title: Negotiating relational practice patterns in palliative home care.
abstract: Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the sociocultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.
authors.affiliation: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada. cwg@uwo.ca
authors.forename: Catherine
authors.initials: C
authors.lastname: Ward-Griffin
authors.forename: Carol
authors.initials: C
authors.lastname: McWilliam
authors.forename: Abram
authors.initials: A
authors.lastname: Oudshoorn
mesh_terms: D000368:Aged; D005260:Female; D006699:Home Care Services; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017008:Negotiating; D009369:Neoplasms / Q000628:therapy*; D024802:Nurse's Role; D009864:Ontario; D010166:Palliative Care