Care and work in nursing the dying : a participant study of a continuing care unit
The hospices attempted to offer a way of dying with dignity which would counter the growing lobby for euthenasia legislation by taking account of 'total pain' (mental, social, spiritual, physical). Participation on an NHS/Macmillan Continuing Care Unit indicated that the nurses were committed to giving 'total patient care', but were conscious of their inability to fulfil their principles. They explained their care of the dying in terms of a tension between 'care' and 'work'. The practical outcome of the tension on the terminal care unit is analysed as 'carework'. This emergent nursing practice, where physical care tends to overshadow 'emotional care', is observed in the routines and rituals of the Unit, of which 'normal death' is one example. The two separate social frameworks of 'care' and 'work' reflect a gender division of labour in which 'caring' is commonly domestically based and carried out by women, and 'work' is in the public domain and dominated by men. Public service 'people work' requires that the two frameworks be amalgamated. The tension between 'care' and 'work' is described as a failure of accommodation between the two which is exacerbated by a science based model of illness. It is suggested that these effects combine in a pattern of resistance which opposes the full implementation of hospice movement aims.