1. careers
2. nursing

CARING TOWARDS DEATH:
A PHENOMENOLOGICAL INQUIRY INTO THE
PROCESS OF BECOMING AND BEING A
HOSPICE NURSE
APPENDICES
by
Ann V Salvage BA, MSc
A thesis submitted in partial fulfilment of the requirements for the degree of PhD
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Contents
APPENDIX 1 _____________________________________________________________________________ 1
LITERATURE REVIEW - SOURCES AND PARAMETERS ___________________________________________________ 1
APPENDIX 2 _____________________________________________________________________________ 1
FACTORS IN CHOICE OF NURSING _______________________________________________________________ 1
Individual/psychological factors _________________________________________________________ 1
Psychological/emotional needs _________________________________________________________________ 1
Aims and desires ____________________________________________________________________________ 1
Congruence with academic interests ____________________________________________________________ 2
Personal experience __________________________________________________________________________ 2
The influence of parents, family and close friends ___________________________________________ 2
The influence of other people: role models and knowing a nurse _______________________________ 3
Teachers and careers advisers ___________________________________________________________ 3
The 'image' of nursing _________________________________________________________________ 3
Effect of specific media ________________________________________________________________ 3
Pragmatic factors _____________________________________________________________________ 4
Chance or default _____________________________________________________________________ 5
APPENDIX 3 _____________________________________________________________________________ 1
DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS __________________________________________________ 1
Gender _____________________________________________________________________________ 1
Age (Range = 21-66) ___________________________________________________________________ 1
Ethnicity (Self-described) _______________________________________________________________ 1
Year of nursing qualification ____________________________________________________________ 1
APPENDIX 4 _____________________________________________________________________________ 1
PARTICIPANT INFORMATION SHEET _____________________________________________________________ 1
Introduction _________________________________________________________________________ 1
What is the purpose of the study? ________________________________________________________ 1
Why have I been chosen? _______________________________________________________________ 1
Do I have to take part? _________________________________________________________________ 1
What if I agree to take part but then change my mind? ______________________________________ 1
What will happen if I do take part? _______________________________________________________ 1
What are the possible disadvantages of taking part? ________________________________________ 1
What are the possible benefits of taking part? ______________________________________________ 2
Will the information I provide be treated as confidential? _____________________________________ 2
What will happen to the results of the research study? _______________________________________ 2
Who is doing the research? _____________________________________________________________ 2
Who has reviewed the study? ___________________________________________________________ 2
Who can I contact to talk about the research? ______________________________________________ 2
I’d like to take part in the research. What should I do now? ___________________________________ 2
APPENDIX 5 _____________________________________________________________________________ 1
PARTICIPANT CONSENT FORM _________________________________________________________________ 1
Title of Research Project: ‘Caring towards death: Becoming and being a palliative care nurse ________ 1
Name and Status of Investigator: Ann Virginia Salvage, Research Student________________________ 1
Consent Statement: ___________________________________________________________________ 1
APPENDIX 6 _____________________________________________________________________________ 1
INTERVIEW GUIDE _________________________________________________________________________ 1
Introduction _________________________________________________________________________ 1
Part 1: Personal information ___________________________________________________________________ 1
Part 2: Telling the story _______________________________________________________________________ 1
Part 3: Focused questions _____________________________________________________________________ 2
APPENDIX 7 _____________________________________________________________________________ 1
RESPONDENT FACTOR CHECKLIST _______________________________________________________________ 1
Thesis: Caring Towards Death
Ann V Salvage (2010)
APPENDIX 8 _____________________________________________________________________________ 1
CHECKLIST RESULTS ________________________________________________________________________ 1
Choosing nursing as a career ____________________________________________________________ 1
Choosing to do hospice nursing __________________________________________________________ 2
APPENDIX 9 _____________________________________________________________________________ 1
PEN PORTRAITS ___________________________________________________________________________ 1
Angela ______________________________________________________________________________ 1
Barbara _____________________________________________________________________________ 2
Catrina _____________________________________________________________________________ 3
Diane _______________________________________________________________________________ 5
Elaine ______________________________________________________________________________ 7
Emily _______________________________________________________________________________ 9
Felicity _____________________________________________________________________________ 10
Grace______________________________________________________________________________ 11
Graham ____________________________________________________________________________ 13
Jenny ______________________________________________________________________________ 14
Kerry ______________________________________________________________________________ 15
Marina ____________________________________________________________________________ 17
Sandra _____________________________________________________________________________ 18
APPENDIX 10 ____________________________________________________________________________ 1
CODING FRAME __________________________________________________________________________ 1
Coding Frame Part 1 ___________________________________________________________________ 1
Coding Frame Part 2 __________________________________________________________________ 20
APPENDIX I
LITERATURE REVIEW:
SOURCES AND PARAMETERS
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 1
Literature Review - Sources and Parameters
The specifications for this critical appraisal of the research literature included all published work
over the period 1980 to 2010. Four nursing, medical and psychological databases were searched:




CINAHL
British Nursing Index - BNI
MEDLINE
PSYCInfo
using combinations of keywords:
 motivation/s
 attitude/s
 expectation/s
 reason/s
 career
 choice
 hospice
 terminal
 palliative.
 vocation*
 occupation*
 decision making.
In addition, manual/computer content searches were undertaken of ten journals considered likely to
publish relevant material:










American Journal of Hospice and Palliative Care
Cancer Nursing
European Journal of Palliative Care
European Journal of Oncology
International Journal of Palliative Nursing
Journal of Palliative Care
Journal of Palliative Medicine
Progress in Palliative Care
Sociology of Health and Illness
Social Science and Medicine.
In addition, the Index of Theses from 1980 to 2010 was consulted.
Other sources of literature include:




References recommended by individuals to whom I spoke over the course of my research
National newspapers
Radio programmes
References identified as useful at:
o Roehampton University Library
o St George's Hospital Medical School Library
o King's College London Library.
Appendix 1 - Literature review sources & parameters
1 of 1
APPENDIX 2
FACTORS IN CHOICE OF
NURSING
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 2
Factors in Choice of Nursing
Evidence from the research on factors affecting choice of nursing falls broadly into seven
categories: individual/psychological factors; parental and family influences; the influence of other
people (including role models and knowing a nurse); educational/careers advice influences; the
influence of images of nursing; 'pragmatic' factors and the effect of chance or lack of planning.
Individual/psychological factors
Psychological/emotional needs
Several studies have identified psychological and emotional needs which individuals have sought
to meet in entering nursing. Kersten et al (1991) in the USA, identified emotional needs which
included self-esteem, self-concept, fulfilment and feeling needed. In the UK, Moores et al (1983)
found that wanting " a job where I would feel needed" was ranked fourth in order of importance for
choosing nursing as a career while Vanhanen and Janhonen (2000a) found that eight of the 19
nursing students in their Finnish study said that they expected a nursing career could make life
meaningful and promote personal growth.
Aims and desires
In many studies a desire to help others or to 'be helpful' to others has emerged as one of the most
frequently cited reasons for entering nursing (Collings 1997; Kiger 1993; Stevens and Walker 1993;
Whitehead 2007; Williams et al 1997). A desire to work 'with people rather than things' has also
been found to be frequently mentioned as a reason for entering nursing (Collings 1997; Moores et
al 1983; Stevens and Walker 1993; Whitehead 2007; Williams et al 1997) and other reasons given
for choosing nursing have included a desire for 'important' work, opportunity to use special abilities,
a desire to make a difference, desire for a profession or for a career which was not ' just a job' and
having always wanted to do nursing (Adejunmobi 1986; Barriball and While 1996; Stevens and
Walker 1993; Collings 1997; Day et al 1995; Kiger 1993; Maben and Griffiths 2008; Moores et al
1983; Murray and Chambers 1990; Whitehead 2007; Williams et al 1997).
Appendix 2 – Factors in Choice of Nursing
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Thesis: Caring Towards Death
Ann V Salvage (2010)
Congruence with academic interests
Congruence with individuals' academic interests has been cited in several studies as a reason why
nursing has been chosen as a career. Thus Beck (2000) found that a fascination with science and
the human body was given as a reason for choosing nursing, Kersten (1991) an interest in science
and disease, Murray and Chambers (1990) interest in medicine/biology and Williams et al (1997)
previous interest in science.
Personal experience
Studies have frequently reported the identification of a link between various types of personal
experience and choice of nursing as a career. In some cases this takes the form of previous
experience of working in a health-related job (Adejunmobi 1986; Barriball and While 1996; Beck
2000; Kersten et al 1991; Mitchell 2002; Moores et al 1983; Murrells et al 1995; Williams et al
1997). In other cases, individuals state that caring informally for sick relatives or friends was
influential in leading them to take up nursing (Beck 2000; Grainger and Bolan 2006; Moores et al
1983; Murrells et al 1995; Vanhanen and Janhonen 2000a). Some individuals cite personal
experience of illness, hospitalisation or other health care as a reason for entering nursing (Stevens
and Walker 1993; Day et al 1995; Kersten et al 1991; Murrells et al 1995; Williams et al 1997).
Finally, experience of having a relative who was ill and/or hospitalised has been offered as a factor
influencing individuals to take up nursing (Day et al 1995; Murrells et al 1995).
The influence of parents, family and close friends
Parents, other close family members and close friends have been reported to exert considerable
influence on individuals who have chosen to go into nursing. These individuals may simply give
advice, information, encouragement, or in some cases, may attempt to discourage individuals from
nursing (Adejunmobi 1986; Barriball and While 1996; Beck 2000; Kersten et al 1991; Williams et al
1997; Moores et al 1983; Murray and Chambers 1990; Murrells et al 1995). Having a close family
member working in a health care profession may also encourage young people to opt for a nursing
career (Beck 2000; Williams et al 1997; Mitchell 2002; Moores et al 1983; Murrells et al 1995;
Stevens and Walker 1993).
Appendix 2 – Factors in Choice of Nursing
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Thesis: Caring Towards Death
Ann V Salvage (2010)
The influence of other people: role models and knowing a nurse
Previous research has repeatedly found that experience of nursing 'role models', either in the form
of knowing someone who is a nurse or having been in a position to observe nurses at work, exerts
a strong influence on the decision to become a nurse (Adejunmobi 1986; Beck 2000; De Vries
2000; Grainger and Bolan 2006; Grossman et al 1989; Kersten et al 1991; Murray and Chambers
1990; Murrells et al 1995; Stevens and Walker 1993; Whitehead et al 2007).
Teachers and careers advisers
Another frequent finding of previous research has been the relative lack of influence and advice
nurses receive from school teachers and careers advisers. Not only are these individuals reported
to be rarely influential in encouraging students to consider a nursing career (Beck 2000; Mignor et
al 2002; Moores et al 1983; Kiger 1993; Murrells et al 1995) but some research has suggested that
careers staff in schools are not well enough informed on nursing to be able to advise students
(Mignor et al 2002; Moores et al 1983).
The 'image' of nursing
Previous research has found that perceived attributes of nursing have drawn some individuals
towards a career in nursing. Improved status, work which is seen as rewarding, fulfilling,
interesting, satisfying or challenging and perceptions of nursing as being glamorous or exciting
have all been cited as having influenced individuals to become nurses (Adejunmobi 1986; Beck
2000; Kersten et al 1991; Moores et al 1983; Murray and Chambers 1990).
Effect of specific media
While images of nursing presented on television emerge from several studies as having exerted a
positive influence on individuals' images of nursing (Kersten et al 1991; Kiger 1993; Murrells et al
1995) one study found that literary fiction had not been influential in attracting nursing students to
enter nursing (Kiger 1993).
Appendix 2 – Factors in Choice of Nursing
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Thesis: Caring Towards Death
Ann V Salvage (2010)
Very little would appear to be known about the influence of leaflets, and advertising about nursing
has seldom been mentioned in research reports, but this is as likely to suggest that researchers
have not asked specifically about these sources of information as to indicate that they have no
effect. Murrells et al (1995) found that 76% of the respondents in their study of registered nurses
said they had seen written information in the form of leaflets or books and/or prospectuses and
38% had seen an advert for nursing. For each of these types of information, only a small
proportion of respondents said it had made them consider the possibility of nurse training. Half of
those who had seen leaflets, books or prospectuses said that they had already considered nurse
training when they had seen the information and that it had strengthened their decision to do so,
but advertising appeared to have had comparatively little effect one way or the other on their
decision (Murrells et al 1995: 399).
Pragmatic factors
Several writers have suggested that nurses in the late twentieth and early twenty first century no
longer regard nursing as a ' vocation ' and are more likely to be motivated by a desire for financial
gain and job security than nurses in earlier times. A recent Daily Telegraph editorial observed that,
traditionally, "nursing was a vocation that emphasised character, service and discipline, traits that
are perhaps less in evidence than they once were" (Daily Telegraph 2009). McSherry (2000: 11)
argues that the reasons people enter nursing have changed and that "today many nurses... may be
motivated by economic and capital gain while working in a profession that is saturated in the
traditional value of selflessness..." It is not uncommon now, he observes, "when asking individuals
for their reasons for entering nursing to find that stability of career or a stepping stone to a better
career are offered."
