The culture of general palliative nursing care in medical departments: an ethnographic study.

BACKGROUND

In many countries, approximately half of the population dies in hospital, making general palliative nursing care (GPNC) a core nursing task. GPNC in the hospital setting is described as challenging, however little is known about its actual practice.

AIM

To explore the GPNC culture in medical departments.

METHODS

An ethnographic study, using Spradley's 12-step method, with observational field studies and interviews with nurses from three medical departments in a Danish regional hospital.

FINDINGS

Three cultural themes emerged from the analysis, focusing on the setting, the practice and the nurses' reflections on GPNC: (1) GPNC provided in a treatment setting, (2) transition to loving care and the licence to perform palliative care (PC) and (3) potential for team improvement.

CONCLUSIONS

GPNC as a culture in medical departments seemed to be embedded in a setting not suited for dying patients. Palliative care was still practised according to the transition model of care, sharply dividing curative from palliative care, and was inappropriately conducted in a fragmented and individual-based way. The term 'loving care' was used as a 'gate-opener' to provide palliative care for the dying; however, the content of this term was not defined or expressed among the health professionals. Practical and professional nursing skills are not sufficient to improve GPNC in the hospital department. Leaders on all levels need also to address the culture in which palliative care is embedded.