Assistant Nurses' Positioned Accounts for Prioritizations in Residential Care for Older People.

Abstract

Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks. Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg's three-level positioning analysis. The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and "the other things." They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of "icing on the cake." Morale is complex in residential care. A narration of "the torn carer" was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values. When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. "The torn carer" is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.