Structures and systems in everday home care nursing work: Impacts on nurse-patient relationships from the patient perspective

This thesis examines the institutional structures and systems that coordinate everyday home care nursing work, and how they impact development of nurse-patient relationships from the perspective of patients. Using an institutional ethnographic methodology and incorporating patient-oriented research approaches, I interviewed patients and caregivers to gather rich descriptions of what actually happens in the day-to-day work of receiving home care nursing services, including the work of home care nurses that is visible to patients. Though institutional constraints related to efficiency and productivity can make providing relational care challenging, patients and home care nurses work around these ruling relations and find ways to meet the relational care needs of patients. The often-invisible labour of relational care needs to be recognized and valued at an institutional level to ensure home care nurses can meet the holistic care needs of patients and provide high quality, personalized, patient-centred care within a resource-constrained system.