Culture and communication in Thai nursing: a report of an ethnographic study

Most nurses live and work in multicultural settings. Given the need for all nurses and health-care workers to communicate--with patients, with families and with other health-care professionals--the study of the relationship between culture and communication can help to inform practice. This paper offers the findings from an ethnographic study of culture and communication, carried out in Thailand. The aim of the study was to address the question: 'in what, if any, ways do Thai cultural issues influence interpersonal communication patterns in Thai nursing and Thai nursing education?'. Data were collected from a variety of sources, including direct and indirect observation, interviews and discussions and the literature on the topic. For the interviews, the sample was a convenience and purposive one made up of clinical nurses and nurse educators (n = 14). Those data were analysed with the aid of a computerised, qualitative data analysis program. Findings reported in this paper include those relating to 'Thainess', Buddhism, the nursing profession and nurse--patient/doctor--patient relationships. The report ends with a 'portrait' of Thai nursing communication. It is suggested that understanding the cultural aspects of nursing in various contexts can help nurses, internationally.     

An ethnographic study of psychiatric nursing

There is a well documented continuing anomaly between what is expected of a psychiatric nurse and observations of practice. This paper presents an ethnographic study carried out in three acute psychiatric in-patient units over one year. Methods used were participant observation and semistructured interviews of 15 trained nurses. Three themes were isolated during and following data analysis: the difficulty of working closely with mentally disturbed individuals; maintaining distance and congruent care. There was a notable dichotomy, that of wanting to work with the patients but constantly feeling that what they intuitively wanted to do was not right.     

Ethics and care: an ethnographic study of psychiatric community health nursing practice

The purpose of this ethnographic study was to explore, describe, and document the practice of a group of psychiatric community health nurses (CHNs), and to provide a forum through which their voices could be heard. Discovery of the nature of issues CHNs experience in an effort to meet the needs of patients with mental illness was the focus. The paper describes the ethical conflict experienced by many of these nurses who wanted to provide beneficial, high-quality care to patients with mental illness but encountered obstacles in practice. Insight into the difficulties nurses experience in applying an ethic of care in the context of administrative constraints, resulting from the strict regulatory mechanisms imposed by third party insurance payers is provided. The negative impact of increasingly stricter payment restrictions on nursing practice and on quality of care is exposed.     

Negotiating "home" and "care" among the HIV+ homeless: An ethnographic case study of home care nursing habitus

The authors combine field work among home care nurses working in an impoverished urban neighbourhood with analysis of changing models of service provision. They explore the concepts of"home" and "care" for the homeless and marginally housed as features of a home care nursing "habitus" in the face of conflicting professional and institutional approaches to HIV care. While the nurses' innovative practice is a result of the failure of existing models to meet the needs of multi-diagnosis patients, it is also influenced by the drive to increase adherence to antiretroviral regimens as a means of slowing the spread of HIV at the population level. The authors describe the nurses' negotiated practice and use Pierre Bourdieu's notion of habitus to theorize about their ability to meet competing demands.     

The experience of nursing home life

Fiveash B. International Journal of Nursing Practice 1998; 4: 166–174
The experience of nursing home life
This study explored the articulate resident's experience of nursing home living. Using an ethnographic approach, data was collected through progressive, in-depth, open-ended interviews and participant observation from two 80-bed nursing homes in New South Wales. Employing purposeful sampling, eight key informants were selected concurrent with data collection and analysis according to the adequacy of information and appropriateness of subjects. Four major themes emerged from the data: (i) against my will, (ii) living in a public domain, (iii) cultural implications of living with others, and (iv) the impact of nursing home residency. Findings indicate that whilst some residents find the experience acceptable, for others the experience is both constraining and dehumanising.     

Spiritual caring: end of life in a nursing home

The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting.     

