Shaping and constitution of homecare nursing professionalism – continuous puzzling across actors

Background
Healthcare sector is changing due to demographic changes and political goals to reduce hospitalizations and outpatient visits. The national association of municipalities in Denmark estimates that the need for professional homecare nurses will increase by 35% in 2030. Furthermore, research indicates that professional homecare nursing has become more advanced in recent years with new expectations (Rasmussen et al 2021, Martinsen et al 2018, Melbye et al, 2018). Canadian research on community health care shows that nursing in the community sector is in crisis related to e.g. unclear role and identity, reduced or underutilized scope of practice and lack of preparation of students for community health nursing (Schofield et al 2011 p.1054). This encourages us to explore how professionalism is shaped and constituted in a municipality to analyze and nuance homecare nursing for future nursing education and practice.

Method
The study is inspired by a praxiographic approach (Mol, 2008) to explore professionalism as a complex practice. Through 5 months of multisite ethnographic fieldwork in a Danish municipality, we explore professionalism in the context of clinical teaching and education. This includes observing clinical teaching of nursing students in various situations, educational practices at different organizational levels and conducting semi-structured interviews with clinical supervisors, nursing managers, and consultants.


Results
Two main results illustrate how professionalism is puzzled into place:
Professionalism crosses and interchanges in between: In tangible situations such as wound care or ways of stepping into citizens’ home, professionalism is being shaped between citizens, everyday objects and circumstances in the citizen's life. Continuously, electronic documentation systems, driven by organizational and political requirements, come into play in the situational enactment of professionalism.
Affective valorizations constitute professionalism: In everyday practice affective valorizations about care, professionalization and service interchange between nursing managers, nurses, students and citizens shaping and constituting professionalism.

Conclusion
The study provides new knowledge to nursing practice and education about how professionalism in professional homecare nursing is continuously formed and shaped. This can be used to nuance and cultivate both future clinical teaching and nursing education in professional homecare nursing.