Whatever public perceptions may be, research has consistently found that financial incentives are
rarely cited as reasons for entering the nursing profession. Financial motivation has emerged as a
factor taken into consideration by those entering nursing (Mackay 1998; Hemsley-Brown and
Foskett 1999; Kersten et al 1991; Meadus and Twomey 2007; Moores et al 1983) but frequently
pay has been well down the list of influencing factors. Hemsley-Brown and Foskett (1999) found
that salary was not significantly associated with choice or non-choice of nursing, while Moores et al
(1983) found that pay was ranked last as an influencing factor. Other pragmatic factors which have
Appendix 2 – Factors in Choice of Nursing
4 of 5
Thesis: Caring Towards Death
Ann V Salvage (2010)
emerged from research include a desire for job security, opportunities for career advancement,
flexible employment, opportunities for travel and convenience/availability (Adejunmobi 1986;
Barriball and While 1996; Mackay 1998; Collings 1997; Day et al 1995; Rognstad et al 2002/2004;
Hemsley-Brown and Foskett 1999; Kersten et al 1991; Meadus and Twomey 2007; Moores et al
1983; Murray and Chambers 1990; Stevens and Walker 1993; Williams et al 1997).
Chance or default
A small number of studies has found that some nurses enter nursing through 'default' (because
they have not been successful in pursuing their primary choice of career (Barriball and While 1996;
Beck 2000) or because they do not know what else to do (Day et al 1995). Beck et al (2000) found
that some nurses had opted for nursing having failed to get into medical school, while Day et al
(1995:359) found that some individuals had "drifted into nursing because they did not know what
else they wanted to do".
Appendix 2 – Factors in Choice of Nursing
5 of 5
APPENDIX 3
DEMOGRAPHIC
CHARACTERISTICS OF
RESPONDENTS
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 3
Demographic Characteristics of Respondents
Gender
Female
25
Male
5
Age (Range = 21-66)
20-29
4
30-39
5
40-49
10
50-59
9
60+
2
Ethnicity (Self-described)
White British/UK/English/Irish
25
Caucasian
1
Canadian
1
White European
1
Australian
1
British Pakistani
1
Year of nursing qualification
1960s
5
1970s
8
1980s
5
1990s
6
2000+
6
Appendix 3 - Demographic information
1 of 1
APPENDIX 4
PARTICIPANT
INFORMATION SHEET
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 4
Participant Information Sheet
Introduction
You are being invited to take part in a research study. Before you decide whether or not to take
part, it is important that you understand why the research is being done and what it will involve.
Please take time to read the following information carefully and discuss it with others if you wish. If
anything is not clear or if you would like more information, you can contact the researcher (see
details below). Please take time to decide whether or not you wish to take part.
What is the purpose of the study?
Nurses who decide to work in palliative care present us with an intriguing and tantalising question.
If a general aim of nursing care is to facilitate patient recovery, why would anyone (given a free
choice) choose to work with people who have no chance of recovery from their illnesses? While
this issue has been briefly touched on by previous researchers, we know very little about why
people decide to work in palliative care. The main aim of the study will be to develop an
understanding of the process by which individuals come to be, and continue to work as palliative
care nurses, based on the viewpoints of the people concerned.
Why have I been chosen?
As a qualified nurse working in a hospice, you are eligible to take part in the study. Interviews will
be held with up to 30 palliative care nurses working in English hospices.
Do I have to take part?
Participation in the research is entirely voluntary, and it is up to you to decide whether or not to take
part. If you do decide to take part, you will be given this information sheet to keep and asked to
sign a consent form (of which you will also be given a copy to keep).
What if I agree to take part but then change my mind?
If you decide to take part, you will be free to withdraw at any time, without having to give a reason.
What will happen if I do take part?
An interview will be arranged during your normal working hours at the hospice at which you work.
An alternative time and venue can be arranged if you would prefer this. The interview will take
about one hour and, with your consent, will be tape-recorded and later transcribed. The questions
will mainly concern the background to your present work and you will be asked specifically about
your personal experiences and choices: what it was that brought you to work in palliative care and
what encourages you to continue. After the interview you will be asked to fill in a short check-list
about your reasons for working in palliative care. When your interview has been transcribed, you
will receive a copy of the transcript and invited to check it for accuracy.
What are the possible disadvantages of taking part?
It is possible that talking about your work and the process which led you into it may bring to the
surface some upsetting memories. Should this happen, the interviewer will offer to terminate or
Appendix 4 Participant Info
1 of 2
Thesis: Caring Towards Death
Ann V Salvage (2010)
postpone the interview and you will be given the opportunity to seek support from a senior member
of nursing staff.
What are the possible benefits of taking part?
The research is being carried out to develop an understanding of the process by which people
come to be and continue to work as palliative care nurses and the results may have implications for
nurse recruitment and retention. It may not be of specific benefit to you as an individual: it is hoped
that you will enjoy and benefit from sharing your own, very personal story, but this cannot be
guaranteed.
Will the information I provide be treated as confidential?
All information you provide will be treated in the strictest confidence. Precautions will be taken to
ensure that you cannot be identified with either the interview tapes or the typed interview
transcripts. Pseudonyms will be used in any written reports on the research, both for you and for
the institution for which you work, and any material which would make it possible for readers to
identify you will be excluded.
All data will be kept in a locked cabinet and the interview tapes wiped and transcripts shredded five
years after the conclusion of the study.
What will happen to the results of the research study?
The study is being undertaken towards a postgraduate qualification (M.Phil/Ph.D) at Roehampton
University, Surrey. The results will be published in 2009 in the form of a thesis which will be held
by the University where it will be available for consultation.
A summary of the results will be sent to all those who take part, and it is hoped that material from
the research will be published in nursing and other journals.
Who is doing the research?
The research is being undertaken by Ann Salvage, a medical sociologist with a background in
gerontological research and a special interest in death and dying. The research is being
supervised by academic staff in the Department of Sociology, Roehampton University, Surrey.
Who has reviewed the study?
The research has received the approval of the Roehampton University Research Degrees Board,
Roehampton University Ethics Committee and the London/Surrey Borders NHS Research Ethics
Committee.
Who can I contact to talk about the research?
If you have any queries, please contact the researcher, Ann Salvage, on 020-8544-9478 (mail
@annsalvage.plus.com).
I’d like to take part in the research. What should I do now?
You can contact the researcher by telephone or e-mail or let a senior staff member know that you
are willing to take part.
Many thanks for your interest in this project.
Appendix 4 Participant Info
2 of 2
APPENDIX 5
PARTICIPANT
CONSENT FORM
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 5
Participant Consent Form
Title of Research Project: ‘Caring towards death: Becoming and being
a palliative care nurse
Name and Status of Investigator: Ann Virginia Salvage, Research
Student
Consent Statement:
I agree to take part in this research which will involve one face-to-face interview. I understand that
the information I provide will be treated in the strictest confidence by the researcher and that both
the taped interview and the transcript of that interview will be stored securely separately from
identifying details. I also understand that my name and the identity of the institution for which I
work will not be revealed in the publication of any findings (including the thesis) and that the
researcher will maintain my anonymity such that I cannot be identified by anyone outside or inside
the institution. I have been provided with written information about the purpose of the study and
am participating in it voluntarily. I understand that I am free, at any time, to withdraw from
participation in this research without having to give any explanation for my decision.
Name …………………………..
Researcher …………………….
Signature ………………………
Signature …………………........
Date ……………………………
Date …………………………….
Please note: If you have a concern about any aspect of your participation, please raise this with
the investigator or her Director of Studies, who is:
Name: Dr Garry Marvin
Contact Details:
Appendix 5 Participant Consent Form
Department of Sociology
School of Business and Social Sciences
Southlands College
Roehampton University
80 Roehampton Lane
LONDON
SW15 5SL
(020-8392-3170)
(g.marvin@roehampton.ac.uk)
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APPENDIX 6
INTERVIEW
GUIDE
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 6
Interview Guide
Introduction
I am a medical sociologist with a special interest in death and dying, and I‟m undertaking my
doctoral research on nurses working in hospices. My interest in this is very personal as I have
experienced the deaths of several people including my father, who died when I was a child, and my
husband (who died at Trinity Hospice some years ago). I have always very much admired the work
that goes on in hospices and I wanted to know more about the nurses who work there. Even telling
people about my research has shown me how much of a „taboo‟ subject death is in our society,
and I want to know more about what it is that leads nurses to choose to work with people who are
going to die rather than get better and return to their normal lives.
I have some general information-gathering questions to start with, and then I‟d like to invite you to
tell me your story, with a few pointers from me. After that I have a few more specific questions to
ask you. If you want to stop the interview at any time, just say so and we‟ll stop.
Part 1: Personal information
 Role at this hospice
 Length of time at this hospice
 Previous jobs (When? where?) (From school onwards)
 Nursing training (When? where?) (Including PG) Qualifications obtained
 Education: LA/Private? Grammar/sec mod? Co-ed/single sex? College/University?
 Qualifications
 Higher education (including any returns to study)
 D.o.b.
 Marital status
 Children (nos and ages)
 Ethnicity
 Religious affiliation (if any)
 How would you describe your social class background?
Part 2: Telling the story
1. Have you ever talked to anyone or written anything about how you came into hospice work?
(Prompt: Family/friends/colleagues/at job interview).
2. Could you tell me a bit about what led you to be interested in nursing and how you came to be
working in palliative care? (Aide-memoire: When/who/what/why/attitudes to
death/anxieties/recent changes re assisted death)
(Probe: Why hospice not hospital?)
Appendix 6 Interview guide
1 of 3
Thesis: Caring Towards Death
Ann V Salvage (2010)
Part 3: Focused questions
1. Would you say there were any particular people who influenced you to do nursing in general or
palliative care work specifically?
(Probe: Parental careers/siblings/teachers/role models/media images/knowing a nurse)
2. Thinking back particularly to your school days, do you think that your experiences at school had
any effect on what you ended up doing in life?
(Probe: Subject choice/careers advice/teachers/early dreams and ambitions/other careers
considered)
3. Would you say that your decisions to do nursing or to go into palliative care were affected by
any practical things like always being able to find a job, fitting in with family responsibilities or
having a job with convenient hours?
(Probe: Job close to home/fitting in with spouse‟s work)
4. Do you think that any of your own experiences in life had any effect on your choice of work?
(Probe: Personal experiences of death or loss/caring for others/health problems)
5. Was there anything in particular about hospice work that attracted you to it?
(Probe: Higher staff:patient ratios?/preferable to hospital?)
6. Do you think there are any particular personal qualities or types of experience that are needed
to do hospice nursing?
(Probe: How do you see yourself in terms of these qualities/experiences?)
7. Thinking back to your original nursing training, would you say it had any effect on your choice of
specialty?
(Probe: Lectures/placements/experience of death/teachers/attractiveness of different
options/perceived prestige of different options/role models)
8. Are there any particular beliefs or values that have guided your life?
(Probe: Source/strength/effect on choice of career or work practices)
9. What does death mean to you?
(Probe: Simply end of life or is there something else?/effect on choice of career/effect on how
they work)
10. How long do you think you will continue working as a hospice nurse?
(If expects to continue for foreseeable future)
10a) Are there any particular things that make you want to carry on or that help you to carry on?
(Probe: Relationships with patients/support/work-leisure balance/pragmatic
factors/rewards/autonomy)
(If intends to stop)
10b) Are there any particular things that make/ would make you think about stopping doing this
work?
Appendix 6 Interview guide
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Thesis: Caring Towards Death
Ann V Salvage (2010)
(Probe: Stress/emotional demands/pragmatic factors)
10c) What would you do then?
11. Do you see palliative care nurses as being different in any way from nurses working in other
specialties?
(Probe: Qualities/attitudes to death/belief systems)
12. How do you think palliative care work differs from other nursing specialties? (Probe: What
makes it special?/More control over work?/Independent working?)
13. Is there anything else you think is important in talking about how you became a palliative care
nurse?
14. What was it that made you decide to take part in this interview?
 Summarise/recap content of interview
 Give checklist
 Thanks
 Re-emphasise confidentiality
 Transcript to be sent to them
 Request telephone number (if appropriate)
 Request names of other potential respondents (if appropriate)
Appendix 6 Interview guide
3 of 3
APPENDIX 7
RESPONDENT
FACTOR CHECKLIST
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 7
Respondent Factor Checklist
Respondent No………
Please rate each of the following items in terms of the level of influence you feel it has had in
leading you to train as a nurse or to work as a hospice nurse (Circle one number for each item in
both columns)
TRAIN AS NURSE
LOW
HIGH
WORK IN HOSPICE
LOW
HIGH
Always wanted to do it
1 2 3 4 5
1 2 3 4 5
Caring for someone as
a child/young person
1 2 3 4 5
1 2 3 4 5
Convenient location or hours
1 2 3 4 5
1 2 3 4 5
Experience of death or
loss*
1 2 3 4 5
1 2 3 4 5
Experience while in nurse
training*
----------------
1 2 3 4 5
Experience with specific
patient/s
1 2 3 4 5
1 2 3 4 5
Family (e.g. mother was
a nurse)*
1 2 3 4 5
1 2 3 4 5
Financial rewards
1 2 3 4 5
1 2 3 4 5
Fitted in with spouse/partner‟s
job or family needs*
1 2 3 4 5
1 2 3 4 5
Job security
1 2 3 4 5
1 2 3 4 5
Knowing a nurse
1 2 3 4 5
1 2 3 4 5
Opportunities for creativity
1 2 3 4 5
1 2 3 4 5
Opportunities for independent
working
1 2 3 4 5
1 2 3 4 5
Opportunities for variety of
experience
1 2 3 4 5
1 2 3 4 5
Personal beliefs/values*
1 2 3 4 5
1 2 3 4 5
Personal health problems*
1 2 3 4 5
1 2 3 4 5
Previous experience of
health care work*
1 2 3 4 5
1 2 3 4 5
Professional status
1 2 3 4 5
1 2 3 4 5
Public status
1 2 3 4 5
1 2 3 4 5
Appendix 7 Respondent factor checklist
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Thesis: Caring Towards Death
Ann V Salvage (2010)
TRAIN AS NURSE
LOW
HIGH
WORK IN HOSPICE
LOW
HIGH
Relationships with patients*
1 2 3 4 5
1 2 3 4 5
Specific people*
1 2 3 4 5
1 2 3 4 5
Spiritual/religious beliefs*
1 2 3 4 5
1 2 3 4 5
Use of technology
1 2 3 4 5
1 2 3 4 5
Wish to be helpful/
useful to others
1 2 3 4 5
1 2 3 4 5
Wish to provide high
quality of care
1 2 3 4 5
1 2 3 4 5
Written information
(e.g. adverts/leaflets)*
1 2 3 4 5
1 2 3 4 5
Other*
1 2 3 4 5
1 2 3 4 5
(* Please give brief details if you choose „4‟ or „5‟)
Appendix 7 Respondent factor checklist
2 of 2
APPENDIX 8
CHECKLIST
RESULTS
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 8
Checklist Results
Of the 30 respondents in the study, 29 returned a completed checklist.
