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Title: Palliative care as progressive journey : the interplay of hope and social death in nurse-patient encounters across three care settings
Author: Nelson, Annmarie
ISNI:       0000 0004 2748 4447
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2006
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In this study I examine the care trajectory of terminally ill patients across three different sites in the hospice setting: home care, day therapy unit and in-patient unit. I will focus on the patients' journey and the nurses' ways of working in each setting as the continuum of care progresses towards the end of life. Much of this work is accomplished through talk, so by focusing the analysis on nurse-patient encounters, this study aims to fill a gap in this sensitive area of health and social care. The study is rooted in the prevailing philosophy of palliative care which aims to address 'total pain', that is, social, emotional, and spiritual, as well as physically occurring phenomena. Upon diagnosis of terminal illness, it will be argued, the patient undergoes a shift in the conceptualisation of 'self. The focus of my analyses will therefore be the interlocking themes of social death and hope vis-a-vis the biological event. I will argue that the concept of social death mediates the interactional trajectories, while hope and 'healing', in the palliative sense, may be seen as counterpoints to the inevitability of the end-of-life journey. The process of social death can be viewed as a continuum as patients experience physical losses and deterioration that will in most cases lead to the institutional setting of the in-patient unit. Palliative care nurses and patients have the opportunity to intersect the continuum with interactional strategies that have the potential to promote hope in order to deflect from the suffering of total pain. The main findings can be captured in terms of the contextual differences across the three care settings as the care process occurs at different stages of the patient's terminal journey. For the purposes of demonstrating the complex interplay of these experiential domains, I adopt a theme- oriented discourse analysis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available