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JWL
23,1
6 Institute of Health and Care Sciences,
Received 6 May 2010
Revised 1 August 2010
Accepted 26 August 2010
Journal of Workplace Learning
Vol. 23 No. 1, 2011
pp. 6-19
q Emerald Group Publishing Limited
1366-5626
DOI 10.1108/13665621111097227
Learning opportunities for nurses
working within home care
Solveig Lundgren
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Abstract
Purpose – The purpose of this study is to explore home care nurses’ experience of learning in a
multicultural environment.
Design/methodology/approach – The study was based on qualitative research design. Data were
collected through repeated interviews with registered home care nurses working in a multicultural
area. The data were analyzed through a qualitative content analysis with a direct approach.
Findings – Six categories describing nurses’ experiences of learning were developed in order to
define which components were determinative in facilitating or constraining home care in a
multicultural environment. The findings show that home care demands high individual nursing skills
and also offers many opportunities for further learning. The most important sources of learning were
the challenges presented in the daily experience of encountering diversity of patients and families, by
informal social interactions and exchange of knowledge with colleagues.
Research limitations/implications – The strength of this study is that data are collected by two
different methods with time for reflection in between. Limitations are that only female nurses
participate in the study and from one team of nurses.
Practical implications – The findings can be used by nurses to create an awareness of the
opportunities that exist in everyday work. For managers, this study highlights learning and
constraints that exist on the organisation level.
Originality/value – This article adds to existing research by describing the learning environment
for home care nurses in relation to the theoretical framework that examines the factors which either
facilitate or constrain learning at work.
Keywords Nursing, Home care, Workplace learning, Sweden
Paper type Research paper
Introduction
Home care nursing is today carried out in a constantly changing environment because
during the last decade, it has assumed another role and importance, reflecting the
transition of care processes from institutional settings to the patients’ own homes. The
goal of home care is mainly to prevent, delay, or substitute long-term and acute
institutional care. As the population becomes older, the financial burden of hospital
care is increasing resulting in reductions of hospital beds and more patients are
discharged from hospital earlier. The demands on home care are expected to become
more complex (Schober, 2007). These organisational changes have required an
increased range and level of professional nursing competence. In the past, nursing
technological skills were limited to their use in care and acute-care situations. However
these existing competencies have now been transferred to the home care sector, in
order to respond to the complex needs of home care patients who can be very sick or
unwell following their discharge from hospital and still in the recovery period after Nurses working
major surgery or other medical interventions (Townes and Cook, 2001). within home care
This new situation demands a high level of skill and competence from the home care
nurse, as the overall concept of “home care” includes not only physical nursing care of
the patient, but also the ability to work within family relationships and give all of them
care and support. Home care nurse work is complex, as it must combine the knowledge
and input of doctors, administrators, consultants, researchers and the realisation that 7
home care is very different than when working with patients in a hospital setting
(Rydeman et al., 2005). Their work differs from that in hospitals in several ways since
they are responsible for a larger number of patients than in hospital care. Additionally,
doctors are not usually employed in home care and nurses mostly work by themselves
with their colleagues at a distance. Furthermore, patient care times are longer
compared with hospital care ( Josefsson et al., 2007, Weman et al., 2004). Nurses having
only had previous experience of working in hospitals realise that the different
circumstances and demands of home care requires a re-evaluation of their previous
working methods and practices (Liaschenko, 1994). Given these changed
circumstances, when nurses enter the home care sector, their previous skills and
experience do not necessarily guarantee that they will be successful. Home care nurses
must be very adaptable and flexible, as they do not have the opportunity for immediate
interaction and consultation with specialist colleagues which are available in hospital
based settings (Townes and Cook, 2001, Fagerberg and Kihlgren, 2001). This suggests
that the learning opportunities and learning needs are different than for nurses
working in hospitals.
The care environment is of the greatest importance for both the nurse and the
patient (Carolan et al., 2006). The place in which the caring process is carried out has
different meanings and implications to different people depending on their
background, ethnicity and previous experience. This influence of place and care
settings can be very determinative (Andrews, 2003) and experience of health care
cannot be separated from the places in which it is performed (Andrews, 2002). Home
care environments are often unpredictable and challenging, and thus require a different
level of spatial negotiation (Liaschenko, 1994, Peter, 2002). Workplace culture and
conditions and their impact on health and health care are important investigative
factors (Andrews, 2006).
Entering, and being in someone’s home changes assumed nursing practices, and the
usual roles of nurse/patient interaction. There are implicit rules of behaviour and
values inherent in any social space, and differences can be clearly seen between nurses
and patients having contrasting and other ethnic backgrounds (Liaschenko, 2000).
Nurses working in multiethnic areas are often faced with problems concerning a
variety of culturally diverse circumstances that require an acceptance and awareness
of cultural differences (DiCicco-Bloom and Cohen, 2003). In addition, home care nursing
is often carried out in collaboration with relatives and in cooperation with other
care-givers; this also requires an appropriate competence for the home care nurse
(Skott and Lundgren, 2009). Gerrish (2000) claims that the work context is important
for nurses to be able to develop their skills and expertise and identify what is required
in any situation. A learning context in which nurses can share, learn and support each
other when required is important (Benner et al., 1996). This is emphasised by Lave and
Wenger (1991) who claim that learning is situated; that is, as it normally occurs
JWL imbedded within activity, context and culture. Work-based learning on the other hand
23,1 is a general term that has much in common with a number of approaches to adult
learning such as informal learning in the workplace (Eraut, 2004) and structured
learning within nursing education.

