The place of standardisation in home care practice: an ethnographic study

Abstract

Aims and objectives: To explore the benefits and shortcomings of using standardised work methods in home care nursing.

Background: Health care is increasingly shaped by the use of standardised work methods. This trend is reflected in the use of management tools aimed at monitoring service quality and efficiency, as well as in the evidence-based movement that has led to a shift in focus from the practitioner to the knowledge found in guidelines and clinical protocols. This study addressed the impact of this development on home care services.

Design: This is an ethnographic study involving fieldwork in home care nursing in Iceland.

Methods: The study took place in one neighbourhood in an urban area in Iceland in 2010. Members of five of six home care nursing teams agreed to participate. Team leaders were observed during visits to older person's homes and at team and interdisciplinary meetings. Semi-structured interviews were conducted with the team leaders and 15 older persons.

Results: The results were presented as three themes: For it all to hang together, which referred to attempts on behalf of the team leaders to coordinate complex services and assistance for the benefit of each patient; Working with more advanced cases, which reflected the uptake of standardised methods to address health matters locally; and Being heard, which reflects the politics of using standardised methods.

Conclusions: Standardised work methods can be helpful and are welcomed by home care nurses as long as they can also use their own discretion and draw on other forms of knowledge when needed.

Relevance to clinical practice: This study brought out the importance of flexibility in home care practice. Standardised work methods are welcomed and seen as helpful as long as they can be used based on the discretion of the practitioner.

Keywords: complex needs; evidence-based knowledge; flexibility; home nursing services; knowledge; local knowledge; long-term care; nursing; standardisation.