Competing discourses in palliative care.

Background: Palliative care focuses on early identification as well as prevention and alleviation of suffering. Previous studies have established that palliative care is a disciplinary area in a state of transformation due to the involvement of different professional categories and that nursing care in the palliative context is influenced by the dominance of the medical perspective.

Aim: This study aimed to describe palliative care from a nursing perspective prior to the implementation of a palliative care programme.

Patients And Methods: The approach was inspired by the ethnographic method and a constructionist perspective was used as a theoretical framework, as the focus was on existing palliative care discourses. Field studies were conducted on a ward where palliative care was provided to patients at the end of life. Approval for the study was granted by the Ethics Committee at Sahlgrenska Academy. Data were collected by means of participant field studies, informal deliberations and other relevant documents.

Main Results: Four different discourses were discerned: caring, non-caring, curing and the organisation.

Conclusions: The ethos on the ward was strongly linked to the medical discourse. We consider that a prerequisite for the organisation of palliative care is an expressed caring perspective based on the patients' experiences of suffering, which perspective is lacking in the curing and organisational discourses.