Table A1 shows, for each checklist item, the percentage of respondents who rated it either 4 or 5
(i.e. as having had a strong level of influence in leading them either to train as a nurse or to work as
a hospice nurse).
Table A1: Percentage of checklist respondents who rated item 4 or 5
Checklist item
Always wanted to do it
Caring for someone as a child/young person
Convenient location / hours
Experience of death or loss
Experience while in nurse training
Experience with specific patients
Family (e.g. mother a nurse)
Financial rewards
Fitted in with spouse’s/partner’s job/family needs
Job security
Knowing a nurse
Opportunities for creativity
Opportunities for independent working
Opportunities for variety of experience
Personal beliefs/values
Personal health problems
Previous experience of health care work
Professional status
Public status
Relationship with patients
Specific people
Spiritual/religious beliefs
Use of technology
Wish to be helpful to others
Wish to provide high quality care
Written information (e.g. adverts/leaflets)
Train as nurse
N
%
15
(52)
7
(24)
3
(10)
5
(17)
N/A
N/A
9
(31)
5
(17)
0
(0)
0
(0)
6
(21)
7
(24)
5
(17)
4
(14)
15
(52)
17
(59)
0
(0)
6
(21)
7
(24)
9
(31)
10
(34)
7
(24)
10
(34)
1
(3)
24
(83)
20
(69)
2
(7)
Work in hospice
N
%
11
(38)
7
(24)
4
(14)
12
(41)
13
(45)
18
(62)
3
(10)
2
(7)
3
(10)
8
(28)
7
(24)
13
(45)
8
(28)
11
(38)
24
(83)
1
(3)
12
(41)
5
(17)
5
(17)
18
(62)
15
(52)
15
(52)
3
(10)
25
(86)
24
(83)
5
(17)
Choosing nursing as a career
A desire to be helpful to other people was the most highly rated factor reported to have affected the
decision to do nursing (83% of checklist respondents rated it 4 or 5). Personal beliefs or values
were rated as important by nearly two-thirds of respondents (59%) and just over half (52%) in each
case) assigned a rating of 4 or 5 to having „always wanted to do‟ nursing and to „opportunities for
variety of experience‟.
Appendix 8 Checklist results
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Reported as having been of least importance in the choice of nursing were financial rewards (0%),
fitting in with spouse‟s/partner‟s job or family needs (0%), personal health problems (0%), and use
of technology (3%).
Choosing to do hospice nursing
The top two categories chosen here echoed those seen as most influential in the choice of nursing.
Eighty-six percent of respondents cited a wish to be helpful to others as influential in choosing
hospice work, while 83% cited a wish to provide high quality care. Personal beliefs and values
appeared to have been more influential here than in choosing nursing (83%, compared with 59%,
assigned this factor a rating of 4 or 5) and relationships with patients appeared to have been a
special consideration: 62% gave this a rating of 4 or 5 compared with 34% who cited this as having
been important in the choice of nursing generally.
Reported as having been of least importance in the choice of hospice nursing were personal health
problems (3%), financial rewards (7%) and family influences (10%).
The checklist results suggest a number of further observations:
 The „always wanted to do it‟ factor appears to be of more relevance to the choice of nursing in
general than to the choice of hospice nursing in particular.
 Hospice work is reported as having been seen to have potential for creativity and independent
working to a greater extent than nursing in general.
 Relationships with patients would appear to have figured much more highly in the choice of
hospice nursing than in the original choice of nursing.
 The influence of specific people and spiritual or religious beliefs is reported to have been
greater in the choice of hospice work than in the initial choice of nursing.
 Experiences while in nurse training are reported by nearly half of respondents as having been
influential in leading them to work in a hospice.
Appendix 8 Checklist results
2 of 2
APPENDIX 9
PEN
PORTRAITS
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 9
Pen Portraits
Angela
Angela has always had a "caring nature". She has an ability to "connect with people" and to reach
out to patients who, she finds, readily confide in her. Now in her early fifties, she has been working
as a staff nurse in the hospice for three years. She feels it is necessary to have "a degree of life
experience" to do hospice nursing and that hospice nurses must have a good sense of humour and
be good listeners who are able to empathise.
Angela's mother, who was in her forties when Angela was born, frequently told her "you'd make a
lovely nurse" and it seemed natural for Angela to take care of her mother as she grew older.
Angela stayed on at school to do a shorthand-typing course to fill in the year until she could begin
nurse training, and worked for a short time - as her sisters had done - at the local council offices to
make some money to help to carry her through her course. She began her training in 1974, being
trained "by the old school of nurses..." which suited her because "I don't like studying". She worked
as a staff nurse for a year before commencing midwifery training and was a midwife for four years
before giving up work to have her children. Working in a nursing home while her children were
growing up, Angela became very aware of the need of families for support when elderly relatives
died, and experienced an event which she has "never forgotten" when an elderly woman died
alone because of inadequate staffing levels. This made her feel "hugely neglectful" and confirmed
her growing interest in working in a hospice environment, where she knew she would have more
time for patients. She had cared for both her parents at home until their deaths, but had been
"pretty appalled" at some of the treatment they had received in hospital.
Angela got her present job by ringing the hospice to inquire whether there were any vacancies.
She works three days a week and feels she could not manage full-time either physically or mentally
"because it takes a lot out of you. I think I've always gone home emotionally wrecked... maybe in
some ways, I give too much of myself". Sensitive to unspoken family issues and with a keen
intuition ("I've got tremendous intuition. My intuition worries me sometimes...") she is hoping to
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undertake a counselling course which she feels will help her to deal more effectively with patients.
She feels greatly supported by her co-workers and manages the stresses of her work by
completely immersing herself in her home life during nonworking hours.
Angela feels that, in the hospice, "small things matter" and she cites the case of a woman who
asked for her bed to be pushed into the garden shortly before she died.
Angela was brought up as a Catholic and thinks she "probably always will be" but says she has
"changed a lot... I'm probably more spiritual now than anything." She has always tried to treat
people how she would like to be treated herself: "I think if you always remember that the person in
the bed could be your father or mother or brother or sister, you won't go too far wrong."
Barbara
Barbara, now in her late forties, is working as a hospice staff nurse - her first post since qualifying
as a nurse relatively late in life. Her mother was a nurse and, although she never pushed her
daughter to follow her into the profession, Barbara admired her and aspires to "be her."
At school, Barbara had no specific academic ambitions. Although a lot of her friends planned to go
to university, she was "very much a family person and didn't want to leave home" so never
seriously considered it and left school to take up an office job. As things turned out, she did leave
home quite soon afterwards as she married young and began a family. When her children were
young, Barbara worked as a childminder and, when her own children went to school, took a job as
a care worker. Working with a community rehab team, she began to feel the need for more of a
challenge in her life and after being promoted to senior carer and finding herself missing the
contact with patients, she took up a new post as an OT and physio assistant before deciding to
commence her nurse training at the age of forty. She was lucky to be sponsored by her primary
care trust to undertake her training, but would probably have gone ahead and done it anyway if the
sponsorship had failed to materialise.
In her work as a carer, Barbara had worked with cancer patients and had found this challenging but
enjoyable. She knew "from the very beginning" of her nursing training that she wanted to work in
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palliative care, and during her course had placements in hospice settings. Her experience of
nursing dying people on acute wards had not been good: "I didn't always feel comfortable about
the way people were cared for." In NHS settings, she found, nurses lacked the time to give
adequate care and the ability to spend time with patients is "very much" an attraction of hospice
care. In their training, she observes, nurses are "taught about holistic care of the patient" but "that
doesn't happen all the time on an acute ward - they don't have the time."
The greater "opportunity for hands-on nursing", she feels, marks hospice care out from other forms
of nursing and this is important to her - "you learn so much about your patient when you're washing
1
them [SP] helping them to the toilet [SP] giving them a bath - you learn so much." She would
definitely not want to return to nursing in an acute NHS setting. Even if the nurse: patient ratio
(which is a definite attraction towards palliative care) were better in acute settings, she would still
choose to work with palliative care patients: "I would certainly agree that hospice nursing is what I
call real nursing."
Barbara feels supported by a strong family unit and especially by her husband, to whom she can
talk about the stresses of her work. Sometimes she will listen to "really loud rock music" on the
way home: "By the time you get home, you've usually got over it."
Describing her religious beliefs, Barbara says "I would say that I'm a Christian." She goes to
church "occasionally" and "certainly wouldn't want to push [my] belief on to anybody. You have to
sort of keep it in a little compartment of its own, really." She tries to treat others as she would like
to be treated herself, but experience has taught her that "not everybody wants to be done as you
would be done, so you've got to have much more of an open mind."
Catrina
Catrina, in her early twenties, admits that nursing was not a lifetime ambition for her. Academically
able, she could have chosen many different careers and describes herself as having come into
nursing "by mistake" and having fallen into it "by accident". She had always wanted to go to
university, but was interested in so many subjects that she found it difficult to choose which to
1
[SP] indicates a short pause
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study. In the end, having identified in herself a liking for working with people and the need for
challenging work, she narrowed down her choices to physiotherapy and nursing. Physiotherapy
was her first choice, but on the day she received her A-level results, she decided to do nursing and
took up an offer to do that instead. Her father would have liked her to have become a doctor, but
she has always preferred the nursing role, seeing doctors as "not in contact so much with the
patients. With nursing... you really get to know the patient and you're doing more of the caring."
Following Pakistani tradition, her two sisters had married young and had children, but Catrina, who
identifies herself as "very independent", firmly rejected that path.
Beginning her nursing training straight from school, Catrina found it was not at all what she had
expected, and she hated her first placement so much that she "really wanted to leave the nursing
course straight away" but her parents persuaded her to stick it out. Apart from the early
responsibility she was expected to assume, Catrina was surprised at the uncaring attitudes of
many of the nurses she encountered in the NHS. She did, however, very much enjoy two of her
placements. In practice nursing, she liked "the preventative side" and found that "you really get to
know patients so well..." She also " loved" her two-week placement in palliative care: "I thought this
was what true nursing was about - you actually practise holistic care and don't just say the word."
At the end of her training, Catrina knew that she wanted to work either in general practice or
palliative care. By that time, many of her peers already had jobs, and although practice nursing
was her first choice, she responded to an advertisement for hospice nurses and was offered a staff
nurse post at the hospice where she has now been working for four months. This is Catrina's first
paid job, and she recognises that she is unusually young to be working as a hospice nurse. She
enjoys working as part of an interdisciplinary team in which nurses' opinions "are valued so much
more" and where there is a comparative lack of "hierarchy". In the hospice, "you have that time" to
care for patients which is not available in the NHS, and she can hope "to make a difference... to
have a patients say to you [SP] it's so encouraging - it really makes my day..." To her, hospice
nurses are clearly different from nurses working in other specialties: "... ward nurses are not caring,
but here there's definitely that huge ethos of care... a lot of people have said that this is what
proper nursing is. I think it refreshes the nurses who work here, so they actually want to come in."
She also sees hospice nurses as more dynamic than other nurses - not simply complaining about
things that need changing but getting on and doing something about them in an atmosphere where
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no one is criticised and "there's that whole thing of everyone teaching everyone else". Catrina
does, however, see a danger in the blurring of roles: " Nursing sort of runs into medicine now, when
you have the junior doctors types, and then... healthcare assistants runs into nurses, so there is a
blurring of all the roles, really." In these circumstances, she fears that nurses may "just lose [their]
nursing status completely..." She thinks she may remain in palliative care, but would be careful to
maintain patient contact were she to be successful in climbing the career ladder.
Catrina is a practising Muslim, whose religion is "definitely important to me, very important". She
believes in some kind of existence after bodily life ends and a "judgment day" in which good and
bad deeds are weighed. However, she is very open-minded and will question her own beliefs: "I
could be wrong - I'm not someone who [says] 'This is what I believe and I know it's true' - I'm not
like that."
Diane
Diane is in her mid-fifties and had a considerable amount of nursing experience under her belt
before she entered the hospice world.
Born abroad, Diane moved to England with her family at the age of nine which, she says, disrupted
her education. The middle child of five, Diane says she was considered "stupid" and an unlikely
candidate for higher education, but she found her niche in nursing and attained much more than
anyone had expected.
Diane was "very, very young" when she decided to be a nurse, and her decision was based to a
large extent on the anticipated approval of her parents, which has always been important to her.
