The notion of empowerment might shed a new light on nursing practices, writes Marek Pawlak in a new blog post.

By Marek Pawlak

In my ethnographic field research on Polish nurses in Norway, I’m focusing on their personal migration stories, work experiences, and adjustment to the Norwegian health care system. Obviously, these issues vary depending on migration strategies, recruitment arrangements, and particular workplaces, but they all also inform our understanding of the complexity of the Norwegian health care system.

Although some nurses I’ve met during my research work in Norwegian hospitals, the majority of the Polish nurses have found employment in nursing homes (sykehjem) scattered around Oslo. The concept of nursing home, though commonly known and present in many welfare states, seems to be imagined and practiced differently. These differences don’t stem solely from the “usual” case of economic conditions and the state’s policy approach to care of the elderly. The social and cultural understandings of care play a pivotal role in “who,” “why,” and “how” we should be looking after the elderly.

Through various discussions I had with Polish nurses working in sykehjem, it became obvious that in order to understand their work, as well as the differences in the approach to care in Poland and Norway, I myself needed to spend some time in a nursing home and experience it as a place of emerging social relations and cultural meanings.  

Hanging out in sykehjem

An American anthropologist, Renato Rosaldo, once famously said that ethnography is all about deep hanging out. I find it a rather accurate way of explaining fieldwork and what “being there” entails. After all, it enables us to rely not only on “what people say,” but also “how people act,” which is often not the same thing.

After several attempts and indispensable help from my Norwegian colleagues, I was finally granted access to two nursing homes in the Oslo area, where I could hang out, talk to the staff, shadow Polish nurses during their shifts, and observe care in practice. I selected two nursing homes for my participant observation. One, let’s call it Hjerte, is state-funded, but administered by a private company. It has almost 100 residents and over 200 staff employed on either fixed or temporal contracts. The other one, Lunger, is a private nursing home with around 50 residents divided into smaller wards of 6-10 rooms. In both Hjerte and Lunger, there are special wards designated for residents with dementia and advanced Alzheimer, as well as day care wards, where residents could come and gradually adjust to the living standards.

There were some differences between Hjerte and Lunger, particularly when it comes to space arrangements. My first impression was that Hjerte is very welcoming and family-oriented space with homey décor and photographs of residents and their families on the walls. Lunger, on the other hand, appeared to me as a very modern, almost hospital-like space with only a few abstract paintings on the walls. It wasn’t as lively as Hjerte, at least at first glance.

In both nursing homes, I spent either the night, day or afternoon shifts following two Polish nurses, participating in their routines, observing their work, and discussing differences between care in Poland and Norway. They showed me around, introduced me to other staff and residents, and explained in detail various nursing procedures. It was an important and rich research experience.

However, I must admit that at the very beginning of my field research I felt discomfort. While shadowing nurses, I felt like an out-of-place stranger, a kind of intruder entering someone’s home and disrupting their daily lives. But, the longer I hung out there, the more welcomed and comfortable I began to feel.

Empowering the self and others

Although the observation and participation in Hjerte and Lunger was not as long as I would have liked it to be, it surely expanded my research problematisations in terms of differences between care practices in Poland and Norway. In both nursing homes, I participated in events organised for the residents and their families. Be it a music performance or a barbeque (moved indoors due to rain), they all revealed a common care for elders. Soon enough, though, I realised these activities were not some special and extraordinary events, but rather routine activities, which engage the staff, residents, and their families, and produce different forms of intimacies. In both nursing homes, I have also visited spaces designated for specific and rather mundane activities. For example, in Lunger there was a grocery store, a restaurant, and a pub, where residents were no longer just residents but also customers, who need to be served.

This sort of approach was best described by a Polish nurse, whom I met in Lunger: “You see, it’s important to get them out of their beds and their pyjamas.” In this rather playful, yet significant, statement she implied not only the existing differences between nursing homes in Poland and Norway, but also the very different idea of care practices. After all, by referring to “beds and pyjamas,” she made a clear distinction between a passive and active approaches to sykehjem’s residents as well as nursing practices per se.

While juxtaposing my fieldnotes from sykehjem with the ethnographic interviews and discussions I had with Polish nurses, I started thinking about empowerment as an important aspect of care. Most Polish nurses, while comparing their work experiences in Poland and in Norway, referred to changes in their relations with doctors and patients, which might be conceptualised as forms of empowerment. They feel empowered because they are treated with respect, as equals and professionals, but they also empower others, the residents and their family members by involving them in various activities.

The notion of empowerment is obviously a complicated one, not least in terms of its neoliberal connotations and usages. It has been hijacked by the neoliberal ideology and has become a part of newspeak, in which empowerment is often linked to the idea of “being active” and “evaluating and managing yourself.” Moreover, empowerment might also be seen as playing a significant role in the gradual shift from welfare-dependency to work as a justification of austerity measures introduced by states. However, empowerment is also about the agency understood in Marxian terms and has been widely used in different contexts to expose the existing hierarchies and power relations. This notion of empowerment might also shed a new light on nursing practices by unfolding the social and cultural background of care itself.