Exploring ‘bodywork’: an ethnographic study of palliative care nursing

This study examined the concept of 'bodywork' in palliative care nursing practice because the body is central to the work nurses do. The term 'bodywork' is used to describe interactions between nurses and patients that relate to bodily change, an issue of particular relevance in cancer and palliative care. The study aimed to explore and give voice to aspects of nursing work that are hidden and often taken-for-granted, and to reveal the complexity of what occurs during the intimate encounters between palliative care nurses, patients and family caregivers.

A qualitative ethnographic approach using participant observation was chosen to explore how community palliative care nurses work. The study sought to understand how the nurses mediated the significant physical deterioration frequently experienced by people at the end-of-life. Participant observation enabled me to work alongside the nurses, becoming part of their world, having access to their culture and therefore the meanings and influences in their practice. Over a 12 week period, I accompanied 7 participating nurses during home visits to patients, making over 70 observations with 40 patients.

Findings revealed some highly skilled palliative care nursing practices, particularly in dealing with death and dying. Nevertheless, the findings overwhelmingly demonstrate that although bodily breakdown was central in the lives of patients and family caregivers, it was not the primary focus of the palliative care nursing role. The dominance and significance of bodily breakdown experienced by patients resulted in a burden of care for family caregivers that had practical, cognitive, emotional and financial dimensions. The nurse participants' focus on psychosocial and coordination dimensions of care influenced their assessment of patients' needs and provision of support for family caregivers.

The findings reinforced the silence and invisibility of bodywork by disrupting the assumption that bodywork is an integral part of palliative care nursing practice. Findings expose the impact of policy change on the structure and delivery of community palliative care, particularly the influence on the palliative care nurse role and service recipients. Policy that drove the restructure of services sought to extend the reach of palliative care but failed to understand the potential impact of this change on the delivery of nursing services and on client care. The resultant mismatch between client needs and service delivery and a potential loss of nursing expertise ultimately widens the gap in service provision. Consequences include an increased burden for family caregivers and potential clinical deskilling of palliative care nurses.