"You are not yourself anymore" : The place of the ethical demand in a practical home care context

The study's rationale: The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its personoriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. Aims and objectives: This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. Methodological design: The article is based on an empirical narrative in the form of an individual qualitative research interview. Findings: The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. Conclusion: The system of New Public Managementsets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize orstrengthen the old person´s dignity