MultiCare. A project on nursing homes as integration and inclusion arenas.
MULTICARE is a research project funded by the Research Council of Norway (NFR), HelseVel, 2016 - 2020. The project is led by the Centre for Care Research, West (SOF V), at the Western Norway University of Applied Sciences (HVL), and partners include NORCE Community, University of Stavanger, Stavanger University Hospital, and The Netherlands Institute for Health Service Research (NIVEL).
The municipal healthcare and care sector is increasingly becoming an arena where immigrants and labor migrants find employment, especially women. MULTICARE researches, from a comparative perspective, the development and work in the municipal healthcare and care services in Norway with a special focus on work as an 'integration key' and workplaces as important arenas for the inclusion of immigrants. More specifically, the project examines how nursing homes organize care work, services, and the multicultural staff. Key questions in the project include: What types of challenges and opportunities, organizational, social, and existential, are experienced by different actors in multicultural work communities in Norwegian nursing homes? What practices, routines, or measures exist at various levels that are directly related to these challenges and opportunities? MULTICARE has four work packages with the following research focuses: 1) Care services in nursing homes in urban and rural areas, 2) Leadership and practices for the integration of ethnic minorities in work communities, 3) Knowledge and training of leaders for multicultural staff, 4) Communication of and practices related to death in multicultural and multireligious work communities.
In MULTICARE, we have found that immigrants often work in the lowest tier of the care sector, such as assistants and healthcare workers, and that it takes a long time to obtain formal qualifications in the Norwegian context due to requirements for both competence and the number of working hours in practice. This leads, among other things, to immigrants spending a long time in precarious work situations, but also that they represent a type of labor and workplace affiliation that can help employers keep costs down. In relation to the labor market as a whole, we can argue that an 'immigrant niche' has emerged in the lowest tier of the care services. Our findings show that some of the minority employees experience discrimination in the workplace, which means that ethnicity and/or skin color become relevant in daily interactions. We have also found that in workplace interactions, competence was not primarily related to the level of education. Competence was also related to the extent to which employees' practices demonstrated professional knowledge of how to provide care, good language skills, or hard work to achieve this, an interest in working at the nursing home, and the ability to prioritize in such a way that all duties and tasks were fulfilled. All of these factors paved the way for a kind of 'ethnic equality' and parity in work communities, a process in which leaders played an important role.
In MULTICARE, we have found that immigrants working in Norwegian nursing homes may experience that their moral identity is challenged because core values they bring from their home country are in tension with some of the core values of the nursing home, and these values are not recognized by the nursing home management. For example, there is no systematic collection of information from leaders regarding the cultural background of immigrants. The findings also show that healthcare workers with a migrant background often develop strong emotional bonds with patients. These close relationships are characterized by mutual vulnerability, and when a patient dies, the death can have a strong impact on healthcare workers with immigrant backgrounds. Research shows that communication is more than just language. This is particularly evident in the interaction between minority employees and residents, where it becomes clear that minority employees often lack content for communication in specific situations that require cultural competence and a shared frame of reference. Our findings also show that decisions made by leaders in the nursing home departments, who are primarily from the majority population, take leaders' Norwegian cultural background for granted, which, among other things, has consequences for how shifts are allocated and how work tasks are distributed.
Frode F. Jacobsen
Centre for Care Research, West
Phone: 55 58 72 12 / 932 30 936
Centre for Care Research, West
Phone: 55 58 58 49