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

Glasdam, Stinne LU ; Ekstrand, Frida ; Rosberg, Maria and van der Schaaf, Ann-Margrethe (2020) In Medicine, Health Care and Philosophy 23(1). p.141-152
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... (More)
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. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Specialised palliative homecare, Philosophy of palliative care, nurses, Bourdieu, Medical logic, neoliberalism
in
Medicine, Health Care and Philosophy
volume
23
issue
1
pages
12 pages
publisher
Springer
external identifiers
  • scopus:85070191963
  • pmid:31385188
ISSN
1572-8633
DOI
10.1007/s11019-019-09918-2
language
English
LU publication?
yes
id
0f4143ae-f691-4085-af2b-27040e701ecb
date added to LUP
2019-08-06 10:03:32
date last changed
2023-10-26 10:42:40
@article{0f4143ae-f691-4085-af2b-27040e701ecb,
  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<br/>medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed<br/>nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources<br/>and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’<br/>drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take<br/>on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more<br/>than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement<br/>palliative care philosophy in practice.}},
  author       = {{Glasdam, Stinne and Ekstrand, Frida and Rosberg, Maria and van der Schaaf, Ann-Margrethe}},
  issn         = {{1572-8633}},
  keywords     = {{Specialised palliative homecare; Philosophy of palliative care; nurses; Bourdieu; Medical logic; neoliberalism}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{141--152}},
  publisher    = {{Springer}},
  series       = {{Medicine, Health Care and Philosophy}},
  title        = {{A gap between the philosophy and the practice of palliative healthcare : sociological perspectives on the practice of nurses in specialised palliative homecare}},
  url          = {{http://dx.doi.org/10.1007/s11019-019-09918-2}},
  doi          = {{10.1007/s11019-019-09918-2}},
  volume       = {{23}},
  year         = {{2020}},
}