Diane feels that "it was always going to be the case that I would be the carer." As a young girl, she
enjoyed visiting a neighbour who was a nurse and talking to her about her work, and when her
grandmother had a heart attack, it seemed natural for her to help out by cooking meals. This made
her feel that she had a role which, as the middle child with little apparent academic ability, was a
welcome change. In her school holidays, she worked in a home for disabled people and met a
nurse whom she thought "marvellous": "So that was definitely what I wanted to do."
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Diane undertook a pre-nursing course after leaving school, and began her training in the late
1960s. Despite constant tiredness and a tendency to faint at the less pleasant aspects of nursing,
Diane loved the training. "I was so excited, because I was with people and people needed me...
and I was good at it." After qualifying, she chose to work in orthopaedics for no clear reason that
she can remember and went on to take up her sister's post. She enjoyed the drama and rush of
the orthopaedic wards and told people at the time that one thing she enjoyed was the fact that
patients did not die - "they get better and they go home and... you mend them."
After undertaking a clinical nursing qualification, Diane worked as a nurse teacher for several
years, combining this with counselling and eventually gave up nursing to work full-time as a
counsellor. Caring for a close friend - a fellow counsellor - who died of cancer brought home to
Diane how much she was missing the "physical hands-on" of nursing, and she decided to do a
'Return to Nursing' course. The course was "terrible" but as part of it, Diane worked in a hospice.
She wanted to do "something that gave me a sense of purpose... something that was meaningful.
More than just sticking people back together again." She "absolutely loved it" and after combining
counselling with shifts at the hospice for a while, she chose to work longer hours at the hospice,
where she told her employers "I just want to be a nurse." To her, that meant having plenty of
contact with patients and families. To her, the essence of being a nurse is the relationship with
patients and their families: "it's that kind of privileged position that we're in, where we get involved
in very intimate situations, like when someone is dying." Nurses she feels, should be nurses and
not attempt to take on roles previously performed by doctors because "it takes away from what
nursing actually is."
Since her return to nursing, Diane has undertaken various roles including a period as a clinical
nurse specialist. In her current job she has less contact with patients and feels it is "not the same
and I've lost that bit where it all tied together." But she feels confident in her teaching role and
enjoys the opportunity to 'be' with patients rather than "rushing around" with which she was happy
as a younger nurse. She likes the way in which hospice nurses continually question their own
practices and enjoys the "hugely wicked sense of humour" on which hospice nurses rely to cope
with the emotional demands of their work.
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Although she comes from a "religious" family, Diane has no religious beliefs herself. She is aware
that there is more to human beings than "just what you see." "There's a... sort of higher kind of
existence" and she thinks and talks about what happens at death "quite a lot". She has sometimes
considered whether she should go to church and believe "just in case it's true".
Elaine
If Elaine had followed the advice of her school careers adviser, she would never have gone into
nursing: " She virtually said I'd be working in a factory and get married, have lots of babies, and
that would be my life". With an unhappy home life (her mother frequently threatened suicide and
her brother had a chronic illness) Elaine did not enjoy her schooldays and left as soon as she was
able at sixteen. She would have liked to have been a doctor or a vet, but, realising she was
unlikely to get the necessary qualifications and knowing her parents could not afford to send her to
university, she set her mind on being a nurse. From school, she did a pre-nursing course at
college and at seventeen and a half commenced her nursing training. Her decision to do SEN
(rather than SRN) training was based on the fact that "I didn't want to be a ward sister - I wanted to
be with patients all the time. And I wanted to... be a basic nurse". Some years later, however, she
did undertake a conversion course to become state registered.
When she commenced her training in the late 1970s, nurse training was "very different" from
today's training. Students spent much longer on the wards, and "a lot of the teaching then was
more practical - much more practical". Soon after commencing her training, Elaine knew she
wanted to do palliative care nursing. As a very young student she witnessed the death of a
teenager from cancer, and was greatly impressed by the way in which the nurses treated the girl
and her parents. One particular nurse "was wonderful" and "I think it was her that kind of inspired
me". However, Elaine was aware that nursing the dying was not "something to do when you were
an inexperienced nurse" so she deliberately set out to acquire the experience to allow her to go
into this work.
Her first job after qualifying as a nurse was on a gynaecological surgical ward at the hospital where
she trained. This was not her first choice of job, and the ward sister did not go out of her way to
make it enjoyable. After a year, Elaine and a friend travelled to Europe for three months, and when
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she came back, Elaine decided to move to medical nursing, where she saw more opportunity to
develop relationships with patients. After a very enjoyable year, Elaine fulfilled a dream of
travelling and working in South Africa where she met and married her husband, gave birth to her
son and had several nursing jobs. On her return to the UK, Elaine's marriage broke up and, on the
advice of her mother (who believed it to be more lucrative) worked nights at a private hospital.
From there, she went on to various nursing jobs including some hospice work and four years
working in the community with a view to becoming a Macmillan nurse looking after dying people in
their own homes, which she particularly enjoyed. At this point, she was accepted to do a degree in
district nursing, but with two children to support, she simply could not afford the salary drop it would
entail.
An interview at a hospice for a job on the home care team was unsuccessful (partly because it was
less than two years since her mother had died and partly because she had no degree) but she was
advised to obtain more oncology experience. Following this advice, she worked as an oncology
research nurse for a year, and then worked for a year on a palliative care ward in a hospital before
applying for another hospice home care team post. Again, she was turned down because she had
no degree. After a period in the community (when she was passed over for promotion - "They took
a person with a degree") it was suggested she go to work at her present hospice, where a senior
staff nurse post would soon become available. She had an interview for the senior post, but was
knocked back a third time: "apparently, I bungled the interview". Elaine is now not sure what to do:
she would like to stay in palliative care but still hopes to work in the community. She would be very
happy to undertake a degree but could only do this if an employer would be willing to support her,
and so far she has not been offered this opportunity. Now in her late forties, she does find hospice
work "immensely rewarding" and is sustained by "knowing that I'm doing something worthwhile with
my life... and that it is appreciated by other people".
Elaine does have religious affiliations, and although "I wouldn't call myself a full Christian and I
wouldn't call myself a Buddhist" she has "beliefs in both those religions" and believes that "we do
come back... to learn another lesson ". As a nurse, she tries to imagine that the patient for whom
she is caring is "somebody that [I] love " and to give them the care she would give to that loved
person.
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Emily
Emily always wanted to be a nurse. There are no nurses in her family so she has no idea where
the desire came from, but nursing was all she ever wanted to do "ever since I was a little girl" and
she has "never regretted" the decision. Now in her late forties, she contrasts her certainty with the
uncertainty of her two sons who have little idea what they want to do in life. Well before she was
18, Emily had applied to do her nurse training, which she completed in the early 1980s.
After qualification, she worked as a staff nurse on a mixed ward, where she learned a great deal
from an "excellent" ward sister who terrified but inspired her, and moved on to take up a district
nursing post. It was while working as a district nurse that Emily came across a palliative care team
on which she drew for her patients and their families. Impressed with the work done by the team
and encouraged by its director, she decided to take a sideways step and left district nursing to join
them. She worked for two years in palliative care but was then encouraged to do further training
and undertook her health visitor training. Having hoped to work with older people, Emily was
disappointed when her health authority insisted that she first work with mothers and children. At
this stage of her life, she had no children of her own and was not comfortable having to provide
advice to mothers."It was the one area I just didn't feel very comfortable telling a group of mothers
how to deal with their child who wouldn't sleep, which is illogical but it is how I felt." She therefore
decided to move back into palliative care, which she had enjoyed, and was taken on at a new
hospice to help to set up its home care team. Her first child was born after she had been in this
post for a while, and she has now been with the hospice for seven years, currently working as a
staff nurse.
Treating patients holistically is important to Emily: every good nurse, she says "should be dealing
with a patient from the top to the toe, and the others around them - their family, their friends, their
work or their needs." To her, it is quite simple: palliative care nursing is "what good basic nursing,
as taught, should be". Palliative care nursing may be a "slower, quieter pace of nursing" but, on
the other hand, "Everything needs to have happened yesterday... there's a certain sense of
urgency... because time is always on your heels." Nurses, she thinks, are "possibly a sort of
person who gets a great deal of satisfaction out of caring for others". She feels nurses need to
have a good sense of humour to work in palliative care, and should probably not be "too serious or
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earnest" with a good balance between their working and non-working lives and support from home,
family and work colleagues.
She describes her religion as "Church of England non-specific" and does not practise as a
Christian but thinks it possible that life continues after death and still feels her father close to her
fifteen years after his death. She feels it is important to be kind to others and to treat people as she
herself would like to be treated.
Felicity
Felicity is a ward manager who, because she works in a hospice rather than on a hospital ward,
manages to maintain contact with patients - something which is very important to her. Now in her
mid-thirties, she has "worked my way up through the grades" to her present post and has been
working at the hospice for eleven years.
Felicity knew that she wanted to be a nurse when she was a child, although other ideas presented
themselves as she came closer to having to choose a career. At school, she was very interested in
writing and drama, and for a while considered training as a journalist. She was greatly encouraged
in this by her uncle, who was himself a journalist, but although attracted by the apparent "glamour"
of the profession, Felicity was not keen to go to university and was aware that the world of
journalism was "a very uncaring world" in which it was necessary to be "very ruthless." Instead,
she left school to take up a clerical job as a "stopgap" measure and it was while doing this job that
one of her friends went into nursing. This "sort of [SP] reminded me that that was what I really
wanted to do, so [SP] I went and applied..."
She began her training in 1991, and by the time she qualified, Felicity knew that she wanted to
work in a hospice. During her training, her uncle had become ill with a brain tumour and, visiting
him in a hospice, she had been greatly impressed with the general environment and began to
consider going into palliative care work. The frustration she felt at the inability of the NHS to
provide adequate care to medical patients further confirmed her desire to work in a hospice.
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After qualifying as a nurse, Felicity was advised to do six months medical and six months surgical
nursing, "so that was what I did to get my background." Having got this experience under her belt,
she went straight into hospice nursing. Felicity was attracted by the fact that palliative care "gets
down to the very basic nursing care of actually caring for somebody." Patients are not "shipped in
and out so quickly that you don't get time to know people..." and "you can spend time with people,
which is really, really important." She enjoys the openness with which death is discussed in the
hospice environment, but acknowledges that to foster this openness nurses have to "feel very
comfortable... that you can deal with the questions that people may ask you..."
She is concerned that nurses now entering palliative care do not seem to have been taught the
"very basic nursing, which is... what we need here" and that instrumental reasons ("getting a job")
may now be more important than caring motivations. To her, it is a privilege and "a real honour" to
look after someone "through their dying days."
Felicity has no specific religious affiliation, although she believes that "there must be something"
after worldly existence ends. She tries to treat her patients as if they were one of her parents: "how
would I want my loved one to be treated?" And this "is how I... live my life... That's what I always
carry with me."
Grace
Grace encountered death at an early age. Her father died of cancer when she was ten, and only
ten years later her mother was widowed a second time. She came into nursing through her lifetime
wish to work in child care, becoming a nursing cadet at fourteen, which meant that she "learned a
lot about how hospitals tick... and what goes on behind the scenes". Her mother was sceptical as
to whether she would cope with nurse training: " I was a very quiet sort of sixteen year-old - I
wouldn't say boo to a goose..." but she was offered a place on a course and eagerly started a
three-year SRN training with a view to eventually becoming a children's nurse. Her first experience
of working on a children's ward, however, made her realise that she would not be able to cope with
the emotional aspect of the work: "Maybe I was just unlucky, but we had such tragic cases".
Following her training Grace worked for a year on a medical ward. Having done surgical nursing
throughout her training, Grace opted for a medical ward for the greater opportunity it offered to get
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to know the patients. After a broken love affair, she moved to another part of the country, where
she worked for over twenty years at the same hospital, mainly in acute medical and coronary care.
Over this time, Grace was aware of the fact that on acute NHS wards, nurses simply did not have
time to give terminally ill patients the care and attention they needed. She was also aware that the
focus in acute care was mainly on "conditions" and "procedures" rather than on patients as people,
and was dissatisfied with the lack of patient contact resulting from the excessive amounts of
paperwork which accompanied senior positions: "... it was very frustrating. And I wanted to be able
to do what I came into nursing (SP) for, and that was to care for people."
A house move brought with it new opportunities and Grace accepted the offer of a hospice post.
Her colleagues in acute care "threw their hands up in horror...Uhh! Do you want to go and work in
a hospice? Such a sad (SP)..." Grace had certainly enjoyed the bustle of acute care but had "sort
of burned myself out... I was ready for a new challenge and this was the right environment". Now
in her late forties, she has been working as a staff nurse at the hospice for eight months. Far from
being "bored" as acute colleagues predicted, she is very much enjoying the work: "I actually said to
Maria, the sister, said I felt like I've refound nursing." Grace considers it "an honour to be with
somebody in their final days, weeks, months" and greatly appreciates the fact that she now has
time to give the care she feels people need: "We [staff] were having this conversation this
morning... how nice it is to have time..." She likes the way in which staff of all grades work together:
"We all muck in together, really" and feels far more appreciated by patients and relatives then she
remembers feeling in the acute sector: "I don't miss the medical ward at all. I don't think I would
ever go back to that - to medicine." Working in a hospice environment has taught her to value her
own health and not to take it for granted: "... I've just seen too much of it, and I know... how not to
think 'Well, it won't ever happen to me'..."
Grace has no religious affiliation but does describe herself as "spiritual". She believes in some
form of continuation of life after death and "I do believe in reincarnation to a degree." She feels
that a lot of hospice nurses are "quite spiritual", "more so than you get, I think... on a medical ward"
although she admits that it may simply be that palliative care nurses talk more about spiritual
matters. She always tries to treat patients "the way I would want my relatives to be treated... if I
can't do it like that I wouldn't want to do the job".
