Caring towards death

: a phenomenological inquiry into the process of becoming and being a hospice nurse

Abstract

This thesis seeks to illuminate the question of why nurses choose to work with dying patients, with the meanings nurses attribute to their experiences forming the essential material of the study. Adopting a hermeneutic phenomenological perspective, the study involved semi-structured interviews with 30 nurses working in English hospices. The results provide evidence of the ways in which narrative and experience inform one another in an active process of occupational identity formation. Through a search for congruence between ideals and working environments, the nurses had arrived at a point of equilibrium, having identified in hospice a setting in which their nursing ideals could be implemented.

A marked feature of the nurses' accounts was 'dichotomous perception' of the nursing care provided in NHS settings and that provided in hospices, with the dimensions of these contrasts representing ideals embodied in nurse education. Aspects of hospice nursing particularly valued by the nurses were opportunities to provide 'good' nursing care, 'hands-on' nursing, holistic patient care, 'being there' for patients and availability of time.

In the face of conflicts between discourses of nursing care and management discourses focused on cost-effectiveness, these nurses remained uncompromising in their desire to provide 'good' patient care and were, in Maben et al's terms, "sustained idealists". However, the equilibrium they had achieved was perceived by some to be under threat, with financial restrictions and other factors challenging the nurses' identity as hospice nurses.

In developing an understanding of the way in which individuals set their personal narratives in the context of societal factors and engage their dynamic selves in ongoing conversation with themselves and others, the thesis illustrates that, as individuals, we can only make sense of ourselves by taking account of the world around us.

Date of Award	2010
Original language	English
Awarding Institution	University of Roehampton
Supervisor	Steven Groarke (Supervisor) & Ulla Gustafsson (Supervisor)