7.1.1. Curing

From the nurse informants’ opinions emerged the curing component. The patients’ recovery, good health, and ability to maintain health were said to be the goals of professional nursing care. The nurses considered medication and technical interventions, such as inserting cannulas or nasogastric tubes, giving injections, and applying splints, as means for helping and curing incapacitated patients. The nurses expressed their frustration because, in their opinion, the hospital was not adequately equipped to allow nursing procedures. The nurses spent a great deal of their working time for medication and technical interventions, or activities related to them.

Apart from technical interventions, health education was important for achieving this goal. The nurses considered themselves enlightened with knowledge related to nutrition, hygiene, micro-organisms, medicines or family planning, and shared the opinion that people need health education because of their ignorance. They emphasised the importance of the assessment of a patient’s need for performing technical interventions and belief assessment for tailoring health education.

The nurses viewed protection of life as their moral responsibility. This led to the use of authority over the patients, which was seen in situations where a patient’s life was in danger due to lay healing practices, or when they were not able or willing to obey the nurses’ instructions. The nurses were distant when the patient was dying or a mother had a still birth or when the patient had AIDS. The informants explained that they were afraid of the reactions of the patients or their relatives, or they did not want to add to their burden by paying attention to what was happening or had happened.

The nurse informants considered themselves trained health care professionals and viewed themselves as members of the medical team. To be allowed to perform technical interventions or medicate patients, they depended on the orders of the medical personnel, which was criticised by some informants, who wanted to widen the role of nursing care more to the medical side. The nurses emphasised training as a way to acquire the knowledge and skills which the profession required. Outward signs of being trained to a profession, such as the certificate of a training institute, the registration, and the right to wear a uniform were considered important. They were public evidence of the profession, approved by the Ministry of Health. The professional status with the knowledge and skills had motivated the informants to applying to nurse training. Nursing was not a way to make money for the informants.

7.1.2. Caring

The nurse informants compared mothers to nurses and shared the opinion that every mother is a nurse, because she practises primary care. Primary care meant taking care of the basic needs of a child and running a household in a way that maintains health in the family. The informants strongly supported the opinion that taking care of a child includes interventions found in professional nursing care, such as comforting, touching, presence, protection, and health maintenance. This reflected the view that taking care requires skills which are acquired naturally and which normally belong to motherhood.

Comforting and engouragement were observed every day in the nurse-patient encounters. It occurred prior to nursing or medical interventions whenever a patient felt himself unsure or awkward, and its aim was to reduce the patient’s fear. The meaning of touching was to reduce fears and to make the patient feel an esteemed person. The nurses built up the relationship with the patients and their relatives by greeting, talking politely and kindly, listening, looking into their eyes and touching them – all activities showing the nurse’s presence. Story-telling, giving pain killers and a promise to contact a doctor were used to reassure and comfort the patients and their relatives. The nurses emphasised personal characteristics, such as friendliness, and calling as indispensable attributes of the care profession.