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Protective coping: A grounded theory of educative interactions in palliative care nursing

Morgan, Adrian K (1999) Protective coping: A grounded theory of educative interactions in palliative care nursing. PhD thesis, Murdoch University.

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The purpose of this study was to examine the nature of educative interactions that occur between care providers and patients in palliative care. The author identifies and describes interactions that take place between nurses, terminally ill patients and their informal caregivers. He explains the symbolic nature and characteristics of the. interactions and interprets their therapeutic value in order to construct a theory to help explain the function of educative interactions that occur between the nurse, patient and informal caregiver.

In view of the complexity of social interaction, and the fact that patient education in nursing care has not been extensively researched as yet, a qualitative framework was considered the most appropriate method to investigate this topic. This approach helped to make sense of interactions from the perspective of participant's own lived experiences, and provided an understanding of the importance of educative interactions in the provision of quality palliative nursing care. These understandings were then used in a grounded theory process which utilised a constant comparative method of analysis, a method which facilitated the exploration of a wide range of phenomena and provided methodological rigour through systematic and detailed procedures.

The findings of the fieldwork performed for this study suggest that educative interactions in palliative care are predominantly informal and can have direct and indirect outcomes effecting and affecting the care of the individual. A strategy central to this process and frequently identified in the data was categorised by the author as 'protective coping'.

Protective coping is characterised by nursing interactions that consistently help to protect, maintain and safeguard the integrity of the patient in this situation. In palliative care, it comprises an interplay of two distinct interactional patterns which appear to constitute an interactional continuum that has protective-management at one pole and protective-adjustment at the other. Protective-management refers to the nurse taking control over the care situation on the assumption that the nurse knows what is best for the patient and will act upon this knowledge in the patient's best interest, whilst in protective-adjustment there is an assumption that the patient can determine what is in their own best interest, and that nursing actions need to ensure that control remains with the patient. Although most interactions occurred at various points between these extremes, it was apparent that protective­adjustment was by far the most common category.

Protective coping was identified as a basic social interactional process fundamental to the optimisation of patients' well being during terminal illness care, and it came to be seen as a particularly important process in managing the profound vulnerability experienced by all concerned as a result of the inevitability of patient's deteriorating health. An important implication of these findings is that an understanding of the knowledge-power relationship in palliative care is crucial, because it influences essential educative processes. Nurses need to maximise the empowerment of patients and informal carers through the provision of relevant knowledge, rather than just considering their protection. This means the nurse has to learn to recognise the right of individuals to maintain control over various aspects of their lives, how to help them make decisions that are consistent with maximising the therapeutic potential of palliative care, and then how to support them in implementing their decisions.

The success of palliative nursing care was found to be highly dependent upon two key factors: the first is the nurse's ability to effectively relate with those individuals who are within their sphere of care; the second is the need for consistency in the way that patients and informal caregivers are encouraged to be involved in care related decisions. Nurse-patient-informal caregiver teamwork was also found to be crucial to the continuity of care, particularly in rural areas where distance and resources may limit the availability of visiting nurses. This study, therefore, also highlights the need for nurses to develop a genuine dialogue with the patient, informal caregiver, and anyone else involved, in order to promote and manage the process of collaborative care.

In general, the findings of this study will therefore be useful to academics concerned with the education of undergraduate and postgraduate nursing students, as well as nurses and other health professionals practising in palliative care. In particular, the findings enabled the author to propose changes to nursing curricula with the potential to augment and improve positive palliative care outcomes at his university.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): Division of Social Sciences, Humanities and Education
Notes: Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: Thank you.
Supervisor(s): Tripp, David
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