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Graham
As a nursing student, Graham placed great value on spending time talking to patients. His
willingness to sit and talk was a cause of some conflict with those who were responsible for training
him. In the acute sector, he feels, staff generally place far greater emphasis on physical tasks, and
communicating with patients comes at the end of the list of priorities.
Now in a management position, Graham has less direct contact with patients than he had at the
beginning of his hospice career. While he would not want to move any further away from direct
patient care, he feels that he can do more to benefit patients in his current role than by acting as
"just a pair of hands".
At school, he had little idea what he wanted to do when he left (other than considering
accountancy, which some of his friends planned to do). On his headmaster's advice, he focused
on maths and science rather than on the humanities and he decided not to undertake further study
immediately he achieved his A-levels.
After leaving school, Graham did temporary work in order to get enough money to do some
travelling, and spent two years travelling and doing casual work abroad. On his return to the UK,
still unsure what he wanted to do, he did further temporary work before surprising his friends by
registering to do nurse training. His sister and an uncle were both nurses and having met a lot of
nurses on his travels, he found that the idea of combining nursing with further travel had
considerable appeal.
During his training, Graham developed a strong interest in oncology and palliative care nursing and
managed to secure a placement on an oncology ward: by this time he had "quite a firm idea of
what I wanted to do". Oncology appealed as a specialty where "nursing had a much higher
importance" and where "the role of the nurse was much more significant." Here "you got to actually
spend time talking to people " which he found "the most rewarding thing" in his training. Left to his
own devices, Graham would probably have gone straight into oncology or palliative care but was
strongly advised to get six months experience in the acute sector. This he did, and feels that he is
better able to cope with situations which arise in palliative care as a result, but once his six months
of "penance" was up, he went to work in an oncology ward, which seemed to him to be the best
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route into hospice work. After three years as a staff nurse here, he moved to the hospice in which
he now works, on the advice of a nurse and good friend who as an "incredibly skilled and caring
nurse" "really inspired" him and who had a clear picture of nursing as a profession.
To Graham, palliative care is "hugely creative" offering an opportunity to work with a great variety
of people in different situations, adapting one's approach to suit individuals‟ needs. Here, care is
more "nurse-led" and to a much higher extent than in other specialties, teamwork-based. He
appreciates the strong support provided by his hospice colleagues and plans to remain in hospice
work as long as it remains challenging and rewarding.
Graham has no religious affiliation, although one of the things that attracted him to hospice work
was his observation that, in the period approaching death, some patients would be "moved to this
sort of mystical place" and a desire to find out more. He focuses on doing his best at whatever he
does, although at times this ideal can seem both "a blessing and a curse ".
Jenny
For Jenny, training as a nurse was something of a 'natural progression.' As a child, she was
"always the one that held the handkerchief on the bloody knee of a brother or sister or cousin"...
and the one to whom older relatives turned for help with their younger children. "I just seemed to
be interested always in that sort of thing" says Jenny. At school, she was "really focused" on her
future career - nursing was all she had ever wanted to do. Now in her late fifties, she started her
nurse training in 1966, having completed a pre-nursing course at school and having worked as a
nursing auxiliary for a short time.
At the time she finished her training, Jenny had thoughts of travelling and decided it was important
to gain experience she would be able to use anywhere. She therefore worked on an accident ward
for eighteen months before commencing her midwifery training (which she undertook at a hospital
chosen partly for its "very high standard of care..." She “loved” midwifery and enjoyed being able to
work "to a very high standard" and to "feel proud" of the way that she worked. Over the years,
however, Jenny saw standards of midwifery care deteriorate and left to work elsewhere, including
posts as a company nurse, a school nurse, and finally head of a nursing home. While running the
nursing home (for elderly mentally ill patients) she was approached by GPs and district nurses to
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take palliative care patients and built up a reputation in the area for providing terminal care for this
client group. Undertaking specialist training at the hospice at which she now works seemed a
natural next step, and Jenny was impressed with the level of care provided there and later worked
in several different hospices, being particularly impressed and influenced by Dame Cicely
Saunders at St Christopher's Hospice.
Death has always been a subject with which Jenny has felt comfortable, and she likes the open
attitude towards it which hospices adopt and encourage. She enjoys the contact with patients and
relatives and the "teamwork" of working with families, patients and nurse colleagues. She would
like to continue to work until she is seventy: "I'd feel that a privilege."
Jenny enjoys the high standards of care which it is possible to provide in a hospice and reflects that
"I think it's much more of the ilk and standards that we used to have in nursing, which you don't find
now in the NHS." She is a Christian and although she does not attend church regularly, does pray
and "read around and... talk to other people about it." Her religion, she says, is "very important" to
her. The Christian story offers reassurance and helps her to see life and death as part of a
"process" in which death is not an ending. To her, it is important for nurses to be able to "make a
connection" with patients at the end of their lives, being “respectful and kind" and “making those
last days... weeks, months, whatever they are... really count."
Kerry
When Kerry had to go into hospital at the age of eleven, she watched the nurses at work and
thought "I wouldn't mind doing that job." The idea remained with her, but at the age when she had
to choose a career, she didn't apply "because I thought I was not good enough to do it." She did
not have the O-levels she thought she needed to get into nursing school, and her parents wanted
her to do secretarial work "because it was posh to work in an office..." From school, she went to a
further education college for a year to do office studies, before going to work as a secretary in a
legal environment. It was not long, however, before she realised "No, this isn't for me" and went to
the library to see what she could find out about training as a nurse. She easily found a place to do
a two-year SEN course, beginning her training in the late 1970s. She "loved" the training, finding it
easy and thanks to her mother's encouragement, somehow found the drive to continue after her
father was killed in a road accident eighteen months into her training. She remembers her training
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as having been very different from that received by nurses today: "... it was practical training. They
really used to teach you properly."
Following her training, Kerry married and quickly became pregnant. She left nursing at this point to
return temporarily to secretarial work, and when her children were young had various caring jobs
including childminding, working as a social services carer and working in a medical geriatric ward.
When her marriage broke up, Kerry found herself homeless with two young children and although
this came as a huge blow to her self-respect and confidence, she was "driven by something else to
pull [myself] out of it". After doing a Return to Nursing course, Kerry upgraded herself to State
Registered Nurse by following a 'conversion' course (she later went on to do a diploma in health
studies and a degree in community care).
After a period of nurse teaching and further ward and community nursing, Kerry did district nurse
training. She especially enjoyed working with dying patients but the high care standards she
aspired to led to her working extremely long hours, which put strain on her relationship with her
partner. Around this time, her aunt died "in an appalling way" of cancer and it was at this point that
Kerry decided she had "just had enough." She accepted her partner's offer to pay her mortgage
and agreed to take a less demanding job with fewer hours. After a brief and unrewarding period
working for NHS Direct ("I thought 'This is not me. I want hands-on nursing'") she went back into
district nursing but once again became frustrated by lack of staff commitment to care and her own
inability to deliver care to meet targets.
Aware of a need for drastic change, Kerry secured a post in palliative care. Her move (to work as a
staff nurse) involved a trade-off between decrease in salary and professional status and increased
work satisfaction and quality of life. Now in her late forties, Kerry has been working as a staff nurse
at the hospice for seven months, working three long days a week. She sees more of her partner,
has more time to care for her elderly mother and enjoys her working life more. She may try for a
higher post but is "quite happy doing the bedside nursing". Here, Kerry is able to give care to the
high standards that she likes to provide for patients and it is "the old-fashioned care - you actually
give the care”. She contrasts hospice care with acute hospital care, in which "... you're just another
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body - treat, out, next one in... you're a number, that's all it is and it's targets... That's not proper
care."
Kerry sees herself as a 'spiritual' rather than a 'religious' person. As she sees it, "... especially with
palliative care, you've got to have some spirituality, otherwise... you just think 'What the hell is all
this about?'" She firmly believes that death is not an end but a "going forward" and sees this life as
an opportunity to learn lessons before moving on to something else.
Marina
In her early twenties, Marina is comparatively young to be working as a hospice nurse. Now a
staff nurse, this is her first post-training job and she was lucky to have been able to work as a
health care assistant at the hospice until her qualification was confirmed. She had decided to
become a nurse "when I was tiny" and as a child enjoyed caring for family members. When her
cousin was in hospital following an accident, she was impressed by the care he received from
nurses, which reinforced her desire to do nursing.
At school, Marina considered becoming a vet for a while, but nursing remained attractive, and
when teachers suggested that she studied medicine, "nothing would change my mind from being a
nurse". To her, nursing was "more hands-on" than medicine and she was very aware that in the
general hospital environment, nurses frequently had to act as intermediaries between patients and
medical staff. While still at school, she took the initiative in organising a work experience
placement in a hospital pathology laboratory. A training placement on a neurological surgical ward
introduced Marina to patients with cancer, and although she had always imagined herself working
on a busy acute ward, a relationship she developed with one particular patient changed her plans
for the future and she decided to move towards "cancer care of some sort" quite early on in her
training.
Marina‟s aunt is a nurse, also working on palliative care, and she encouraged her niece to follow
her interests and go straight into palliative care rather than get other experience first. She
considers herself lucky and is very aware of the fact that other students have had difficulty finding
jobs in their chosen specialties in the cash-strapped NHS.
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When she commenced work at the hospice, Marina was "very shocked" at the level of autonomy
nurses had in drug administration - a latitude she had observed in no other specialty in her training.
She is acutely aware of the responsibility this places on nurses but feels very "supported” by the
other hospice staff and feels the autonomy enhances staff morale.
One thing Marina likes about working in a hospice environment is the status equality between
doctors and nurses. Even when she worked as a health care assistant, her opinion was valued by
the doctors "as much as one of their fellow consultants" and she is not afraid to ask questions on
how and why things are done. She also greatly appreciates the opportunity to spend more time
with patients than is possible in an NHS environment. To her, this is a feature which distinguishes
hospice care from other specialties and she is also very aware of the limited relationships doctors
can develop with patients. While enjoying the closeness of patients which the hospice makes
possible, she accepts that "at some point, you do have to cut off" in order to maintain a
professional role and protect oneself emotionally.
For a nurse to consider going into palliative care, she feels, it is necessary to "think outside your
box" with hospices having a relatively low profile because of their association with death and dying.
Palliative care nurses have to be prepared to "go above and beyond" and need to have made a
conscious choice that palliative care is what they want to do.
Marina is keeping her options for the future open. She thinks she may move back into hospital
work to gain experience, move into oncology or work in the community. She is a Roman Catholic
who does not attend church regularly but who does believe in some form of afterlife. She finds that
patients who share her religion "find it easier to talk to me, cos I know sort of what they're about,
and things like that".
Sandra
Nursing was not something Sandra considered while she was at secondary school. Her major
interest was art, and that had been her career focus "for ever - that's all I ever wanted to do."
However, a work experience placement in graphic design and doing an A-level in it served to
disillusion her about the possibility of using art as the basis of a career, and she went on to take
further A-levels in law and psychology with a view to possibly entering some sort of legal work.
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Unfortunately, a setback in her private life meant that she had to withdraw from her studies and led
to a "massive rethink" about her future. The idea of doing nursing came when she was 21 and
feeling that, by this stage of her life, she should have chosen a career. For no clear reasons other
than this, nursing presented itself and she began her nursing studies in 1998.
Sometimes frustrated by the limited role allowed to students, Sandra opted for the diploma rather
than the degree course, seeing little point in struggling for academic excellence (despite her facility
for essay writing) when her main objective was to develop her practical nursing skills. Looking
back, she sees this as having been a "very odd" choice for her "cos I do set very high standards".
During her training, Sandra took the opportunity to do a placement in a hospice. She likes to do
things that are "a bit different" and thought that this option looked a lot more interesting than the
other two on offer. She chose to write an assignment on the effect of family dynamics on the dying
experience rather than pain, which was chosen by most of the other hospice placement students.
After gaining her qualification, Sandra worked in neuro-disability for a few months, but found the
support for newly qualified nirses inadequate. She visited the hospice where she had done her
placement and was delighted to be offered 'bank' work. She now (in her late twenties) works four
days a week as a staff nurse there and is studying for her degree in palliative care.
Sandra has always been interested in psychology and takes what she describes as a
"psychological" approach to her work. She has always been very aware of "how people are
affected by things" and tries to be as open with patients as they are willing for her to be. She
recognises that death is a "life-changing" event for relatives as well as patients, and tries to gain
insight into the ways in which people cope with the "huge journey" towards death. Two recent
personal bereavements brought home to her even more acutely "how much your words that you
say" will remain with relatives, and she is very aware of the need to be sensitive in communication
with patients and relatives.
For Sandra, hospices have a very clear and positive role in helping to relieve patients' symptoms
and offering psychosocial care and she feels that palliative care nurses often fail to appreciate the
impact they have on patients and families. In the hospice, there is time to provide psychosocial
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care that is not possible in hospital, and if a patient happens to want to talk when a nurse is due for
a tea break, that nurse will sit with the patient and give them the time they need. She likes the
support she receives from other staff and the appreciation of patients and relatives, and thinks that
she will continue in hospice work "until I do become the nurse I dread, who stops caring".
Sandra has no religious affiliations, although she sometimes wishes she had a religion as she can
see the comfort this brings some people. She believes that all people have a right to choose how
they will be treated at the end of their lives as this is "the last thing they will do" and tries to treat
her patients as she herself would like to be treated.
