The Changing Role of a Nurse in Lithuania Related to Integrated Team-Based Home Care Pilot Projects
Although the legal acts of the Lithuanian Ministry of Health emphasize the autonomous role of the nurse in the health care system, the understanding of the nurse as an assistant of a physician still prevails in primary health care. Many countries acknowledge nursing as an autonomous profession, where a nurse is entitled to independent decisions in cooperation with (not subordination to) a physician. The aim of the article was to describe the findings of a qualitative case study analyzing the nurses’ roles as they were shaped by the innovative integrated home care pilot projects in Lithuania and the diverse spectrum of challenges met by nurses.
Methods. The data were collected via group interaction in 4 focus groups with 5 nurses in each group (20 nurses from 20 municipalities). Inductive and deductive data analyses were used ensuring reliability and validity of findings through researchers’ triangulation.
Results. The roles of the nurses corresponded to the roles of advanced nurses: consulting and cooperating with family members by integrating the formal and informal nursing service at home with social services, consulting the nursing person and managing the nurse assistant teams, and mediating between the family doctor, hospital, and emergency aid and the patient. The degree of autonomy varied in different pilot municipalities, although the descriptions of nurses’ activities had the same legal basis.
Conclusions. Attained autonomy in the integrated team-based home care pilot projects facilitated the change of the nurse role. The challenges to the role change were connected to the interaction with primary health care practitioners, posttotalitarian experience, lack of a person-centered approach, and change through innovation.
Correspondence to L. Danusevičienė A. Mickevičiaus 9, 44307 Kaunas, Lithuania. E-mail: firstname.lastname@example.org
Received 13 May 2014, accepted 23 July 2014.