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Table 4 Findings

From: Gaming the system to care for patients: a focused ethnography in Norwegian public home care

Categories Pattern-categories Themes
Frustration and discontent due to organization and lack of time (O, P5, P6, N1–3, N6, N8, N9) Conflicting values Rigid organizational systems complicating nursing care at the expense of caring for patients
Being managed by economic values (O, N1-N9)
Documenting just to be surveilled (O, N4, N6-N9)
Invisible “time-thieves” (O, N1–10) Trying to make ends meet
Organization that complicate the provision of care (O, N1–4, N6, N8–10)
Unsolvable time-puzzles (O, N1–6, N8–10)
Organization at the expense of patients (O, P4, P6, P7, N1–4, N6, N8–10) Increased suffering related to care
Time pressure affecting relationships, caring, quality and compassion (O, N1–6, N8–10)
Experiences of busyness and stress (O, P1–6 N1–6, N8–10)
Meaningful relationships and conversations (O, P1–8 N1–10) Understanding relationships as a fundament for nursing care Having the patient’s health and wellbeing at heart
Being able to trust nurses causes feelings of safety and serenity (P2–8, N1–10)
Prioritizing conversations (O, N1–8, N10)
Nursing care tailored to unique and changing needs (O, P1–4, P6–8, N1-N8, N10) The value of caring actions, which cannot be measured
Meaningful actions that cannot be fixed in decisions (O, P2, P3, P5–8, N1–10)
Focusing on the patient’s needs (N1–6, N8–10)
Nurses making autonomous choices based on professional judgement (O, N1–9) Professional autonomy Compensating for a flawed system
Juggling minutes (O, N1–7, N10)
Manipulating timers and decisions (O, N1–4, N6–10)
Patients adjusting their behavior to ease nurses job (O, P1–5, P7, P8, N1–6, N8) Accepting and adjusting behavior
Nurses surrendering to the system (N2, N3, N5–8)
Grateful patients with few demands (O, P1–8, N2, N3, N6)
  1. Patients (P1–8), Nurses (N1–10) and Observational data (O)