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APPENDIX 10
CODING
FRAME
Ann V Salvage, BA, MSc
School of Business and Social Sciences,
Roehampton University
University of Surrey
2010
Thesis: Caring Towards Death
Ann V Salvage (2010)
Appendix 10
Coding Frame
The coding frame was developed in two parts, as data analysis progressed. Each item on this twopart list of topics which emerged from the interviews was allocated a number and the data coded
using these numbers. Within this list, main themes and sub-themes may be identified. For
example, main themes include characterisations of acute NHS care (see 'Acute'), being with
patients (see 'Being with') and holistic care (see 'Holistic care').
Coding Frame Part 1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
A&E: actively trying to cure
A&E: compared with hospice
A&E: enjoyed
A&E: expected would do/be suited
A&E: necessary to be a rounded nurse (with midwifery)
A&E: not like
A&E: nurses find it hard to slow down in hospice
Academic: doubted ability
Academic: likes studying/good at
Academic: not good at
Academic: success in later life
Academic: used to be scared of/not now
Acceptability as factor (nursing general)
Accident/chance as factor (nursing)
Accident/chance as factor (palliative care)
Accompanying/alongside
Acute: active treatment
Acute: aims to cure/heal
Acute: anyone could do tasks
Acute: bad news delivered badly
Acute: brutality of cancer trials
Acute: building maintenance poor
Acute: busy
Acute: coming from is difficult for nurses
Acute: conveyor belt nursing
Acute: death is not dignified/respectful
Acute: death is taboo
Acute: decline in standards
Acute: doctors arrogant/power happy
Acute: does do good work (chemo) for palliative patients
Acute: experience is useful in hospice (chemo, radio, oncology)
Acute: family ignored
Acute: frustrating for nurses
Acute: is for younger nurses
Acute: know patients for very short time
Acute: lack of resources/staff/time (leading to poor care)
Acute: little hands-on
Acute: many nurses want to be elsewhere
Acute: medical model dominates
Acute: more attractive to some - more get up and go
Acute: more HCAs/less nurses
Acute: no job satisfaction
Acute: not best place for dying
Acute: not creative
Acute: not holistic
Acute: not individualised care
Appendix 10 Coding Frame
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Thesis: Caring Towards Death
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
Ann V Salvage (2010)
Acute: nurses are anonymous
Acute: nurses avoid dying people
Acute: nurses cannot give good care
Acute: nurses do not know patients well enough to judge needs
Acute: nurses don't know the end of the story
Acute: nurses expected to do the impossible
Acute: nurses have little impact/make little difference
Acute: nurses have no autonomy in drug administration
Acute: nurses lack of support for study
Acute: nurses lack of support/care for
Acute: nurses overworked/exhausted
Acute: nurses sometimes in it for the money
Acute: nurses stressed
Acute: nurses won't talk to relatives
Acute: patients known by their illness/condition
Acute: patients not like (quotes)
Acute: patients/relatives can't talk to doctors
Acute: poor agency staff are reemployed
Acute: poor standard of care
Acute: poor standard of care (personal experience)
Acute: relatives dissatisfied/demanding/have problems
Acute: respect for nurses working in
Acute: rigidity of drug administration for pain
Acute: SPRs low
Acute: status gap between nurses/doctors
Acute: system at fault, not staff
Acute: task-oriented
Acute: time wth patients not valued
Acute: time: can't spend with patients
Acute: unsafe staffing levels (example)
Acute: used to give good care but now only in hospices
Advertisement: brought to hospice (and as factor)
Advised to get general experience first
Age decided on nursing
Age decided on palliative care
Age decided on palliative care: before general nursing
Aims: personal: in hospice
A-levels chosen for nursing
A-levels chosen with no career in mind
A-levels: chosen for other career
A-levels: not done because considered stupid
All I ever wanted to do (nursing general)
Alternative medicine: has worked as practitioner
Alternative medicine: nurse uses herself
Alternative medicine: uses on patients
Always wanted hospice
Always wanted nursing
Animals: liked as a child
Ann: relates to/identifies with respondent
Ann: tearful/upset
Ann: tries out ideas on respondent
Attraction: ambience/environment
Attraction: family care/relationships
Attraction: good death
Attraction: holistic
Attraction: hospice interesting and different
Attraction: hospice was new/setting up
Attraction: impressed by work of community team which she worked with
Attraction: jobs are available/not in hospitals
Attraction: lack of targets
Attraction: little things
Appendix 10 Coding Frame
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Thesis: Caring Towards Death
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
168.
Ann V Salvage (2010)
Attraction: more time with patients
Attraction: not rush/can just be with people
Attraction: not trying to cure, so energy not taken up by treatments/rushing
Attraction: nurse-controlled
Attraction: nurses opinions valued
Attraction: nurses supported
Attraction: nurses valued
Attraction: openness about death/acceptance
Attraction: opportunity to give care to old standards
Attraction: opportunity to give real basic care
Attraction: opportunity to make a difference
Attraction: opportunity to provide good/complete care
Attraction: other specialties follow doctor's orders - here nursing important
Attraction: patient empowerment/autonomy
Attraction: patient-oriented (not task-oriented)
Attraction: patients seen as people
Attraction: relationships with patients
Attraction: seen as effective, worthwhile in community/wanted to be part of it
Attraction: staff patient ratios
Attraction: status equality of staff
Attraction: talking to people
Attraction: wanted something with a sense of purpose/meaningful
Attraction: wide range of treatment options
Attraction: working in things that really matter
Australia: better colleague support
Australia: differences in training
Auxiliary: working as prior to training
Bad death as factor (attributed)
Bad death as factor (personal)
Bad death experiences
Bank to permanent
Bank work at hospice
Basic nursing: as what nursing is all about/essence of
Basic nursing: can be very boring if you don't engage with person
Basic nursing: can have wonderful experiences
Basic nursing: definition
Becoming: gaining experience/confidence in hospice work
Becoming: late entrant to palliative care
Becoming: novice, but wants to learn hospice work
Bedside nurse: describes self as
Bedside nurses: hospice fits philosophy of those wanting to be
Bedside nurses:SENs seen as
Bedside nursing: definition
Bedside nursing: is donkey work
Being with: example (Cicely)
Being with: less valued than physical care
Being with: more important than physical tasks/other
Being with: nurses from acute find difficult
Being with: reduces pain
Beliefs: everyone should be offered terminal care
Beliefs: not quite sure we choose our parents
Beliefs: problems in this life are lessons
Beliefs: value of terminal care
Bereavement (patient‟s death) effect of
Bereavement: lack of personal experience helps to do (easier to detach)
Birth/death: need equal care
Book as factor (novel)
Book as factor (on hospice)
Burnout: experienced in acute
Burnout: potential for
Burnout: sees lots in hospice nurses
Appendix 10 Coding Frame
3 of 24
Thesis: Caring Towards Death
169.
170.
171.
172.
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.
197.
198.
199.
200.
201.
202.
203.
204.
205.
206.
207.
208.
209.
210.
211.
212.
213.
214.
215.
216.
217.
218.
219.
220.
221.
222.
223.
224.
225.
226.
227.
228.
229.
Ann V Salvage (2010)
Cadet nurse: details
Cadet nurse: was
Calling: work as a
Care versus cure
Career aspirations: get married and have children
Career choice: feeling an obligation to decide
Career dilemmas/choices: between nursing and other career
Career dilemmas/choices: between specialties
Career: ' bitty'/'chequered'
Career: expectations of others
Career: never wanted anything else
Careers advice: had but had already decided to do nursing
Careers advice: can't remember but had decided to do nursing anyway
Careers advice: can't remember but think not
Careers advice: did have but not as good as today
Careers advice: did not have
Careers advice: given too early
Careers advice: nobody suggested nursing (men)
Careers advice: not stated but already decided
Careers advice: not use
Careers advice: now greater choice/more difficult to choose
Careers advice: poor/limited
Careers advice: told would have limited career/factory/babies
Careers could not do: teach children/midwife/sick children etc
Careers rejected/put off (e.g. doctor, teaching, city, art, office)
Careers: nursing not a lifetime ambition
Careers: only considered caring one
Careers: other done first, though wanted to do nursing
Careers: other people's ideas of 'suitable'
Careers: other/previous: caring
Careers: other/previous: non-caring
Careers: others considered
Caring as essence/foundation of nursing
Caring career: desire for as factor (nursing general)
Caring is: about listening/sensitivity as well as physical
Caring is: helping people to do what they would do on their own if could
Caring is: to do with interactions with people
Caring job: as factor (nursing)
Caring job: not as factor
Caring: art of does come with practice
Caring: in a 'depersonalised' way
Caring: putting on an act of
Changes in hospice: deterioration in relationship between nurses/doctors
Changes in hospice: different treatments/procedures
Changes in hospice: forced to be more financially accountable
Changes in hospice: increase in patient turnover
Changes in hospice: increased demand for
Changes in hospice: increased pace
Changes in hospice: less caring nurses now (example)
Changes in hospice: less time
Changes in hospice: medicalisation
Changes in hospice: more like NHS
Changes in hospice: more young people
Changes in hospice: new patient groups means skills are useful
Changes in hospice: nurses (trained) do less hands-on
Changes in hospice: nurses having to learn new skills
Changes in hospice: patients more in/out
Changes in hospice: previously more religious nurses/religious
Changes in hospice: split: longer working 'bedside' nurses/more recent
Changes in hospice: tighter controls on individual needs (e.g. rabbit, horse)
Changes in hospice: when first entered was not a medical specialty
Appendix 10 Coding Frame
4 of 24
Thesis: Caring Towards Death
230.
231.
232.
233.
234.
235.
236.
237.
238.
239.
240.
241.
242.
243.
244.
245.
246.
247.
248.
249.
250.
251.
252.
253.
254.
255.
256.
257.
258.
259.
260.
261.
262.
263.
264.
265.
266.
267.
268.
269.
270.
271.
272.
273.
274.
275.
276.
277.
278.
279.
280.
281.
282.
283.
284.
285.
286.
287.
288.
289.
290.
Ann V Salvage (2010)
Changes in hospice: wider focus: not just end-of-life
Changes in hospice: wider range of conditions treated
Changes in nursing role: blurring of roles
Changes in nursing role: do less for patients
Changes in nursing role: doing what doctors did
Changes in nursing role: more autonomous
Changes in nursing role: more technically skilled
Changes in nursing role: what can/should do
Changes in nursing: deterioration in standards
Changes in nursing: faster patient turnover
Changes in nursing: increasing split between bedside nursing/management
Changes in nursing: increasing split between those with/without autonomy
Changes in nursing: more doing as just a job
Changes in nursing: more nurses from abroad
Changes in nursing: not concerned about tidiness
Chequered career (academic)
Children/parents/husband: working around
Choice of specialty: initially chose hospice/pc
Choice of specialty: initially chose other
Choice of specialty: other specialties follow doctor's orders/lower status
Chose nursing because it encompassed the things I like
Clinical supervision/reflective practice: mentions/has
Colleagues: respect/admiration for
Communication: doctors not good/nurses better
Communication: importance of how you give bad news
Community nurse specialists have doctor-like role
Community nurse specialists: increasing number
Community nurse specialists: not hands-on
Community nursing job as factor (pc)
Community palliative care nurses: role of
Community palliative care work: differentiated from hospice work
Community pc work: good at relating to patients/autonomous in drugs
Community pc work: seen as rewarding/enlightening
Consultant suggests hospice as factor
Conversion course: did
Conversion course: sponsored
Co-production of data
Costs (nursing general)
Costs: (hospice nursing)
Counselling training: has done
Counselling training: has found personally helpful
Counselling training: has helped with work
Counselling training: hopes to do
Counselling: has found personally helpful
Counselling: has had herself
Counselling: has worked as counsellor
Crying in job
Death is: don't know
Death: anxious about dying, not death
Death: can be beautiful/positive/release
Death: can be distressing for relatives
Death: can be negative if patient not ready/not accept
Death: children and
Death: end of life/physical life
Death: end of one stage/the beginning of another/going forward
Death: final
Death: happens when lessons had been learnt/ready to move on
Death: has always been an open subject
Death: has had threats to own life
Death: have to protect oneself as see so many
Death: how dealt with in hospice
Appendix 10 Coding Frame
5 of 24
Thesis: Caring Towards Death
291.
292.
293.
294.
295.
296.
297.
298.
299.
300.
301.
302.
303.
304.
305.
306.
307.
308.
309.
310.
311.
312.
313.
314.
315.
316.
317.
318.
319.
320.
321.
322.
323.
324.
325.
326.
327.
328.
329.
330.
331.
332.
333.
334.
335.
336.
337.
338.
339.
340.
341.
342.
343.
344.
345.
346.
347.
348.
349.
350.
351.