Conceptual framework
8 In the ongoing development of personal competence in order to be able to give
adequate care to patients, learning at work is an essential requisite. Learning is
regarded as a process in which knowledge and competence are increased and formed
by individuals in their daily work and their interaction and community of practice.
Competence can thus be described as the knowledge and ability required of an
individual or working team in order to effectively accomplish work related to a certain
assignment, situation or context (Ellström, 1996).
In order to empirically study the development and experience of learning and work,
a number of components must be identified as being essential in this overall process
(Ellström, 2001). Certain factors and components have been identified as either
promoting or constraining an integration of learning and work. These factors include
potentials such as the learning potential of the task which includes levels of task
complexity, variety and control or scope of action, opportunities given for feedback,
evaluation of results, formalization of work processes, participation in resolving
problems, developmental activities and not least the application of learning resources.
Participation in the planning and organisation of work refer to structural aspects of the
learning environment; whereas the other components are related to the work content
and skill requirements (Ellström, 2001). Subjective aspects of the learning environment
include how work is experienced, and if any allowances are made for participant
influence in work scheduling, planning and execution. All these components are
important in facilitating or limiting an integration of the learning and working process
(Tabari Khomeiran et al., 2006, Arbon, 2004, Ellström, 2001). Learning and competence
also includes an intentional dimension, i.e. the individual nurse’s conception of how
they experience their working situation (Sandberg, 1994). On the other hand, “collective
competence” assumes that members of the working teams together share a mutual goal
and have a common understanding of the rules, norms and attitudes expected and
implicit in their work.
Both structural conditions and individual situations can either facilitate or limit the
learning process in any organisation (Söderström, 1996). It is vital that the individual
feels that learning is meaningful, that they can control and influence the learning
process and that the organisation is aware of and acknowledges the result (McKenna
et al., 2004, Ellström, 2001). The recent changes in working conditions and situations
have affected home care nurses opportunities for ongoing learning, and little is known
about their feelings and experiences of learning within this sector. The purpose of this
study was to explore the learning experiences of home care nurses working in
multicultural environments.

