Journal of Clinical Nursing 2001; 10: 583±584
Research in Brief
considered the most appropriate method of investigation.
This approach helped to make sense of interactions from
the perspective of the participants' own experiences, and
provided an understanding of the importance of educative
interactions in the provision of quality palliative nursing
care. These understandings were developed through
grounded theory processes which used a constant com-
parative method of analysis (Strauss & Corbin, 1994), a
method that facilitated the exploration of a wide range of
phenomena and provided methodological rigour through
systematic and detailed procedures.
A grounded theory of nurse±client
interactions in palliative care nursing
ADRIAN K. MORGAN PhD, MEd, BEd HONS, RN
Coordinator, Nursing Programme, Edith Cowan University, Faculty
of Regional Professional Studies, South-west Campus, Western
Australia 6230
Background
This recently completed West Australian study speci®c-
ally examines the educative interactions that occur in
palliative care between nurses, terminally ill patients, and
their informal caregivers. The aim is to identify, describe
and theorize the nature, characteristics and therapeutic
value of such interactions. It builds on a previous study
Findings
The ®ndings of the ®eldwork suggest that educative
interactions in palliative care are predominantly informal
and can have direct and indirect outcomes affecting the
care of individuals. A strategy central to this process and
frequently identi®ed in the data was categorized as
protective coping.
(
Morgan, 1994) that investigated patient education as a
dimension in the role of generalist nurses caring for
minimally dependent adults.
Protective coping is characterized by nursing interac-
tions that consistently help to protect, maintain and
safeguard the integrity of patients. In palliative care, it
comprises an interplay of two distinct communication
patterns which appear to constitute an interactional
continuum that has protective management at one pole
and protective adjustment at the other. Protective man-
agement refers to nurses taking control over the care
situation on the assumption that they know what is best
for patients and will act upon this knowledge in patients'
best interests. With protective adjustment there is an
assumption that patients can determine what is in their
own best interests, and that nursing actions need to ensure
that control remains with the patients. Although most
interactions occurred at various points between these
extremes, it was apparent that protective adjustment was
by far the most common and facilitative category.
Research aim and context
The purpose of this research was to examine the symbolic
nature and characteristics of informal educative interac-
tions, interpret their therapeutic value and construct a
theory to help clarify and explain the way in which these
assist individuals to cope. Previous studies have focused
on the support needs of patients and informal caregivers
(
Wilkes & White, 1998) and the maintenance role of family
members (Pincombe & Tooth, 1996). However, the
current study provides additional insight into life events
that are unique to the process of terminal illness and how
individuals react towards these.
Methodology
In view of the complexity of social interaction and the fact
that patient education in palliative nursing has not been
extensively researched as yet, a qualitative framework was
Protective coping was identi®ed as a basic social
interactional process fundamental to the optimization of
patients' well being during terminal illness care. It came to
be seen as a particularly important process in managing
the profound vulnerability experienced by all concerned as
a result of the inevitability of patients' deteriorating
Correspondence to: Adrian K. Morgan, Coordinator, Nursing Programme, Edith
Cowan University, Faculty of Regional Professional Studies, South-west Campus,
Western Australia (tel.: +61 8 9780; fax: +61 8 9780 7813; e-mail:
a.morgan@cowan.edu.au.).
Ó 2001 Blackwell Science Ltd
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