Kliniken flyttar hem Sjuksköterskans institutionella praktik inom specialiserad palliativ hemsjukvård

Detta är en avhandling från Uppsala : Acta Universitatis Upsaliensis

Sammanfattning: The thesis focuses on the nurse and her practice in end-of-life care in the field of palliative home care. The overall question is how nurses come to do what they do within this practice and where they get the practice, which can also be expressed as the  genesis and structure of the practice. The thesis’ social relevance takes its starting point in the Swedish Elderly Care Act (Ädelreformen) and theoretical inspiration from Foucault’s discourse analysis regarding the establishment of the clinic.The thesis has a practice-theoretical approach in which Bourdieu’s habitus concept, explaining how practice is generated, is central. The habitus concept can be described as a set of subjective dispositions in the individual that prompt her to act in a certain way. These dispositions are expressed in attitudes, strategies, and capacities and can be seen in relation to the practice structure.The thesis’ method is based on observations, conversations, and interviews with the nurses about their work, education, and social background. Conversations between the nurses and the spouse living with the sick person were recorded and transcribed. Encompassed by the study were six nurses, whose work was followed for seven months in 13 private homes.The actions performed by the nurses in their practice proved to be homogenous, a circumstance they were not aware of. There was agreement between the nurses’ underlying structure and how they handled their practice, i.e. the end-of-life care in the private home. The nurses had similar ideals and had developed similar habituses as they grew up and during their adult lives.The thesis is empiric in that the reader follows the nurse in her work in private homes. The nurse organizes this care in the home in consultation with the patient and the person living with them in an extraordinarily cautious manner. How the nurse handles difficult situations and conversations with spouses and often dying patients, is viewed in relation to the nurse’s habitus and dispositions.Key words: nurse, palliative home care, practice theory, habitus, observation, pedagogical practice, Bourdieu, Foucault