Caring in the preparation of long-term psychiatric patients for non-institutional care: ethnonursing study

Practical nurses in elder care and changes in Finnish society - a biographical study

BACKGROUND

Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them.

AIM

The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience.

METHODS

The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis.

FINDINGS

The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care?

CONCLUSIONS

The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.

A literature review of patients' compared with nurses' perceptions of caring: implications for practice and research

Caring is a salient feature of nursing practice and has been studied extensively from the nursing perspective. Nonetheless, little has been forthcoming in relation to patients' perceptions of the meanings and processes of caring. The present literature review shows that whereas nurse clinicians focus on the psychosocial aspects of caring, patients assign the highest value to technical skills and professional competence. Similarly to patients, a small proportion of nurses view competent clinical expertise as the fundamental component of caring. Noncaring behaviors include physical and emotional absence, belittling and inhumane actions, and lack of recognition of a patient's uniqueness. Patients' participation in decisions regarding their care may or may not be an element of a caring interaction. Ethnonursing studies describe the "caring culture" as one based on likeness, consensus, and conformity. Based on review findings, implications for practice and research are outlined.

Nursing care as a calling

A calling is a deep desire to devote oneself to serving people according to the high values of the task or profession. The aim of this study is to clarify the relationship between a calling experience and professional knowledge, nursing action and motivation. The data were collected from all the registered nurses (n = 179) at five hospitals. The response was 70%. The nurses who were committed to their profession and experienced their job as a calling, had a good knowledge about the ill feeling and maladjustment of their patients and were also good sources of support for their patients. They understood the importance of family ties and offered support to their patients' families. They were aware of the needs of dying patients and their concern with spiritual questions, and satisfied these needs well. It was characteristic for them to collaborate closely within a team, to experience the content of their work as enriching and to possess proficient professional abilities. They were therefore excellent in supporting both the individual patient and his or her family. They had a deep understanding of the whole process of patient care. According to these results the calling experience is not in conflict with professional principles.

Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

This article describes and analyses the way of life of deinstitutionalized long-term psychiatric patients in Northern Finland. The major focus of the paper is the central areas of life of the outpatients as one dimension of subjectivity. The data were collected by interviewing 25 discharged long-term psychiatric patients. The findings suggest that home was the central area of life for the outpatients but they differed in their relation to it. Some of the patients were actively building their home. For some others home was an asylum in which to hide from social life. Many patients had hobbies that only took place inside their homes. One of the problems that the outpatients had to face was lack of work. The elderly patients who generally regarded work as a virtue experienced difficulties in finding something to do in their modern suburban homes. Social participation was mostly labelled by the old and familiar hospital models. The patients had no new acquaintances. They kept contact with their former fellow patients.

The life situation of a long-term psychiatric patient: some restrictions in, and possibilities of, open care

This paper describes and analyses, from a sociocultural viewpoint, the ways of life of discharged long-term psychiatric patients in northern Finland. The paper focuses on subjectivity: control of life and fundamental experiences in life. The data consist of interviews with 25 outpatients who have moved to live in residential homes, rehabilitation centres or their own homes after receiving preparatory training in the psychiatric hospital. The findings suggest that the way of life of the outpatients did not significantly differ from that of other people belonging to the same generation of Finns. With respect to control of life, a conspicuous feature was the strong tendency to let themselves be led by others, and to self-sacrifice for the good of others. For the patients, independence was the best aspect of open care. Fear for being branded as a psychiatric case or as a former mental patient threatened the patients' external control of life. The central element of control of life of the Finns is work. The outpatients thought work a matter of honour and they did not find their present, inactive way of life satisfactory.

Changes in psychiatric caring values in Finland

A shift from institutional to non-institutional caring systems took place in Finnish psychiatric care in the 1980s. This article describes the values related to caring and the changes that occurred during the time span of a decade in a ward that rehabilitates mental patients as non-institutional care in northern Finland. The changes in patient and staff values are examined by studying the changes in caring practices in the ward. The ethnonursing method developed by Leininger (1995, 1991) was used to examine the rehabilitation of psychiatric patients. Data were collected by interviewing twenty patients and eleven staff members. Results demonstrated that by the 1980s individualism was increasingly valued and personal freedom and self realization were more valued than hard work and solidarity. People's values shifted from universality to greater diversity. Transcultural nursing implications are discussed.