Caring Towards Death: A Phenomenological Inquiry Into the Process of Becoming and Being a Hospice Nurse

Ann V Salvage

University of Roehampton

Abstract

This thesis seeks to illuminate the question of why nurses choose to work with dying patients, with the meanings nurses attribute to their experiences forming the essential material of the study. Adopting a hermeneutic phenomenological perspective, the study involved semi-structured interviews with 30 nurses working in English hospices. The results provide evidence of the ways in which narrative and experience inform one another in an active process of occupational identity formation. Through a search for congruence between ideals and working environments, the nurses had arrived at a point of equilibrium, having identified in hospice a setting in which their nursing ideals could be implemented.

A marked feature of the nurses' accounts was 'dichotomous perception' of the nursing care provided in NHS settings and that provided in hospices, with the dimensions of these contrasts representing ideals embodied in nurse education. Aspects of hospice nursing particularly valued by the nurses were opportunities to provide 'good' nursing care, 'hands-on' nursing, holistic patient care, 'being there' for patients and availability of time.

In the face of conflicts between discourses of nursing care and management discourses focused on cost-effectiveness, these nurses remained uncompromising in their desire to provide 'good' patient care and were, in Maben et al's terms, "sustained idealists". However, the equilibrium they had achieved was perceived by some to be under threat, with financial restrictions and other factors challenging the nurses' identity as hospice nurses.

In developing an understanding of the way in which individuals set their personal narratives in the context of societal factors and engage their dynamic selves in ongoing conversation with themselves and others, the thesis illustrates that, as individuals, we can only make sense of ourselves by taking account of the world around us.

Ageing as Navigating a Life-Course: A Social-Anthropological Exploration in the West of Ireland

Michael J. Simonton

National University of Ireland

Abstract

This thesis is a qualitative, longitudinal exploration of the social anthropology of ageing in the North Connacht town of Ballybradán (a pseudonym). As ageing is a lifelong process, it was found appropriate to conduct a longitudinal study of how people age socially. To do this, the author has followed the same group of people (or their living relatives) through twenty-five years of their life courses as the country and social matrix have experienced recession, inflation, economic boom times, and reversals of emigration that include new populations in the Irish census. The synergistic effects that these contextual variables have had on the lives of his respondents is exemplified, not only in the changes in his descriptions of life in the north west of Ireland and research on institutionalization in a North Connacht nursing home, but in his respondents’ own stories, which were elicited through in-depth taped interviews. These interviews led to a series of life history autobiographies, with a focus on one family in particular in the style of Oscar Lewis. The stories tell of lives which reflexively illustrate alternative views of modern Ireland: different ways of being or not being ‘successful’ and of coping with the status implication of this. This modulates the story of modern Ireland by showing that it has not simply been smooth progress: people’s lives have been changed in diverse and varying ways. By exploring how people have navigated their life courses, creating meaning and purpose amid the ebbs and flows of socioeconomic change, we have traced a local alternative status system in Ballybradán based not only on conventional measures of success but also on being known and being seen within a local setting.

Activity Engagement with People with Dementia at Home: Family Carers’ Perspectives

Pat Yin Fan Chung

University of Southampton

Abstract

Government policies currently emphasise the need to support those with dementia at home, and family carers are increasingly advised to engage their relative in daily activities. Knowledge about family carers’ involvement in the activity needs of individuals living with dementia is fragmented. This study explored carers’ decision making related to their engagement with their relative in everyday activities at home.
Following research governance and ethical approval, 30 in-depth interviews (initial and follow-up) were carried out with 15 resident-carers who were recruited via local community mental health teams. Then five focus groups were conducted through carer support groups. The majority of carers were spouses, three were daughters and one a female friend. Both the interviews and focus groups explored the experiences of involving relatives in daily activities and highlighted the carers’ strategies, feelings and reflections. Themes were identified which formed a temporal model consisting of five activity patterns. These were the usual, recognisable, illogical, irresponsible and dispossessed patterns. The model illustrated the complexity and long-term nature of family carers’ activity-related decisions. Over the passage of time carers attempted to recapture the past self of their relative through engaging them in beneficial activity. The findings provided deeper insight in the understanding of the processes by which carers negotiated strategies; and how such processes challenged the carers’ own sense of self.

The model offers a new approach for occupational therapists and other healthcare professionals to guide home-based activity programmes in which carer’s perspectives are taken into account. Practitioners could gain a more complete understanding of the caregiving situation, so that they can, more effectively, support the family member and hence the person with dementia more effectively. Further research will focus on developing a toolkit to enable practitioners to recognise the complexities, uncertainties and conflicting values which confront carers in their decision-making and so enhance partnership working.

Doing Harder Time? The Experiences of an Ageing Male Prison Population in England and Wales

Natalie Mann
University of Essex

Abstract

In his seminal text ‘Society of Captives’ (1958), Gresham Sykes discusses the general pains of imprisonment which all prisoners are subjected to; including such issues as the deprivation of liberty, the deprivation of heterosexual relationships and the deprivation of autonomy, Sykes argues that these ‘pains’ can be understood as ‘punishments which the free community deliberately inflicts on the offender for violating the law...or...as the unplanned concomitants of confining large groups of criminals for prolonged periods...’ (1958: 64).

Throughout this text Sykes recognises the fact that different prisoners experience these pains differently, and as a result, are affected to a greater or lesser degree, but what I wish to propose and investigate throughout this thesis, is the idea that apart from the general pains of imprisonment discussed by Sykes (1958), certain characteristics which certain prisoners hold, makes them more likely to suffer from what I term ‘added pains’, the extra difficulties, deprivations and frustrations which exist within certain sub-sections of the prison population. The ageing prison population is a key example of a group who experience added pains of imprisonment; their weaker appearance, their old fashioned views and their less able bodies are all factors which result in them experiencing extra problems within prison and it is these added pains and the ageing men’s experiences of them, which I wish to address throughout this thesis.

The thesis is interjected with images from Edmund Clark’s (2008) photographic work on HMP Kingston’s elderly residents, and this not only provides thought provoking illustrations but also serves to contextualise some of the major points made.