Tradition och horisont vårdkulturens betydelse för vårdens praxis

Abstract: The main aim of this thesis was to illuminate and understand aspects of care culture as a meaning–making process that influences the care praxis. In health care there is increasing recognition of the impacts on organizational culture of health-related matters. Although the factors studied affect care and nursing care, there has been little research from a caring science perspective. Care culture is understood from a hermeneutic perspective as a meaning-making process related to tradition, horizon and “bildung”. These three concepts give care a meaning cohesion that helps caregivers to orient themselves and acquire a care praxis.Study I was an interview study with seventeen nurses working on different wards. Study II was a focus group study, and included three focus groups with 24 nurses and a secondary qualitative analysis of interviews from study I. Both studies I and II used a phenomenological-hermeneutic approach. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study IV was a case study involving 12 individual interviews and one focus group interview that included four participants. All participants were working at various levels in the municipal organization and were directly or indirectly connected to a mistreatment situation. This research also included a two-day field study and a document study. The individual interviews and focus group interviews were analyzed using a phenomenological hermeneutic approach.The findings show that care culture can be experienced as positive and enabling of good care but also as defective and an obstacle to good care. Three different care cultures were identified: a service, a social and a motherhood culture. All cultures showed traces of caring values, but from a caring theory perspective, none of them fully demonstrated understanding of the notion of existential caring revealed as the integration of freedom and vulnerability. By studying the underlying traditions and the caregivers’ horizon, the care culture can be illuminated and understood through its expression in praxis. From gaining a comprehensive understanding, a caring ideal could open up and reflect the care culture´s boundaries. This means that ideals can have different interpretations depending on the conditions the care praxis is based on. The gap between care theory and praxis can therefore be understood to mean that the care culture does not use Bildung as a process of alienation and appropriation, resulting in no transformation of the prevailing tradition.Care culture could be distinguished from three different perspectives. They are referred to in this thesis as the prevailing, the visionary and the critical perspective. Developing a hermeneutic concept of culture, understood as the care culture´s critical perspective, could serve as an opportunity for a reinterpretation of nursing theory´s meta-paradigm concept of environment.