Ann V Salvage (2010)
Death: I need to face up to it more
Death: inevitable
Death: Irish attitudes to
Death: lack of personal experience
Death: lack of personal experience makes it easier to deal with
Death: manage it by assuming loved ones still here
Death: mother warned I would die young/a bonus to still be here
Death: moving into another part of what we are/another place
Death: not completely comfortable with dead person
Death: not scared/fazed
Death: not think much about
Death: part of life
Death: part of me is still cut off from it (because of mothers fanaticism)
Death: patients: frightening for
Death: patients: those with religious beliefs sometimes most scared
Death: patients: timing is the last choice patients have
Death: peaceful/quiet
Death: person going from us but coming towards something else
Death: person not there any more
Death: personal experience so happy to talk about it/at ease
Death: process not end
Death: sadness
Death: scared of own death/dying
Death: seems far off when young
Death: some nurses not easy with/scared
Death: spirit has left the body
Death: taboo/denial/stigma
Death: talks/thinks a lot about own death
Death: will be able to get what I want because of my knowledge
Death: working in hospice has affected my attitude to
Degree: lack of costs job
Depression: has suffered
Desire for acceptance of death as factor (pc)
Desire for career where I could apply learning/skills
Desire for good hands on nursing as factor (attributed) (pc)
Desire for less stress as factor (pc)
Desire for profession: not just a job as factor (nursing)
Desire for slower environment as factor (pc)
Desire just to be a nurse (in pc)
Desire to be basic good nurse
Desire to be good at both management and basic patient care/difficult
Desire to be knowledgeable and effective
Desire to be needed as factor (nursing)
Desire to be needed as factor (pc)
Desire to do nursing well/provide quality care as factor (pc)
Desire to enjoy work
Desire to help vulnerable people could be distorted paternal instinct
Desire to help/care for people
Desire to work with children as factor (nursing)
Different people want to do different jobs/this is good
Disillusionment with NHS: inability to care as wished as factor (pc)
Disillusionment with NHS: lack of funding
Disillusionment with nursing (general)
Disillusionment with nursing as factor
Dissatisfaction with care in acute as factor (pc)
Distance/proximity: distancing techniques
Distance/proximity: maintaining the boundary
District nurse/community nurse: has worked as
District nursing: lack of support from staff
District nursing: liked
Divorce as factor in return to nursing
Appendix 10 Coding Frame
6 of 24
Thesis: Caring Towards Death
352.
353.
354.
355.
356.
357.
358.
359.
360.
361.
362.
363.
364.
365.
366.
367.
368.
369.
370.
371.
372.
373.
374.
375.
376.
377.
378.
379.
380.
381.
382.
383.
384.
385.
386.
387.
388.
389.
390.
391.
392.
393.
394.
395.
396.
397.
398.
399.
400.
401.
402.
403.
404.
405.
406.
407.
408.
409.
410.
411.
412.
Ann V Salvage (2010)
Divorce/relationship breakdown
Doctor: not want because less hands-on
Doctor: not want to be (hard work/acad demanding)
Doctor: not want: nursing fits much better with my interests
Doctor: not want: offered money to train but rejected
Doctor: not want: school suggested she be
Doctor: wanted to be but not right temperament/academically able
Doctors: bad news: were bad at giving/now better
Doctors: can't make relationships with patients
Doctors: hospice ones better/different
Doing nursing well: depends on time
Drugs: a lot of trust put in you/scary/responsibility
Drugs: hospice nurses good at getting second opinion
Drugs: need good knowledge of drugs and make decisions on needs
Drugs: shocked at freedom
Drugs: single nurse administration (pc)
Drugs: single nurse administration scary but increases morale
Drugs: take a lot of nursing time
Drugs: two nurse administration (acute)
Drugs: well supported
Effectiveness/efficiency: measuring in hospice
Elderly care: compared to hospice
Elderly care: enjoyed/because of rapport/at ease
Empathy: is not being crucified but able to stand alongside
Encountering community pc team as factor (pc)
Evidence of awareness of fragility of health
Evidence of dislike of unconventional specialties
Evidence of independent thinking
Evidence of personal high standards of care/uncompromising
Evidence of personal initiative
Evidence of self-analysis/awareness
Evidence of sensitivity to family needs
Evidence of sensitivity to patients‟ suffering/empathy
Evidence of wanting to learn
Experience necessary to do hospice/not for newly-qualified
Experience necessary: but if sure should be able to do
Experience of life: helpful in hospice
Experience: six months before hospice: a penance but necessary
Expertise: development of/seeing a pattern of death
External locus of control
Extra: providing that extra bit
Factors in leaving
Factors in remaining
Family member a doctor
Family member a nurse
Family member in health-related job
Family need: awareness of as factor (pc)
Family: care suffers if no time
Family: interest in
Family: needs of
Family: shift in focus of care towards
Father was a doctor as factor (nursing)
Father's death as factor (pc) (nsg)
First death experience: negative
First death experience:positive
First job: in hospice
First job: post qualifying
Friend did nursing as factor (nursing)
Future
Gender: as a child assumed boys became doctors and girls became nurses
Gender: female nurses seen as less ambitious
Appendix 10 Coding Frame
7 of 24
Thesis: Caring Towards Death
413.
414.
415.
416.
417.
418.
419.
420.
421.
422.
423.
424.
425.
426.
427.
428.
429.
430.
431.
432.
433.
434.
435.
436.
437.
438.
439.
440.
441.
442.
443.
444.
445.
446.
447.
448.
449.
450.
451.
452.
453.
454.
455.
456.
457.
458.
459.
460.
461.
462.
463.
464.
465.
466.
467.
468.
469.
470.
471.
472.
473.
Ann V Salvage (2010)
Gender: hospice very female-dominated
Gender: nurses followed doctor's orders in training
Gender: nurses have had bad deal on pay because mainly women
Gender: rejected 'traditional' role for women
Gender: 'traditional' careers for men
Gender: women often as able as men in nursing but don't shout about it
Gender: women prefer to nurse not manage (man!)
Gender: working women: changing attitudes
Good death: definition
Good death: general
Good nursing care: definition
Good nursing care: depends on having enough nurses
Hands on: amount varies
Hands-on: all work together
Hands-on: antithesis is doing the maths all day
Hands-on: can go for some time without any
Hands-on: definition
Hands-on: despite warnings, takes on more senior jobs
Hands-on: 'dirty' work is unpleasant but meaningful if doing it for the person
Hands-on: duties which take nurses away from
Hands-on: if became a manager would try to keep
Hands-on: manager but does
Hands-on: manager does little but feels more influential managing
Hands-on: manager/less than would like
Hands-on: manager: loved but had to move up to pay bills
Hands-on: mentioned
Hands-on: missed when doing other work
Hands-on: not as much as would like (non-manager)
Hands-on: not part of community palliative care role
Hands-on: now done by HCAs
Hands-on: put off nursing initially because nurses did not do
Hands-on: staff nurses not precluded
Hands-on: the essence of being a nurse
Hands-on: took demotion to resume
Hands-on: tries to get balance right
Hands-on: we do here because small hospice: lucky
Hands-on: when you really to get to know patients
HCA: has worked as
HCAs: have a lots of knowledge and skills, but not want academic
HCAs: lower ratio in hospice than in acute
Health visiting compared with pc (include with midwifery)
Health visiting: enjoyed
Health visitor/district nurse to hospice (sideways)
Health visitor: did, but not like working with mothers and babies
Health visitor: is/has worked as
Hearing about this hospice through friend as factor (pc)
Holistic care (general)
Holistic care: depends on good SPRs
Holistic care: depends on nurses wanting to give holistic care
Holistic care: depends on resources
Holistic care: gap between theory and practice
Holistic care: hospice makes most realistic claim
Holistic care: mismatch between emphasis on training/opportunity to give
Home/work: managing the boundary
Home: difficult home life (a lot of nurses have)
Home: family pressure to achieve
Home: family problems cause to leave when young
Home: father a problem
Home: father absent/dead/shadowy
Home: father died when young
Home: happy/close home life/childhood
Appendix 10 Coding Frame
8 of 24
Thesis: Caring Towards Death
474.
475.
476.
477.
478.
479.
480.
481.
482.
483.
484.
485.
486.
487.
488.
489.
490.
491.
492.
493.
494.
495.
496.
497.
498.
499.
500.
501.
502.
503.
504.
505.
506.
507.
508.
509.
510.
511.
512.
513.
514.
515.
516.
517.
518.
519.
520.
521.
522.
523.
524.
525.
526.
527.
528.
529.
530.
531.
532.
533.
534.
Ann V Salvage (2010)
Home: mother a problem
Home: parents actively discouraged from nursing
Home: parents caring
Home: parents did not encourage to do nursing
Home: parents discouraged from doing medicine
Home: parents encouraged to do different career
Home: parents encouraged to do nursing
Home: parents expected little
Home: parents nondirective on career
Home: parents proud
Home: protected/sheltered
Home: relative is/was doctor
Home: relative is/was in other health/caring profession
Home: relative is/was nurse
Homosexuals in nursing: a lot
Homosexuals in nursing maybe because a caring environment/support
Homosexuals in nursing: very spiritual, lovely people
Hospice allows easy access to doctors
Hospice deals with death in dignified way
Hospice does lots of different things
Hospice image: ( other nurses) (See also 629 etc)
Hospice image: ( public)
Hospice image: (initial)
Hospice is: a different way of working (from acute)
Hospice is: a forgotten area to the public
Hospice is: a great opportunity for anyone
Hospice is: a place that can do a lot for patients
Hospice is: a place where doctors and nurses have equal status
Hospice is: a place where nurses not feel have to get patients better
Hospice is: a place you can care well
Hospice is: a protective environment for nurses
Hospice is: a relatively new development
Hospice is: able to maintain high standards of care
Hospice is: able to offer care to the old standards which not get in NHS
Hospice is: able to provide good care because of good SPRs
Hospice is: about care not cure
Hospice is: about empowering patients/patient autonomy
Hospice is: about having time
Hospice is: about living
Hospice is: about maintaining something/not improving/curing
Hospice is: about making the last weeks/months count
Hospice is: about symptom control
Hospice is: about talking to people
Hospice is: an unusual calling
Hospice is: calm/peaceful
Hospice is: caring about the little things (not dealt with in NHS)
Hospice is: concerned with other conditions apart from cancer
Hospice is: constrained by money (small percentage of NHS funding)
Hospice is: giving up control to patients/relatives and meaning it
Hospice is: gold standard of good care
Hospice is: good at supporting staff
Hospice is: holistic
Hospice is: holistic: most of all specialties
Hospice is: less interventionist
Hospice is: like home
Hospice is: low SPRs
Hospice is: low-tech
Hospice is: medical-led (at present)
Hospice is: more interesting than other specialties (training options)
Hospice is: more mainstream than it was
Hospice is: not a hard and fast science
Appendix 10 Coding Frame
9 of 24
Thesis: Caring Towards Death
535.
536.
537.
538.
539.
540.
541.
542.
543.
544.
545.
546.
547.
548.
549.
550.
551.
552.
553.
554.
555.
556.
557.
558.
559.
560.
561.
562.
563.
564.
565.
566.
567.
568.
569.
570.
571.
572.
573.
574.
575.
576.
577.
578.
579.
580.
581.
582.
583.
584.
585.
586.
587.
588.
589.
590.
591.
592.
593.
594.
595.
Ann V Salvage (2010)
Hospice is: not a long-term institution
Hospice is: not attractive to many nurses
Hospice is: not the end of the road
Hospice is: nursing in a purer form
Hospice is: open about death
Hospice is: patient- not problem-centred
Hospice is: patient-focused/family-focused: they dictate need (examples)
Hospice is: responsive to immediate need
Hospice is: responsive to individual patient wishes (e.g. rabbit, horse)
Hospice is: slower than acute
Hospice is: small/lower number of patients
Hospice is: unity of purpose/singing to the same hymn sheet
Hospice is: what good basic nursing should be
Hospice is: what nursing is all about
Hospice is: where care is provided at a very personal/intimate time in life
Hospice is: where everything fitted into place for me
Hospice is: where I can exercise nursing as should be
Hospice is: where most likely to find psychosocial dimension
Hospice is: where people can die peacefully with dignity
Hospice is: where people live
Hospice is: where poor nursing in acute sector can be rectified
Hospice is: where skills learned elsewhere are most useful
Hospice job: feels cheated way into (no experience)
Hospice job: got by calling in/ringing
Hospice job: got by looking at website
Hospice job: test run
Hospice jobs: unsuccessful applications
Hospice nurses: autonomous
Hospice nurses: autonomy allows faster pain relief
Hospice nurses: can be lazy
Hospice nurses: can develop relationship with patients over a period of time
Hospice nurses: can nurse
Hospice nurses: feel supported
Hospice nurses: give too much of themselves
Hospice nurses: good at caring for family
Hospice nurses: good at looking for reversible causes/symptoms
Hospice nurses: good sense of humour
Hospice nurses: have balanced view of managing demands
Hospice nurses: have more impact in what they say/do than they realise
Hospice nurses: have their views taken seriously
Hospice nurses: know patients well enough to judge needs
Hospice nurses: make patient as comfortable as possible
Hospice nurses: meet the family where they are
Hospice nurses: much less conscious of grade
Hospice nurses: not good at recognising need for emotional support
Hospice nurses: protected from reality of NHS
Hospice nurses: public image of
Hospice nurses: sensitive
Hospice nurses: some disrespectful of dead bodies
Hospice nurses: some love to talk about how caring they are
Hospice nurses: treated as a person/respected for your skills
Hospice nurses: very sensitive to nuances of patient need
Hospice nurses: want to be there for everybody all the time
Hospice nurses: well supported
Hospice nursing: allowing people to die with dignity
Hospice nursing: allows nurses to treat patients as people
Hospice nursing: an ideal which allows you to practice as you aspire to
Hospice nursing: basic/fundamental nursing
Hospice nursing: being with the family
Hospice nursing: being with the patient
Hospice nursing: can be very busy
Appendix 10 Coding Frame
10 of 24
Thesis: Caring Towards Death
596.
597.
598.
599.
600.
601.
602.
603.
604.
605.
606.
607.
608.
609.
610.
611.
612.
613.
614.
615.
616.
617.
618.
619.
620.
621.
622.
623.
624.
625.
626.
627.
628.
629.
630.
631.
632.
633.
634.
635.
636.
637.
638.
639.
640.
641.
642.
643.
644.
645.
646.
647.
648.
649.
650.
651.
652.
653.
