‘I try to make a net around each patient’: home care nursing as relational practice
In many of the Nordic countries, where home care services have been universally and publicly provided over a long period of time, scholars have raised concerns that the use of these new organisational methods will undermine practitioners’ ability to provide services that accommodate individual needs 3. Studies from the Nordic countries have found a high motivation to provide meaningful assistance to patients and their relatives among home care staff, while their work environment is increasingly experienced as financially constrained 6. In UK, studies have revealed how a pay‐for‐performance contract introduced to General Practitioners (GP) challenged the practice of holistic care which had previously prevailed 8. This payment structure has been found to dictate a task‐based approach 9 which discourages practice nurses from engaging in activities that are not part of the payment structure but that are nevertheless seen as important to patients’ well‐being 10. The danger, following the implementation of organisational changes that aim at rationalisation and retrenchment, is that the practices involved in providing home care services will become eroded or at least changed in fundamental ways 11.
In this article, I draw on findings from a study of home care nursing practice to make the often hidden work of everyday home care nursing practice visible. In doing so, we may come to understand what aspects of this increasingly important area of health‐care should be preserved and enhanced. The study was conducted in Iceland, and at the time of the data collection, home care services had only been minimally influenced by the organisational methods referred to above, making it an excellent site to study this practice.