A qualitative case study of hospice nurses’ perceptions about their work and competencies

FOCUS:
This study sought to describe and interpret hospice nurses’ perceptions about the knowledge, attributes, skills and competencies they possess, which enable their work with the dying client, relatives/significant others.

METHODOLOGY, SITE, PARTICIPANTS, DURATION:
An amethodological, collective and qualitative case study design, aimed at description and understanding was used to describe hospice nurses’ perceptions about and enabling their practice. The study took place in a hospice unit in a metropolitan Australian hospital.

One cohort of ten actively practising hospice registered nurse participated. One participant refused participation due to recent return to work after extended leave. Three methods of data collection were used – a short sociodemographic survey, a semi-structured interview and narration of a critical incident – in the setting of one face to face session with each participant. Data were analysed manually using Polit and Hungler’s (1995) guidelines for qualitative analysis. Overall, data collection was ten months, data were analysed over the following six months.

FINDINGS:
Findings revealed hospice nurses’ perceptions about the reasons they choose to work in hospice (an unexpected finding) and the context of hospice nursing practice. Five themes emerged about perceived knowledge including self, people/life, scientific, palliative and basic nursing knowledge; four traits of participants including honesty/being non judgemental, assertiveness and flexibility. Practice themes included psychomotor and practice skills including communication (being, listening, sharing, observing, counselling), empathy, advocacy, teaching/learning, assessing, symptom control and management, and ‘good basic care’. Participants defined the term competency in a variety of ways, making ten competency statements including valuing/respecting the client, facilitation client control, palliative philosophy, holistic care, communicating, alleviation of suffering, basic nursing care, acting as a consultant, being a multi-disciplinary team member and knowing one’s own limits.

The issues of interest arising from this study are:

1. The complex, multi-dimensional nature of hospice nursing practice.

2. The complex, long-term nature of competency research.

3. The nature of the client/nurse relationship and its power dynamics

4. The integrated aspect of role components

5. The dichotomy between the positivist assumptions of much of the competency language and research and the holistic, intangible, subjective nature of hospice nursing practice