Method
The senior manager of home care services in a suburban district of a large city in
southern Sweden was contacted about the study and its purpose. She then took an
initial contact with the nurses working in this area, and an introductory meeting was
held, where the author gave information about, and explained the aim of the study its Nurses working
form and construction, the proposed methods for data collection as well as the within home care
conditions for their participation. The nurses were assured confidentiality and
anonymity. Following their informed consent, this included their acceptance of
voluntary participation which could be withdrawn at any time. Five home care nurses
working within the same team agreed to participate in the study. The nurses were told
that the researcher had limited knowledge of home care and wanted to learn from them. 9
All the nurses were female; one had only worked within home care for about one
year but all the other members of the team had more than ten years of working
experience within home care. All but one had experience of working in hospital care,
for example in intensive care and different surgical and medical wards for several
years. The nurse’s working area or district comprised many high-rise apartment blocks
built during the 1960s and 1970s as well as some detached houses located on the
outskirts of a large city in southern Sweden. More than half of the inhabitants in this
area had been born abroad (more than 50 per cent) mostly from the Balkans, the Middle
East, Somalia and Asia. The whole district can be described as having a low status and
being a “low income” area. At the time when the interviews were carried out, a
reorganisation of home care was being introduced. The nurses complained that they
did not know how or where they would be working in the future within this new
organisational system.

Data collection and analysis

In order to respond to the aim of the project, a qualitative research design was chosen.
Data were gathered using the noted responses in several interviews conducted with the
team of registered nurses (n ¼ 5). They were initially interviewed individually, in order
determine their understanding and learning experiences of home care within this
multiethic area. The interviews were all conducted in an office which could guarantee
privacy and they lasted from one to several hours. The formal interviews commenced
with an open-ended question: “Please, tell us in your own words about how you feel
about working in this district” followed by open and targeted questions about learning.
A preliminary analysis of the text was then undertaken, and subsequently presented to
the nurses so that they were able to comment on our understanding of their reported
feelings and experiences. This was followed by a group interview with the nurses, and
any questions which had become obvious during the initial interviews were openly
discussed. A final individual interview with each of the nurses concluded the data
collection process. Credibility was ensured by all the interviews being tape-recorded
and transcribed verbatim, so that all the material collected was open to a thorough
examination of the meaning and content, which had been carefully correlated and
coded.
A qualitative direct content analysis was used to reach an understanding of nurse’s
learning experiences in home care (Hsien and Shannon, 2005). Each interview was read
a number of times and all transcribed text that on the first impression appeared to
represent learning conditions and processes within the home care sector were noted
and highlighted. The next step in the analysis was to code all highlighted passages
using the identifying key concepts in accordance with the theoretical framework given
above. The analysis continued with the codification of all these highlighted texts, and
entered according to their relevance within each coded sub-section. Texts which could
JWL not be categorised within the initial coding categories were given a new code. Peer
23,1 group colleagues within the field of nursing research were consulted, and they
reviewed the material, and responded to the researcher reflecting their agreement or
disagreement with the final categorization of the data.

Findings
10 Experiences of learning in home care within multicultural environments are presented
in the following six categories: competency in home care nursing; interaction despite
language barriers; compliance with established rules, regulations and guidelines; the
ability to solve problems and create new working methods; new patterns of thinking;
and integrating the concept of learning within practical work experience. The themes
are illustrated by quotations from the interview texts.

