Relations in home nursing
This paper discusses the substance of social relation and ‘relatedness’ between the home nurse
and his/her patient and considers whether this is relevant to the outcome of the patient.
Home nursing in Denmark is legislatively given and free of charge. The first aim of home nursing
is to care for patients in their home and to ensure that their actual nursing needs is met. Due to
regulations from the authorities, prescribed treatment and health promotion are also among the
activities that home nurses are supposed to perform. Hospitals, general practitioners, staff from
the municipality, citizens and even the patient can request a visit by the home nurse to a patient.
One important aspect of the work of a home nurse is meeting the long-term needs of the patient.
Home nurses, therefore, usually get to know their patients over a period of time. Another aspect
of home nursing is that activities are performed in the patient’s own home, which stands in
contrast to the work of nurses in hospitals and nearly all other health professionals, except health
visitors. To be in a patient’s home to take care of a patient gives the home nurse a unique
opportunity to get to know the patient personally and to establish social relations with the patient
– and vice versa.
The question is what impact does a social relation have on the patient? A social relation
characterised by the fact that it is fundamentally and primarily professional. Does the relation, for
example, affect the social and physical outcome of the patient? In order to examine these
questions, home nurses were interviewed and participatory observation conducted to investigate
how home nurses perform in practise. This article introduces some answers and poses more
questions of the substance and effect of home nurses’ social relations with their patients.
The English anthropologist Janet Carsten has in several studies analysed the concept of
‘relatedness’. Relations and relatedness are well-established concepts in anthropological kinship
studies. Carsten examines how relatedness is formed in biological/ non-biological families,
created families, among friends and in neighbourhood. According to these studies it seems that
activities (practice), houses (places) and time are decisive elements in the creation of relations.
Parallels to Carsten’s study of relatedness can be found in home nursing, as the home nurse
practice nursing activities in the patient’s home over a period of time and consequently social
relations are often established.
The professional competence of the home nurse and her right to access the patient is the starting
point for the nurse – patient relationship. Some patients are, however, very trustful. When a home
nurse (who may be unknown to the patient) rings the patient’s doorbell, the patient, as a rule
gives access to their home without asking or seeing an identity card. This is despite the fact that
home nurses tend to wear private clothing. Yet it is the patient who gives the permission for home
nursing activities to be carried out, and who gives the permission to initiate the relation with the
home nurse. Some patients only want the home nursing activities and no more. Other patients do
not have the ability and the capacity to establish a social relationship; these patients frequently
need more time and attention from the nurse.
The nurses themselves are positive that when a good relationship between the nurse and the
patient exists, this may result in quicker improvements to the patient’s condition. These
statements need however a more thorough exploration.
Administration and coordination of the activities of all help around the clock performed for the
patient are, apart from clinical nursing, a constant and important patient in the patients’ home or
assignment of the home nurse. Unintended mistakes reduce the confidence of the patient and
may damage the relationship between the home nurse and the patient. Hence visits by the same
home nurse are very important, as the continuity of care is essential for making social relations
with the patient.
Not all patients agree to the reason and aim of the home nurse’s visit, and it can take time for the
nurse to gain the patient’s confidence and encourage support from the patient or the family. A
home nurse may, for example, visit a patient in order to change a bandage. On entering the
patient’s home for the first time she finds a patient or a family with several other health problems
that needs to be acted upon. However, patients always have to give consent for this to happen. If
a patient chooses not to allow anyone to take action, the nurse is unable to act unless children
are involved. The important issue for the nurse is therefore to perform the nursing activities the
patient agrees to. In these situations the home nurse is balancing her relations and activities so
as to suit each patient on how to inform about the health problems and possible solutions.
Patients choose the home nurse they are acquainted with to discuss a problem. If possible, they
rather wait for a nurse they know than to speak with a substitute home nurse. Some patients may
consider the home nurse as a family member; it can therefore be a surprise and a trauma when
nursing activities are brought to an end – even when the patient has been prepared this to
happen.
There is no doubt that social relations and ‘relatedness’ is shaped between the home nurse and
the patient, as a home nurse’s activities in practice are performed over time in a patient’s home.
However more detailed and thorough studies are needed in order to learn the significance and
meaning the home nurse’s relation to the patient has for the outcome.