Making ‘it’ work: Nurses as essential linchpins in the home care context

Registered- and community health nurses in municipal home care (hereafter referred to as home care nurses) have a demanding job that is special compared to other forms of healthcare. The work is mobile, and care in the field is often carried out in solitude. At the same time, the patients being cared for often have complex care needs, requiring cooperation and interaction. Contact with colleagues in overlapping settings is frequent. Work responsibilities are clearly divided, but the work situation is clearly co-dependent. At the same time, contact with other actors can be poor. As the home care nurse is the hub of healthcare in the municipality, this makes their work situation demanding.
The overall aim of the thesis is to increase knowledge about the psychosocial work environment of Swedish home care nurses with emphasis on teamwork, communication, and technology use. More specifically, the focus is on how they make communication and their situation work. By analyzing this from theoretical frames of reference, increased understanding of how communication can affect conditions in the psychosocial work environment and working together can be achieved. The thesis research has been conducted within the framework of two projects. The first research project investigated the introduction of interprofessional mobile teams in Scania and their impact on the work environment of municipal health- and care staff. The second research project investigated how the COVID-19 pandemic affected the work environment of care workers. This thesis encompass one scoping review and four empirical papers. The approach in this thesis was qualitative and explorative, with a methodology inspired by ethnography. The data collection methods consisted of semi-structured interviews and shadowing.
The results of the thesis show that teamwork in the home care context is not a well-researched area. However, the existing literature indicates that teamwork can be an important source of support for home care nurses to maintain
control over their situation and to find support in their work. The results show that despite the region-wide implementation of mobile teams in Scania, the practice was rarely developed successfully. The success factors found in organizational precedents and in the scientific literature were missing in the municipalities studied.
It is important for home care nurses to work together and communicate at work to cope with the work situation. Nurses work together with others in the municipality, as well as with regional and private providers. Technology is important here, as it is used as a medium through which communication flows enables interaction at a distance. On the one hand, with the right combination of various media’s capacity to convey communication and the processes needed to work and solve tasks, the psychosocial work environment can be promoted. On the other hand, if this combination is not right, the work environment can be negatively affected. Home care has started to undergo a digitalization process that historically has not been very technology intense. The pandemic accelerated this process and forced home care nurses to adopt new ways of working to maintain home care provision and to protect staff. New technologies were introduced to maintain interaction during a time of social distancing, all of which subsequently met different fates based on how they fit the conditions present after the pandemic.
In conclusion, it can be said that teamwork, communication, and technology use influence people's psychosocial work environments. At the same time, the psychosocial work environment shapes both the conditions in which people work together and their communication. Nurses' work situations are strained and our need for nurses is great. It is therefore important to provide nurses with the working conditions they need to feel good and to excel in their work.