Abstract
Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’ drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement palliative care philosophy in practice.
Highlights
An estimated 65% of the dying population in Sweden, and other high-income countries, will require palliative care (Morin et al 2017)
Nurses were positioned under doctors in specialised palliative homecare
Nurses are socialised into the role of assistants to doctors, and the medical logic unconsciously rules their practical sense in specialised palliative homecare
Summary
An estimated 65% of the dying population in Sweden, and other high-income countries, will require palliative care (Morin et al 2017). Sekse et al (2017) carried out a systematic literature review to explore how nurses describe their role in providing palliative care for patients with life-threatening diseases. Consistent with palliative care philosophy, nurses describe how they work from a holistic perspective, handling a breadth of activities in their working day. This includes the requirement for them to be attentively present, dedicated and able to use flexible and non-traditional methods in their work. Studies show that nurses find that they establish a one-to-one relationship with each patient and his/her family in palliative care, where the patient’s situation requires the nurse’s support and involvement (Parola et al 2018; Sekse et al 2017). Working in palliative care leads to a confrontation with nurses’ own mortality (Parola et al 2018)
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