The Caring Context
The concept “caring context” contains both concrete and cultural/political aspects, and it varies a lot. In Sweden professional caregiving is regulated by the Health Care legislation (Hälso- och sjukvårdslagen), but it can sometimes be hard to separate it from the social work, which is regulated by the Social Welfare law (socialtjänstlagen).
Swedish health care is performed during both public and private management, but with only few exceptions, financed by Swedish taxpayers. It can be given both as primary care and in hospitals. Concerning the latter the patient can be either hospitalized or an outpatient. A third variation is prehospital care, which in Sweden has developed from only transport to acute qualified care with requirements on at least one registered nurse in every ambulance.
The caring context also depends on medical specialty, and if patients are at an acute or quite stadium of their diseases. Thus the same patient can be cared for in different caring contexts, for example intensive care during the acute phase, and later on in rehabilitative care. Some attendees at hospitals can need care without being ill, for example women who give birth, blood donors or individuals involved in a research project.
Cultural (political) aspects
The complexity in the concept “caring context” increases further when it comes to implicit and explicit cultural or political aspects. For example, twenty years ago the care of elderly persons, where the medical treatment is completed, was transferred from health care to the social welfare system in the communities. This political change led to redefinition of “elderly care” to “social work”. Yet it is next to impossible to get a seat on a municipal housing without severe sickness that makes you disabled.
Another example is psychiatric care. During the 90s the mental hospitals were closed in the whole west. Today “psychiatric care” only contains acute care and primary care. The rehabilitative care of severally mentally ill people, which previously existed in health care, was redefined as social work. In both these examples political decisions thus changed both context and goals. The health care’s focus on to soothe, heal and alleviate symptoms, was changed to personal responsibility and slogans like “emphasize the healthy aspects”.
Care given under the Health Care legislation is performed by both certified personnel (physicians, registered nurses, physiotherapists, psychologist, occupational therapists etc.) and non-certified personnel (staff nurses, mental care workers etc.). In the context of health care formal competence is important, and so is professional responsibility. Issues such as patient participation and autonomy have, however, increased in importance during the last decades.