An ethnographic study of human dignity in nursing practice

BackgroundThe ethical values of nursing are crucial to the provision of humane care. Human dignity is a core value that must be preserved in order to deliver such care. No studies to date have compared the perceptions of nurses and/or patients regarding the components of dignified care embedded in actual clinical practice.PurposeTo explore the delivery of dignified care by professional nurses. This was an ethnographic qualitative study combining inductive and deductive methods to identify emergent themes. A multicenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units.Setting and sampleMulticenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units.MethodWe conducted 158 hours of participant observation of 27 nurses. Semi-structured individual interviews were undertaken with 20 of these nurses, with data saturation being reached. Data were collected between September 2014 and May 2016 and were analysed using ATLAS.ti 7.2 for Windows.ResultsTwo themes emerged from the analysis: Delivering dignified care and Factors influencing the delivery of dignified care. The nurses regarded human dignity as one of the key values of their profession. However, there was a discrepancy between their perceptions of the care they offered and what they actually did, due mainly to a lack of awareness about their own practice. Respect, confidentiality, privacy and communication were identified as the key elements underpinning dignified care. Institutional policies were seen as the major obstacle to the delivery of humane care, the key issues being frequent shift rotations, a high patient-nurse ratio and excessive paperwork.ConclusionsThe results of this study underline the importance of delivering dignified care and the need to ensure that nurses' attitudes and behaviours are consistent with this goal. The ethnographic approach, combining participant observation with individual interviews, revealed discrepancies between nurses' perceptions of the care they offered, or should offer, and what they actually did. This suggests a need for professional forums in which nurses can become more aware of their own clinical practice.     

The nursing home as a home: a field study of residents' daily life in the common living rooms

Aim. This Norwegian‐based study investigates how and to what extent the idea of the nursing home as a home has been realized. Background. For the last two decades, Norway, as other Western Country has had an explicit national policy that nursing homes should become more like homes. The research literature indicates that residents in nursing home seem to lack the opportunities to maintain a private sphere. Design. A field study design was conducted. Methods. Data were collected in 1999 in two long‐term units in a traditional nursing home by using participant observation and interviewing the residents. A phenomenological hermeneutic analysis strategy was used to get an impression of the residents’ everyday life. Results. The residents spend most of their time in the common living room. The common living room has an ambiguous boundary between the public and private spheres, unlike the clear boundaries characterizing a home. The relationship among the residents is fragile, and the residents who can, withdraw from the common living room. Conclusions. Despite having single rooms and more home‐like interior decoration, the residents in nursing home still have reduced opportunity to develop a private everyday lifestyle. The long‐term unit examined in this research had a forced relationship between the residents, and the residents with best health resources systematically withdraw from the common area to control both where and with whom they wish to spend their time. Relevance to clinical practice. This study lays the foundation for rethinking daily routines in long‐term units in nursing homes. One way to realize the idea of the nursing home as a home could be to define the living room as a clear public area and to give the residents a chance to develop a more private lifestyle by alternating between their private rooms and a public common living room.     

Quality of life at the end of life for nursing home residents: perceptions of hospice and nursing home staff members

This study examined whether the perceptions of nursing staff members about the importance of quality-of-life domains and their perceived ability to influence those domains for residents at the end of life were affected by their institutional affiliation, level of training, or residents' cognitive status. Respondents were 146 Certified Nursing Assistants (CNAs) and Registered Nurses (RNs) from nursing homes and hospices. Magnitude estimation scales were used to rate the importance of and perceived ability to influence 11 quality-of-life domains for both cognitively intact and cognitively impaired residents. Overall, respondents' scores indicated a high level of importance of all quality-of-life domains and similarly positive perceptions that they could influence quality-of-life domains for hypothetical nursing home residents. Analysis of variance revealed that respondents reported lower average importance and ability to influence ratings when considering residents with cognitive impairment. Respondents affiliated with hospice agencies also reported lower average importance and ability to influence ratings on some domains, although the high ratings overall limit the clinical significance of these differences. Importance ratings were not affected by the level of education, but CNAs reported higher perceived ability to influence ratings on four domains than did RNs. Future studies should explore whether the domains measured adequately capture the end-of-life experience in nursing homes.     

On sources of powerlessness in nursing home life

As feelings of identity and integrity are important for old people's efforts to maintain a healthy life, experiences of powerlessness ought to be prevented. This paper describes sources of powerlessness in nursing home life. Participant observations regarding lucid, elderly patients were undertaken in two Swedish nursing home wards. The observations focused on interactions on the wards, observed patient reactions and structuraVfunctiona1 conditions of life on the wards. The constant, comparative analysis searched for events or conditions which seemed to result in reactions signifying positive or negative experiences. Tender, loving care, strong cohesion and affection between patients and personnel were typical of the observations, yet patients complained of imprisonment, powerlessness and hopelessness. Observations are reported as related to legitimate, reward, expert, informational and reference power, self-confidence/respect and socialization. Also existential sources of powerlessness were identified. It is concluded that many factors co-operate to create feelings of powerlessness in the patients. Empowerment measures are suggested on organizational, interactional and personal levels.