Negotiating Boundaries: The Nurse Family Member Caring for Her Own Relative in Palliative Care
Authors:   , McClunie-Trust Patricia 
Published: November 2021

<p>This research illuminates the challenges of living well within one's own family as a nurse caring for her own relative who is dying of a cancer-related illness. Developing a deeper awareness of the consequences of this caring work has been the central focus for inquiry in this research. Nursing requires epistemologies that encompass new ways of understanding how we live within our own families and communities and practice as nurses. The theoretical framework that guides this research interprets the French Philosopher Michel Foucault's (1926-1984) critical history of thought as an ethical project for nursing. It uses conceptual tools developed in his later writing and interviews to draw attention to how discursive knowledge and practices constitute subjectivity in relations of truth, power and the self's relation to the self. The first aspect of the analysis, landscapes of care examines the techniques of discourse as relations of power and knowledge that constitute nurse family members as subjects who have relationships with their own families and other health professionals. The second aspect analyses care of the self and others as self work undertaken to form the self as a particular kind of subject and achieve mastery over one's thoughts and actions. Nurses are called to care because they are present within their families with knowledge and expertise that makes a difference to how a dying relative experiences palliative care. Caring discourse positions nurses with responsibilities to their own; responsibilities that require sensitivity in knowing how to negotiate the relational spaces that constitute relationships with other family members and health professionals. Family discourse calls nurse family members to care as daughters, daughters-in-law, wives or mothers within normative understandings about the obligations that families have to care for their ill or dependent members. The discourse of expertise in knowing as a nurse positions nurse family members as interpreters of information for their families and observers who use their inside knowledge of how the health system works to watch over the ill person's clinical care. This expertise, which becomes visible as the exercise of professional authority in practising nursing, challenges the normative frameworks that classify and demarcate professional and lay roles in caring for the dying person. As an exploration of the complex and contradictory subjectivities of the nurse family member, this research illuminates the forms and limits of nursing practice knowledge. It shows how nursing is practised, and the identity of the nurse is created, through intellectual, political and relational work, undertaken on the self in relation to others, as modes of ethical engagement. Within this ethical engagement, nurse family members work to transform the self into discursive subjects, with the knowledge, skills and other capacities that are necessary to honour their commitments and responsibilities for care of another person. The experience of caring for their own relative transforms nurse family members' previously held values about how nurses ought to be with others in their professional work, creating a deeper sense of interest in and concern for the vulnerability of other people in palliative care.</p>