title: Client-centered home care: balancing between competing responsibilities.
abstract: This study explores and describes the perceptions of nurses with respect to everyday client-centered care. A grounded theory study was conducted with 10 Dutch nurses and auxiliary nurses giving home care to chronically ill clients. Participatory observations and semistructured interviews were held. Nurses perceived roles and responsibilities competing with the role as a responsive professional to the client demand: a critical professional, developer of client competencies, individual, and employee. Strategies in balancing between competing responsibilities were distinguished: pleasing, dialoguing, directing, and detaching. Directing (related to impaired client competencies) and detaching (related to organizational barriers) were also used as second choice strategies. Effectively balancing between competing responsibilities was seen in dialoguing and directing as second choice. Conditions identified related to these strategies are awareness of, and responsibility taking for competing responsibilities. Recommendations for practice concern a care relationship and a dialogue with the client, critical ethical reflection, professional autonomy, self-assertiveness and organizational support.
authors.affiliation: Zuyd University, Heerlen, the Netherlands.
authors.forename: Tineke
authors.initials: T
authors.lastname: Schoot
authors.forename: Ireen
authors.initials: I
authors.lastname: Proot
authors.forename: Marja
authors.initials: M
authors.lastname: Legius
authors.forename: Ruud
authors.initials: R
authors.lastname: ter Meulen
authors.forename: Luc
authors.initials: L
authors.lastname: de Witte
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001242:Assertiveness; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003152:Community Health Nursing / Q000193:education / Q000458:organization & administration; D003220:Conflict, Psychological; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D016294:Models, Nursing; D017008:Negotiating / Q000379:methods / Q000523:psychology; D009426:Netherlands; D024802:Nurse's Role / Q000523:psychology*; D009728:Nursing Assistants / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D015279:Organizational Culture; D010344:Patient Advocacy; D018802:Patient-Centered Care / Q000458:organization & administration*; D017009:Professional Autonomy; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires