| Summary: | The phenomenon ‘being with’, in relation to caring for patients who are close to death, is an important aspect underlying specialist palliative care. This study examines how ‘being with’ is constructed in day-to-day nursing practice in an inpatient hospice in Scotland. This thesis begins with a formulation of ‘being with’ in facing death as part of Cicely Saunders’ notion of a better way of caring for dying patients. The thesis proceeds to outline my methodological and analytical approach using principles for Ethnomethodology developed by Harold Garfinkel and Charles Taylor’s philosophy of interpretation. In the beginning of this study, the nurses and nursing care assistants told me that ‘being with’ was part of their day-to-day care within the hospice. We seemed to share the same understanding of the phenomenon. However, I came to understand that the nurses’ and nursing care assistants’ perception of ‘being with’ was different from the way Saunders formulated ‘being with’. I argue that nurses and nursing care assistants had constructed ‘being with’ when caring for patients who were close to death as providing comfort rather than dealing with the uncomfortable psychological and emotional effects of facing death. The consequence of this was that the patients were ‘comforted’ but they were not encouraged to face death in the way Saunders suggests, and as I had endeavoured to do in my own practice, thus leaving out an important part of specialist palliative care. Through revisiting Saunders’ notion of ‘being with’, I came to the view that there is a tension between the ‘theory’ and the ‘practice’ of ‘being with’ in relation to its practical outworking. It may be that Saunders has underestimated how difficult it is for nurses and nursing care assistants to ‘be with’ patients facing death due to the physical demands of caring for dying patients and secondly to facing death per se. On the basis of this study I offer some important insights into the tension between the hospice ideology of a ‘good death’ as provided by Saunders, and the day-to-day management of care of dying patients in this hospice.
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