Competency in home care nursing

Nurses stated that their work in home care was challenging, since their work in
patients’ homes was very complex. They emphasised the need for self-confidence and
self-reliance because they have to trust their own knowledge and intuition, as they are
usually working on their own in their assessment and diagnosis of the patient’s
situation and condition. They must be able to suggest alternative care treatments
before any contact is taken with the responsible doctors who could advise on the
medical situation and status. This was especially noted in encounters with patients
coming from other ethnic backgrounds and could be the source of misunderstanding, if
the patient demanded a treatment which was inappropriate in the opinion of the nurse.
One of the nurses expressed this as follows:
This work is satisfying because it gives you a freedom [. . .] but at the same time it is a tough
and difficult job because [. . .] there are many decisions, fast decisions that have to be made
[. . .] you do not have a general practitioner always holding your hand.
They stressed that their home care work was comparatively solitary compared to
nurses working in hospital wards, as they do not have the same kind of close collegial
network to support them as do their ward-based colleagues. As they were working in a
multiethnic area, they had to have an ongoing awareness assessment concerning the
cultural background of the patient. An important factor in this is an acknowledgement
of cultural differences, and an acceptance of the personality of the patient. As most of
these patients have their close or extended families wishing to participate in their care,
nurses felt that they must also be oriented towards the needs of both patients and
family, and to adjust to and be aware of the family needs and requirements. They
stressed the importance of showing concern for both patient and relatives, which
sometimes required a delicate balance between the patient and the family and they
underlined the importance of proceeding very cautiously. This required a high level of
empathy and flexibility, and the ability to deal with difficult situations without any
immediate support. It also includes the support and advice given to close relatives, and
the consideration of their stated opinions and their personal experience of the care
situation. The nurses stated that their professional competence was tested with every
new patient and new situation. They thus declared that they needed the independence
and courage to take decisions and initiatives of different kinds, to initiate procedures
without waiting for approval, directions and guidelines from the management:
 You are always learning so much [. . .] to be flexible [. . .] it really [. . .] widens ones boundaries Nurses working
[. . .] one becomes more open-minded [. . .] in my way of thinking, this work is really a
development process. within home care
Furthermore, as another nurse said:
It is a constant variation in which things were happening [. . .] you just had to [. . .] listen to the
patient [. . .]
11
They felt that every day gave them the opportunity to learn new things since each
home must be considered as a unique setting. This required nurses to organise their
own work schedule, and being open for any of the patients or relatives wishes, to
relinquish control of a situation, and not taking anything for granted. One nurse
described this aspect of her work as follows:
It feels very exciting each time you have a new patient [. . .] you have no idea of what lies
behind the door [. . .] so you put yourself into neutral and await all the challenges” [. . .]

Interaction despite language barriers

Nurses felt that they, in their every day work, could receive feedback from meetings
with patients and their families in their home environments. However, they did
experience language barriers when caring for patients coming from other cultures.
This meant that the nurse had to simplify her statements and instructions, changing
and adapting her usual methods of communication. This involved using a simple
language, using short meanings and simplified words and expressions in the attempt
to communicate and to be understood.
There were many occasions when nurses caring for people from other cultures,
experienced uncertainty about how these patients experienced the care provided. Some
misunderstandings were often caused by differences in their understanding of the
meaning and concepts of the language used. This meant that the nurse could not
always be sure that she and the patient had the same comprehension of the meaning of
the words; or if the patient had other unexplained expectations or needs. To avoid any
misunderstandings and to get feedback from patients, nurses often relied upon
non-verbal communication signals, and learned by observing their patients’ body
language, reflecting what they wanted, or did not want, or any of their other feelings.
This was one way in which nurses were able to understand the meaning of both
positive and negative feedback.
You can show and learn so much through body language: You must be more demonstrative
in your body language when you are unable to communicate with words.
Nurses reported that they had all learned a lot through being in situations in which
something had gone wrong, or they had made some mistakes or had received negative
feedback. These situations gave them the opportunity to reflect upon and examine
their performance, and how they had been able to offer and supply care services. They
stressed that cross-cultural interaction and communications takes much more time and
energy than caring for those within the indigenous population. However, in most cases
communications were judged as satisfactory, so that the nurse was able to estimate the
outcome of the care needed and provided. One nurse described it in this way:
It always seems to be the bad meetings [. . .] these are when you learn [. . .] you know that you
have to do it in a different way the next time.
JWL Compliance with established rules and guidelines
23,1 Nurses new to the home care sector felt a need for formalised instructions concerning
how they should act within any patient interaction situations. Experienced nurses
called into question the benefit of formalised and written routines, as they felt that
these would limit their freedom of action and flexibility based on their own prior
experience of actual situations. They also emphasised that when caring for patients in
12 their homes they could not comply with all the given instructions and guidelines, as
they felt that these had been formulated and based upon the care and treatment of
hospital patients. They were all in favour of this more independent way of working as
they felt they could use all their knowledge and extend their individual competence.
[we] are not able to have the same control as hospital nurses [. . .] what patient has eaten or
drunk [. . .] you feel as if something is missing somewhere [. . .] But you begin to see it as a
completely different situation [. . .]

