Patients' and carers' views of quality palliative and supportive district nursing care

Student thesis: Phd


Quality of care is conceptualised by professionals and in policy documents as: compliance with 'best practice' guidelines; improving satisfaction rates; fiscal efficiency; and ethical care. 'Quality' in palliative and supportive district nursing care has been conceptualised in all these ways. However, the empirical research in this area draws mostly on professionals' and carers' views with little research addressing patients' views. With political rhetoric pushing for a 'patient led' NHS, research into how patients conceptualise quality in this area is necessary to both critique this rhetoric and/or facilitate its aims. Therefore, this research investigates patients' and carers' views on the quality of palliative and supportive district nursing care.Participants were recruited to an exploratory qualitative study resulting in a convenience sample of twenty six patients (all of district nursing caseloads) and thirteen carers. All participants were over eighteen, able to consent, lived in their own homes, were under the care of district nurses, and had palliative care needs. Eighteen participants had a cancer diagnosis, six had a non-malignant diagnosis, one had co-morbidities, and one participant did not disclosed their diagnosis. Semi-structured interviews were conducted with all participants, five participants were interviewed twice. Post-structuralist theories were used with discourse analysis techniques for the final analysis.The findings identify three of the most influential discourses in relation to the morality and quality of care: Firstly, 'busyness', and how its performance by district nurses masks patients' and carers' ability to critique care, instead producing a pseudo-quality which fixes patients and carers subjectivities. Secondly, 'power/knowledge' and the ways in which it prevents patients and carers accessing care which they need, and altering care to suit their needs. Thirdly, 'the home' and how it (re)forms district nursing care and district nursing care (re)forms the home; meaning that actions by district nurses must also consider the impact on the home as well as the patients and carers. In conclusion quality care may be produced by: ceasing to measure quality; involving patients and carers with commissioning and directing palliative and supportive care; supporting groups other than district nurses such as patients, carers and third parties to produce and distribute knowledge about district nursing care; increasing patients' and carers' ability to communicate with one another about their care.Further research may investigate: how patients and carers with palliative and supportive care needs may be involved in commissioning; the most appropriate wording and means to distribute knowledge about palliative and supportive district nursing care; ethnographic work to explore how district nursing and the home interact; more detailed theorisation of how the material and the discursive can be accounted for within post-structuralism.
Date of Award1 Aug 2013
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKaren Luker (Supervisor) & Catherine Walshe (Supervisor)


  • Deleuze
  • Butler
  • District Nursing
  • Nursing
  • Palliative care
  • Post-structuralist
  • Supportive Care
  • Foucault
  • Quality
  • Poststructuralist

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