Client-nurse relationships in home-based palliative care: a critical analysis of power relations.
OBJECTIVE
To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care.


BACKGROUND
As in all social relations, power is present within client-nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client-nurse relationship in palliative care settings has not been extensively investigated.


METHODS
Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding.


RESULTS
Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination.


CONCLUSIONS
Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at various levels of the health care system.


CONCLUSIONS
The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general.
Oudshoorn
Abram
A
School of Nursing, The University of Western Ontario, ON, Canada. aoudshoo@uwo.ca
Ward-Griffin
Catherine
C
McWilliam
Carol
C
D000368:Aged; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003152:Community Health Nursing / Q000458:organization & administration; D003299:Cooperative Behavior; D004522:Educational Status; D005260:Female; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007389:Internal-External Control; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology*; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D011209:Power, Psychological; D017009:Professional Autonomy; D036301:Qualitative Research; D011795:Surveys and Questionnaires