The ability to solve problems and create new working methods

Nurses felt that their work was independent, allowing them a great degree of personal
freedom and the opportunity to work according to their professional judgement. The
result of this was that each individual nurse had developed their own methods of
working, creating patient activities and dealing with problems. They stressed that
there was a great difference between home and hospital care situations, as home care
nurses were expected to analyse the underlying causes and immediately deal with any
problems encountered using their own judgement and experience.
It is up to us to decide when we feel we have to contact the doctor [. . .] this is different from
hospital, where they have regular rounds.

New patterns of thinking

Home care nurses stated that they had learnt mostly by the experience gained during
the course of their everyday work. Relationships with patients and their families,
especially with those coming from different cultures was one of the greatest
contributory factors in their own knowledge development. Through their encounters
with people belonging to different cultures they were forced to adopt new patterns of
thinking. If they were inexperienced in these cultural situations, for instance in how
they should deal with severe illness, they usually consulted their colleagues. This,
however, was usually undertaken by telephone from the home of the patient, or later
when they were in the home care office. However, present organisational procedures
allow very little time for the exchange of ideas and experience, interaction with other
nurses, or opportunities to receive new knowledge. Following their formal education,
nurses are given very few opportunities to extend and increase their knowledge. Any
further education and learning initiatives are regarded as the responsibility of the
individual nurse.
We learn so much when we can get an insight into other cultures.
According to the nurses, there are few management initiatives which promote further
learning activities. The new organisational structure has even reduced the time
allowed during working hours for reading scientific and professional journals in order
to increase their knowledge and awareness of the latest developments taking place
within the care sector. Nurses stated that managers should encourage and initiate Nurses working
learning activities based on an assessment and awareness of the nurses’ needs of an within home care
ongoing education.
I was sent on a course – on my own, and when I came back no one asked me about it, and
there was no time or opportunity to inform the others about what I had learned. I think it is a
poor use and sharing of the knowledge that exists.
13
Organisational constraints
The nurses felt that their work was greatly affected by new management procedures
determined by the external organisation, and that decisions were mostly made
according to budget limits and targets, and not according to the needs of patients. Due
to “financial cutbacks”, the time allotted to and spent with each patient had become
severely limited. The nurses were frustrated because management prioritised the
statistics of efficiency and outcome of nurses visits per day, rather than the content of
the care given, and how this affected the nurses’ working situation. This concentration
on “efficiency” has lead to an increasing conflict between financial directives and the
nurses concern for their patients. This has resulted in a change from patient-centred
care to one of carrying out nursing tasks as quickly as possible, so that the holistic
view and care of the patient has become lost. Some of the nurses express this as
follows:
Unfortunately, they cut down on the financial resources we had, so we always have to work in
a hurry [. . .] but we still try to give our patients some qualitative time [. . .] we have to be very
good at prioritizing individual cases.

