Medicine, Health Care and Philosophy 23 (1):141-152 (2020)

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 prevailingmedical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowednurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resourcesand 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 takeon an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on morethan medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implementpalliative care philosophy in practice.
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DOI 10.1007/s11019-019-09918-2
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Outline of a Theory of Practice.Pierre Bourdieu - 1981 - Human Studies 4 (3):273-278.
The Cost of Conscience.Jeanette Kennett - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (1):69-81.

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