A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

Research output: Contribution to journalArticle

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.

Details

Authors
Organisations
External organisations
  • Palliativ vård och ASIH Helsingborg
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Medical Ethics

Keywords

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalMedicine, Healthcare and Philosophy
Publication statusE-pub ahead of print - 2019 Aug 6
Publication categoryResearch
Peer-reviewedYes