Clinical Nursing Research

 

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Clinical Nursing Research, Vol. 15, No. 4, 231-254 (2006)
DOI: 10.1177/1054773806291845

Client-Centered Home Care

Balancing Between Competing Responsibilities

Tineke Schoot

Zuyd University, Heerlen, the Netherlands

Ireen Proot

Maastricht University, Maastricht, the Netherlands

Marja Legius

Fontys University of Professional Education, Eindhoven, the Netherlands

Ruud ter Meulen

University of Bristol, Bristol, United Kingdom

Luc de Witte

Zuyd University, Heerlen, the Netherlands

This study explores and describes the perceptions of nurses with respect to everyday client-centered care. A grounded theory study was conducted with 10 Dutch nurses and auxiliary nurses giving home care to chronically ill clients. Participatory observations and semistructured interviews were held. Nurses perceived roles and responsibilities competing with the role as a responsive professional to the client demand: a critical professional, developer of client competencies, individual, and employee. Strategies in balancing between competing responsibilities were distinguished: pleasing, dialoguing, directing, and detaching. Directing (related to impaired client competencies) and detaching (related to organizational barriers) were also used as second choice strategies. Effectively balancing between competing responsibilities was seen in dialoguing and directing as second choice. Conditions identified related to these strategies are awareness of, and responsibility taking for competing responsibilities. Recommendations for practice concern a care relationship and a dialogue with the client, critical ethical reflection, professional autonomy, self-assertiveness and organizational support.

Key Words: client-centered care • awareness • responsibility taking • dialogue • ethical reflection


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