here there was room for the employees to contribute with simple tasks other than what had been decided in advance.
In these municipalities, the researcher found that there were slightly lower shoulders and higher well-being. The staff talked to each other about things that were difficult with the patients.
Whereas in the third municipality, it was expected that the employees should not do anything other than what was stated in the patients’ decision. In this municipality, the employees ended up doing the extra services in secret, without documenting it, says Hertzberg.
– It seemed that there was lower well-being and higher turnover in that municipality, she says.
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– Do a great job
She believes the study shows how pressured home nursing is. And that the decisions that the employees must follow work best when they are indicative.
– It is important that the employees are able to manage their own days. Resolution works very well in nursing homes and hospitals. But it’s different when you’re at people’s homes, she says.
– The staff do everything they can for their patients. They do a great job, and should be seen and recognized even more, Hertzberg believes.
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This is what the researcher found:
- Home nursing staff in three municipalities broke rules and decisions to provide care to patients.
- They also risked their own health and safety.
- One of the municipalities treated the patients’ decisions more strictly than the other two.
- Here, too, the employees did more than they were supposed to, but kept it hidden.
- At this workplace, it seemed that there was lower well-being at work and higher turnover.
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