Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria

Background Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people. Methods We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings. Results We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’. Conclusion Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-023-10276-2.


Ques,ons related to professional life in general
Ques,ons about pa,ents and rela,ves • Please describe a typical first admission with a pa1ent.
-Are first assessments depending on the seYng (is the first admission in home care different from the clinic?)-What are the ini1al steps during the first assessment?-How do you educate the pa1ent about the wound and the treatment?Ques,ons about other health professionals

Debriefing
Thank you for sharing your 1me and insights during our interview.Your contribu1on has been immensely valuable to our research; it provided us with a deeper understanding of the intricacies of wound care.Your perspec1ve adds a unique layer to our study, and we appreciate your openness in sharing your experiences.How was the interview experience for you?Your well-being and sa1sfac1on are crucial to us, and if there are any aspects you'd like to discuss or provide feedback on, please feel free to do so.We want to ensure that the interview process is respeccul and aligns with your expecta1ons.Is there anything you feel was led unexplored or any topics you would like to revisit?Your input can guide us in refining our research focus and ensuring that we capture all relevant aspects.What mo1vated you to par1cipate in this research?Understanding your perspec1ve helps us appreciate the significance of your involvement and contributes to the context of your responses.Lastly, if you have any further ques1ons or if there are colleagues or acquaintances you think might be interested in par1cipa1ng in our study, please do let us know.Your network could poten1ally enrich our study.
We look forward to incorpora1ng your insights into our research and contribu1ng to a deeper understanding of wound care.Would you like to be informed about forthcoming publica1ons?We would be pleased to stay in touch and share our research progress with you.
Thank you again for your 1me.

•
To start off, tell me a bit about yourself and what you do professionally.• How did you start working in wound care?• How does a typical day in your work life look like?• What do you enjoy about your work?• What do you experience as challenging about your work?(For those who work in nurse-led clinics or home care) • How would you describe working in the clinic?• How would you describe working in home care?(If the interviewee worked in another medical field before) • How would you describe your work now compared to your work in field _____?• In your percep1on, are there differences in the field of wound care, compared to other medical fields?
Ques,ons related to wound care in the Austrian health system • How would you describe inpa1ent / outpa1ents / hospital / private / primary care in Austria?(Formula1on of ques1on depends on the seYng in which the interviewee has worked or is currently working) • How would you describe wound care in Austria?• Based on your experiences, what could be improved / what works well in Austria's' wound care?• What do you consider "important" in wound care?• How would you describe "successful wound care"?• What does "wound healing" mean to you? (Beyond wound closure) • In your opinion, what could policymakers do for wound care in Austria?