Discussion
This study investigates nurses’ experiences of learning through their daily work in
home care in a multi-cultural area. The findings indicate that home care in a
multicultural area is complex and varied, and demands a comprehensive and extensive
knowledge from the nurses and require more flexibility since they have to deal with
different culture expressions. They stated that their work allowed many learning
opportunities as they were constantly challenged in order to provide quality care to
patients. They understood and recognised that their work demanded a self-trust and
self-reliance in their professional role which encompassed their competence, medical
skills, knowledge and experience. These factors were the basis which they used when
taking independent decisions regarding patient’s treatment and medical status i.e.
referral to the responsible doctor or admittance to hospital. All the nurses emphasised
the importance of flexibility, having a cultural awareness and being able to adjust to
any situation. This shows that they have the awareness, capacity and self-confidence
to identify and take advantage of their working situation in order to learn. They were
all well aware that caring for patients in their own homes, especially those patients
having a foreign background requires a great deal of understanding and empathy.
Encounters with patients from different cultural backgrounds were not seen as
presenting any particular difficulties (apart from language difficulties), but were rather
considered as “opportunities for learning”
Nurses stressed that they had to develop their skills of observation and
interpersonal communications to be able to know and satisfy each patients particular
JWL nursing needs (Spence, 2004). To communicate with and to interpret patient’s verbal as
23,1 well as body language was described as a challenge. Providing culturally appropriate
care is in many ways more difficult, because it requires that nurses must adapt their
own cultural beliefs, values and practices to the beliefs, values and practices of their
culturally diverse patients (Narayan, 2002). At the same time, the nurses were well
aware that their ability to learn was related to their particular work place, i.e. the
14 patient’s own home environment. The nurses considered the most important sources of
learning were the challenges provided by their work, their daily experience of
encountering diversity of patients and families, and by social interaction and the
exchange of knowledge with their colleagues (Berings et al., 2008).
The nurses in this study stated that learning resources, in terms of the time given
for analysis, personal reflection, the exchange of ideas and experience were not allowed
for on a regular basis. This meant that the time for any review of the care given was
limited, reflecting the current priorities given by management and the overall
organisational directives. The organisation must realise and become aware that nurses
need some time for a consideration and review of their home care actions, and a time
for interaction with their peer group in order to update their knowledge if their work
place is to be considered as a learning environment.
Nurses must be able to provide an adequate level of home care as the aim is to allow
patients to remain in their home environment as long as possible. Furthermore, many
studies conclude that home care nurses require strong support from their superiors
since their work is individual and solitary compared with the situation of nurses
working in hospitals (Grönroos and Perälä, 2008, Ellenbecker et al., 2006). Particularly,
any newly qualified nurses need to receive feedback and support concerning practical
problems they encounter as soon as possible. But presently, the opportunities given for
support, for feedback, and any review of the outcome of their care work together with
colleagues is limited, and the support given by their superiors is even more limited.
As is shown in the findings, some nurses wished that there were some formalised
and written rules or instructions about how they should deal with daily routines such
as giving prescriptions and complying with administrative requirements. One
argument for the formalization of routines is that it could save time for the performance
of more creative nursing tasks especially for nurses new to the work. However, from a
learning perspective, the formalization of work processes can be regarded from two
distinct points of view; they could either seriously impede learning if the individual
tended to focus on “doing things right” instead of “doing the right thing”, or make it
possible to reallocate attention and time from following routines to more creative tasks
(Nordhaug, 1994). The nurses were concerned that any rules and regulations could be
counter-productive in the giving of care and treatment to the patient. Nurses stated that
each encounter with their patients and families could not possibly be described as
“routine work”, as each encounter was new and different, and they had to engage in an
interactive process of “getting to know” the patient especially in cross-cultural
meetings.
Even if the nursing tasks are initially determined by the responsible doctor, the
nurses need the self-confidence to rely upon their own knowledge and intuition. They
must also have the insight and imagination to deal with situations in which they have
had no previous experience, and implement solutions to accomplish a positive outcome.
 The constraints and guidelines issued and determined by “the authorities” had a Nurses working
great influence and impact upon how nurses experienced their work and working within home care
situation. If this is expressed as “efficiency” i.e. in the number of visits carried out in
any set time period, it is obviously not in agreement with the experience of the nurses
who are performing the care work in the best interests of their patients, and the
creation of a mutually trusting and secure relationship. In addition, the reorganisation
of home care during the time this study was carried out had resulted in feelings of 15
insecurity and lack of control regarding the future, and fostered feelings of frustration
and gloominess (Skott and Lundgren, 2009, Fläckman et al., 2009). The nurses also
wished that the managers would initiate learning activities based on a realistic
assessment of the nurses needs. Very few management initiatives have been
undertaken in order to provide further learning opportunities and activities. It has been
suggested that being given sufficient opportunities to participate in the
decision-making process related to their own work is especially important for
sustaining competence in a demanding environment such as home care (Grönroos and
Perälä, 2008).
The findings in this study indicate that nurses are more than willing and in fact
want greater opportunities for further learning and personal development. They realise
that the complexity and variety of their everyday encounters with patients offers a
unique learning situation. It can also be concluded that they already have the
conceptual tools and explicit knowledge concerning their care tasks and work
processes to be able to identify and interpret their experience and use these
opportunities for learning (Ellström, 2001). All nurses could give specific examples of
learning at work and the situations in which they had acquired new knowledge. Even if
some of the nurses had experienced negative response situations, these had challenged
their current knowledge and skills and had stimulated them to thinking in new terms
and using these as a learning experience (Wu et al., 2003). However, the learning
potential of any experience, situation or task is only one part of the learning process as
there are also many individual differences and learning potential can be expected to
differ (Ellström, 2001). For example, such as how our personal history affects what we
acknowledge as experience and depending on personal readiness and desire for
learning (Boud et al., 1993).
Learning at work among home care nurses was based mainly on experience.
However, learning at work is a complex process in which nurses are working, thinking,
making decisions and learning at the same time (Berings et al., 2005). According to
Torraco (1999) learning from experience – one’s own experiences and the shared
experiences of others is a central part of developing skilled performance, which,
according to Rolfe (1997) can also be used in future nursing situations. However, it has
been found that knowledge acquired through experience has a specific character and it
has been shown that it is very difficult to develop explicit knowledge through
experience (Svensson et al.(2004). This presupposes that explicit pre-knowledge in the
form of theoretical and professional knowledge is required to facilitate informal
learning by experience. Further research is needed to investigate the similarities and
differences between home and hospital care concerning conditions that are likely to
promote or constrain learning at work for individual nurse, work organisation and
other professionals that work in hospitals and home care. Additionally, it would be
JWL very interesting to use these components for further research in other countries with
23,1 similar home care organisations.

