Client–nurse relationships in home-based palliative care: a critical analysis of power relations

Aim: To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care.
Background: As in all social relations, power is present within client-nurse relationship in palliative care settings has not been extensively investigated.
Method: Applying a critical lens, secondary qualitative data analysis was conducted.  Seventeen nurse and 16 client transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified.  Data analysis involved analytic coding.
Results: Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used an potentially abused.  In analysing the sources and exercise of power, the linkage between macro and micro levels of power for nurses within the relationship.  However, nurses also experience powerlessness within the home care context.  For clients, being able to control one’s own life is a source of power, but this power is overshadowed by the powerlessness experienced in relationships with nurses.  the exercise of power by clients and nurses creates experiences of both liberation and domination.
Conclusions: nurses who are willing ot reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care.  Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies ad funding models implemented at various levels of the health care system.
Relevance to clinical practice: The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general.

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