Glasdam Stinne, Ekstrand Frida, Rosberg Maria, van der Schaaf Ann-Margrethe
Department of Health Sciences, Faculty of Medicine, Lund University, Baravägen 3, 222 41, Lund, Sweden.
Palliativ vård och ASIH Helsingborg, Skåne, Sweden.
Med Health Care Philos. 2020 Mar;23(1):141-152. doi: 10.1007/s11019-019-09918-2.
Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.
姑息治疗理念基于对患者的整体关怀，但研究表明，受历史和管理结构的限制，践行这一理念的可能性似乎较为有限。从护士的角度出发，本文旨在探讨专业姑息家庭护理中的护理实践，以及其如何受到组织和文化结构的影响。受布迪厄思想启发，对九名护士进行了定性的半结构化访谈。研究结果表明，护士强化了医学的惯习，包括那些构成以控制为导向的实证主义方法的医学专业价值观，这些价值观得到临床实践组织政策的支持。在等级制度上，护士处于医生之下：查房是他们工作日的结构化安排。他们充当医疗助手，而盛行的医学逻辑似乎使护士难以实现自身的人文理想。只有很短的时间段允许护士优先考虑患者及其亲属的心理社会需求。行动点具有高度优先级，增加了财政资源并确保了预算分配。每周的探访使护士能够测量、控制和管理患者的药物及症状，这是他们作为医疗助手履行职责的必要条件。研究结果促使护士从伦理角度出发，一方面确保患者及其家属获得良好的姑息治疗，这种治疗不仅关注医疗问题和逻辑，另一方面加强护士在姑息治疗领域的专业地位，并帮助他们在实践中贯彻姑息治疗理念。