Implications for practice

The findings from this study can be used by nurses to create an awareness of the
opportunities for personal development that exist in everyday work. For managers of
16 care, this study highlights learning and constrains that exist on the organisation level.
The findings can be used for development of activities that provides opportunities for
multiple types of learning and for design of work organisation that minimises
constraints and facilitates and support nurses in their every day work.

Strength and weaknesses

A qualitative design is adequate to explore and describe an unknown phenomenon
such as learning experiences of home care nurses that involves a small number of
informants. The strength of this study was that data were collected by two different
methods (individual and group interview) with time for reflection in between which
allows for the possibility to capturing the nurses experiences of learning. The data
collection was carried out in agreement with the informants and there was an
atmosphere of trust between the researcher and participants. The trustworthiness was
further achieved by including quotes that show how the findings are grounded in the
data, and to give “thick descriptions” to allow readers to more fully understand the
findings. Limitations are that only female nurses participated in the study and from
only one team of nurses..

Conclusion
The findings of this study have been analyzed according to the components assumed
critical for facilitating or constraining integration of learning at work. The findings
show that the learning potential in the home care sector is good, since home care
requires a high level of skill and offers many opportunities for learning (Ellström et al.,
2008). The work is complex, as home care work can be judged as having a degree of
complexity that demands flexibility and the ability to work within unstructured
settings, especially for those nurses working in multicultural areas. Even if home care
work is based upon routines and procedures specified by the doctor, nurses had a large
degree of freedom in which they could organise and instigate their own creative
solutions to unusual or unexpected problems, based on their previous knowledge and
experience. It can be stated that they had found an adequate balance between routines
and freedom of organizing work. They could receive valuable feedback from their
patients, but usually not often from their superiors. The evaluation of the outcome of
their care actions was often only a personal assessment and reflection. They gained
knowledge and learning from the wide variety of encounters with patients and
relatives in their nursing activities. They felt that they did not learn much from any
formal educational activities initiated by the management. These findings indicate that
nurses already have sufficient knowledge and skills to be able to identify and utilise
the opportunities for learning they encounter during their daily work. They would all
welcome any opportunities for further formalised learning. However, their greatest
wish was to be allowed the time for increased opportunities to be able to discuss and
exchange work and care experiences with their colleagues. All the nurses in this study
worked in the same home care team and multicultural district, and it is possible that Nurses working
home care in other districts could show different learning experiences. Nevertheless, within home care
the ability to learn and utilise the learning opportunities available in home care
presupposes a sound theoretical and professional knowledge which enables and
facilitates learning from actual experience.

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Corresponding author
Solveig Lundgren can be contacted at: Solveig.Lundgren@gu.se

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