Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria
Abstract Background Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of t...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-11-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10276-2 |
| _version_ | 1797577233588551680 |
|---|---|
| author | Deborah Drgac Raffael Himmelsbach |
| author_facet | Deborah Drgac Raffael Himmelsbach |
| author_sort | Deborah Drgac |
| collection | DOAJ |
| description | Abstract Background Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people. Methods We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings. Results We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’. Conclusion Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing. |
| first_indexed | 2024-03-10T22:05:19Z |
| format | Article |
| id | doaj.art-4ea336f49d3c4edaaf8f1ba347d188dc |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-10T22:05:19Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-4ea336f49d3c4edaaf8f1ba347d188dc2023-11-19T12:48:17ZengBMCBMC Health Services Research1472-69632023-11-0123111210.1186/s12913-023-10276-2Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in AustriaDeborah Drgac0Raffael Himmelsbach1Department of Political Science, University of ViennaResearch Group Senescence and Healing of Wounds, Ludwig Boltzmann GesellschaftAbstract Background Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people. Methods We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings. Results We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’. Conclusion Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.https://doi.org/10.1186/s12913-023-10276-2Chronic wound careInterprofessional collaborationTherapeutic relationshipExperiential knowledgeAustria |
| spellingShingle | Deborah Drgac Raffael Himmelsbach Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria BMC Health Services Research Chronic wound care Interprofessional collaboration Therapeutic relationship Experiential knowledge Austria |
| title | Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria |
| title_full | Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria |
| title_fullStr | Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria |
| title_full_unstemmed | Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria |
| title_short | Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria |
| title_sort | acts of negotiation toward a grounded theory of nursing practice in chronic wound care in austria |
| topic | Chronic wound care Interprofessional collaboration Therapeutic relationship Experiential knowledge Austria |
| url | https://doi.org/10.1186/s12913-023-10276-2 |
| work_keys_str_mv | AT deborahdrgac actsofnegotiationtowardagroundedtheoryofnursingpracticeinchronicwoundcareinaustria AT raffaelhimmelsbach actsofnegotiationtowardagroundedtheoryofnursingpracticeinchronicwoundcareinaustria |