654.
655.
656.
Ann V Salvage (2010)
Hospice nursing: can be very unpredictable
Hospice nursing: can make a difference
Hospice nursing: challenging
Hospice nursing: controlling symptoms
Hospice nursing: creative
Hospice nursing: difficult
Hospice nursing: doing the best you can
Hospice nursing: easy to do minimum
Hospice nursing: enjoyable because part-time
Hospice nursing: ensuring death is as good as it can be
Hospice nursing: flexible
Hospice nursing: gold standard of nursing care
Hospice nursing: good mix of ages/experience
Hospice nursing: helping people when they most need care/where are
Hospice nursing: makes me value life more
Hospice nursing: meaningful
Hospice nursing: more about emotional labour than acute
Hospice nursing: negative comments (general)
Hospice nursing: not for everybody
Hospice nursing: not just a job
Hospice nursing: not like going to work
Hospice nursing: not something you can teach
Hospice nursing: old-fashioned care
Hospice nursing: patient-focused
Hospice nursing: positive comments (general)
Hospice nursing: real nursing
Hospice nursing: should be available in NHS
Hospice nursing: stressful
Hospice nursing: suitable for mature nurses with experience
Hospice nursing: what nursing is all about/is in essence
Hospice nursing: where I refound nursing
Hospice nursing:is caring for the whole family
Hospice: feeling/ambience
Hospice: image (initial)
Hospice: image (other nurses)
Hospice: image (public)
Hospice: lack of initial knowledge
Hospice: negative comments (general)
Hospice: patients like it when nurses tune in and they feel held
Hospice: positive comments (general)
Hospice: shortcomings
Hospices: competition between
Hospices: small more rewarding/differences between large and small
Humour: importance of
Ideal job (at school) features of
Ideals: but aware of limitations
Ideals: nursing care/what nursing should be
Ideals: working outwards from
Ignorance of pc
Ignorance/naivete when choosing nursing
Inexpressible 'knowing'
Inexpressiblity
Intellectual interest in pc
Interest in psychosocial factors as factor (pc)
Internal locus of control
Interpersonal problems cause sideways move
Intuition in nursing
ITU: comparison with hospice
ITU: contrasted with hospice
ITU: image (initial) sexy
ITU: liked (post-training)
Appendix 10 Coding Frame
11 of 24
Thesis: Caring Towards Death
657.
658.
659.
660.
661.
662.
663.
664.
665.
666.
667.
668.
669.
670.
671.
672.
673.
674.
675.
676.
677.
678.
679.
680.
681.
682.
683.
684.
685.
686.
687.
688.
689.
690.
691.
692.
693.
694.
695.
696.
697.
698.
699.
700.
701.
702.
703.
704.
705.
706.
707.
708.
709.
710.
711.
712.
713.
714.
715.
716.
717.
Ann V Salvage (2010)
ITU: not enough support (post-training)
ITU: too stressful (post-training)
Job advertisement as factor
Job satisfaction
Job satisfaction as factor (pc/nursing)
Journey
Just a job: cannot work there if it is
Just a job: some women from West Indies see as
Just-a-job defined
Knowing a nurse (actively dissuade)
Knowing a nurse (but not encourage/not factor)
Knowing a nurse as factor (nursing)
Knowing a nurse as factor (pc)
Kubler-Ross as first reading/contact with death and dying concepts
Last offices
Life after death: believe
Life after death: don't know
Life after death: not believe
Life after death: other comments
Life experience/age: helps you not to rely on caring for others to feel good
Life experience/age: helps you to relax more
Little things (example)
Little things: hospice cares about
Love
Lower stress as factor (palliative care)
Macmillan nurse: wanted to be
Making a difference as factor (palliative care)
Making a difference: definition
Making a difference: mentions
Making a difference: not always know if you have
Management role: not recognised as important in nursing (hospice does)
Management skills: difficult to learn/teach
Management/hands-on: you can't do/know your job sitting at a computer
Management: become detached/superior/less accessible (example given)
Management: frustrating
Management: has lost patient contact/feeling of where it all tied together
Management: important to retain patient contact
Management: no job satisfaction
Management: not want
Management: too many good nurses become managers
Managers: can't make a difference
Managers: have greater influence
Managers: less hands-on/patient contact
Managers: qualities: clinical skills and management ability
Masters degree: has done
Masters degree: now doing
Masters degree: pulled it all together/empowering/confirming
Mature student: helps to be one
Medical model: limitations of
Medical model: training is based on
Medical: liked
Medicine compared/contrasted with nursing
Medicine: competitive/pressure to get to the top
Medicine: contrasted with hospice
Medicine: not all rocket science/a lot can be done by others
Medicine: one-dimensional/regimented/focused
Memories: importance of for family
Memory problems
Men in nursing: assumed homosexual but usually not
Men in nursing: can be quite lazy
Men in nursing: compared to ethnic minority
Appendix 10 Coding Frame
12 of 24
Thesis: Caring Towards Death
718.
719.
720.
721.
722.
723.
724.
725.
726.
727.
728.
729.
730.
731.
732.
733.
734.
735.
736.
737.
738.
739.
740.
741.
742.
743.
744.
745.
746.
747.
748.
749.
750.
751.
752.
753.
754.
755.
756.
757.
758.
759.
760.
761.
762.
763.
764.
765.
766.
767.
768.
769.
770.
771.
772.
773.
774.
775.
776.
777.
778.
Ann V Salvage (2010)
Men in nursing: disproportionate number in higher ranks
Men in nursing: financial pressure dictates job level
Men in nursing: go higher because encouraged to be more proactive
Men in nursing: has gone through the ranks quickly
Men in nursing: more homosexuals because job attracts
Men in nursing: never been a problem for me
Men in nursing: not respect ones who climb ladder but don't know stuff
Men in nursing: percentage/low numbers
Midwifery/palliative care link
Midwifery: considered as specialty but couldn't/didn‟t do
Midwifery: did to very high standard and could feel proud of work
Midwifery: has done
Midwifery: highly stressful so left for palliative care
Midwifery: liked
Midwifery: liked but now not challenging enough
Midwifery: necessary to be rounded nurse (with A&E)
Midwifery: not liked
Midwifery: put off by training
Midwifery: standards have gone down
Mother role
Motivations (attributed) fewer jobs in NHS (pc)
Motivations (attributed) have had some personal experience/loss
Motivations (attributed) just a job - not to look after people (nursing general)
Motivations (attributed) just as job/more dysfunctional because need to care
Motivations (attributed) need to be wanted (pc)
Motivations (attributed) patient gratitude
Motivations (attributed) power/control over patients (pc)
Motivations (attributed) prefer high-tech: do to become expert in pain mgt(pc)
Motivations (attributed) to be liked/wanted/needed (pc)
Motivations (attributed) to get support (pc)
Motivations (attributed) to meet a need in them (pc)
Motivations (attributed) to pay back/need bereavement support (examples)
Motivations: (attributed) some nurses use power against staff (pc)
Motivations: I think a lot about how I/others ended up in palliative care
Motivations: I think a lot about why I do it/surprised others don't
Motivations: I think there is more to me working here than I realise
Motivations: other nurses always want to know why I do it
Natural progression as factor (pc)
NHS cuts (general)
NHS cuts: caused the abandonment of basic principles of nursing
NHS cuts: government fiddles figures on nurses leaving
NHS cuts: have led to job cuts
NHS cuts: hospice is protected
NHS cuts: job cuts in my trust
NHS cuts: lack of jobs as factor (attributed) (pc)
NHS cuts: nurses leaving once qualified
NHS: could be more like hospice if had resources
NHS: jobs: plenty of at one time
NHS: not return to
Night work: different relationship with patients
No real reason for choice (nursing)
Nurse in the family: always ends up caring for parents
Nurses who advised actions/experience
Nurses who influenced to do courses
Nurses: undervalued/less financial reward compared with doctors
Nursing as profession: training emphasised
Nursing aspirations: just wanted to be a nurse
Nursing compared with medicine
Nursing home: has worked in
Nursing home: live in as factor (nursing)
Nursing home: unable to give good care in
Appendix 10 Coding Frame
13 of 24
Thesis: Caring Towards Death
779.
780.
781.
782.
783.
784.
785.
786.
787.
788.
789.
790.
791.
792.
793.
794.
795.
796.
797.
798.
799.
800.
801.
802.
803.
804.
805.
806.
807.
808.
809.
810.
811.
812.
813.
814.
815.
816.
817.
818.
819.
820.
821.
822.
823.
824.
825.
826.
827.
828.
829.
830.
831.
832.
833.
834.
835.
836.
837.
838.
839.
Ann V Salvage (2010)
Nursing home: working in as factor
Nursing image (initial) too difficult
Nursing image (initial) village nurse petrified me
Nursing image (initial): a job with some meaning
Nursing image (initial): me as a midwife on a bike rushing to people's aid
Nursing image (initial): not too taxing academically
Nursing image (initial): nurses with patients all the time/doctors not
Nursing image (initial): put off by work experience: nurses not hands-on
Nursing image (initial): you would need to know so much to do it
Nursing image (nurses): nurses make people better
Nursing is: a practical activity: academic ability does not make a good nurse
Nursing is: about basic patient care and management
Nursing is: about caring for people in whatever way they need care
Nursing is: about caring not treatment (= care/cure)
Nursing is: about doing things for people (was once the essence of nursing)
Nursing is: an art
Nursing is: being with patients
Nursing is: getting people well
Nursing is: hands-on/direct contact with patients and families
Nursing is: making a difference
Nursing is: my identity
Nursing is: my saving grace/given me a sense of purpose
Nursing is: nursing people
Nursing is: relationships with patients/relatives
Nursing is: something you can do in any context because you care for people
Nursing process
Nursing profession: identifies a clear role for
Nursing role: extension of
Nursing role: under threat from medicalisation
Nursing: fear about its future
Nursing: gave me a role
Nursing: I couldn‟t do anything else
Nursing: shortcomings
Oncology/chemo:harder cos patients assume you will get them better
Oncology: experience of post-training
Oncology: image (initial) 'sexy'
Oncology: liked/comfortable with
Oncology: provides care in the „right‟ way/how would want family cared for
Oncology: similar to hospice/unlike acute
Oncology: working in as factor (pc)
Opportunity to do 'real'/'proper' nursing as factor
Opportunity to make own mark as factor (nursing)
Orthopaedics: liked because patients not die/get better
Pain: can be helped by talking/massage (gives example)
Pain-control: skill in
Palliative care different?
Palliative care in hospices different from in hospitals
Palliative care nurses different?
Palliative care: definition: research on
Palliative care: relatively new discipline
Paperwork: a lot for all nurses
Paperwork: conflict with patient care
Paperwork: exacting
Paperwork: too much in my current job/earlier job
Parental approval as factor (nursing)
Parental approval: seeking
Parents advising children not to do (nursing)
Patient contact as factor (nursing)
Patient contact: enjoys
Patient contact: is what matters in basic care
Patient empowerment as factor (pc)
Appendix 10 Coding Frame
14 of 24
Thesis: Caring Towards Death
840.
841.
842.
843.
844.
845.
846.
847.
848.
849.
850.
851.
852.
853.
854.
855.
856.
857.
858.
859.
860.
861.
862.
863.
864.
865.
866.
867.
868.
869.
870.
871.
872.
873.
874.
875.
876.
877.
878.
879.
880.
881.
882.
883.
884.
885.
886.
887.
888.
889.
890.
891.
892.
893.
894.
895.
896.
897.
898.
899.
900.
Ann V Salvage (2010)
Patient empowerment: example of family who had all knowledge
Patient needs: everyone needs to know they're listened to
Patient-focused care (example)
Patients and relatives like: time, peace, quiet
Patients ask why am I dying?
Patients prefer hospice
Patients tell you a lot
Patients: a lot go home
Patients: evaluate hospice care well
Patients: going through the hardest stage of their life
Patients: relationships with
Patients: respect for in life and death
Patients: variety of needs (from bedfast to those needing symptom control)
Patients: wide range of health conditions
Pay: CNSs get more
Pay: hospice = hospitals
Pay: mentions positively
Pay: never good
Pay: no one would do it for (nursing)
Pay: not concerned about/not in it for the money
Pay: slightly higher in hospice
Pay: warned I would be poor at training interview
People who influenced as factor: to do nursing
People who influenced as factor: to do pc
People who influenced: no one (nursing)
People who influenced: no one (palliative care)
People who influenced: not directly but helpful (nursing)
People who influenced: not directly but helpful (pc)
Personal crisis as factor: (nursing)
Personal experience as factor (not specific)
Personal experience of caring as adult (not as factor)
Personal experience of caring as adult as factor (nursing)
Personal experience of caring as adult as factor (pc)
Personal experience of caring as child (not as factor)
Personal experience of caring as child as factor (nursing)
Personal experience of caring as child as factor (pc)
Personal experience of death
Personal experience of death as factor (pc)
Personal experience of death: helpful in hospice work
Personal experience of difficult childhood as factor (pc)
Personal experience of disability
Personal experience of hospital as factor (in return to nursing)
Personal experience of illness/hospitalisation as factor (nursing)
Personal experience of illness/hospitalisation as factor (pc)
Personal experience of illness/hospitalisation: family member
Personal experience of illness/hospitalisation: self
Placement at hospice: post-qualifying
Planning for hospice: followed advice but still not get job
Planning for hospice: jobs
Planning for hospice: qualifications
Planning for hospice: specialties
Planning for hospice: training placements
Planning for other specialties
Planning: career not planned
Power of the pc nurse: negative
Power of the pc nurse: positive
Practical issues in choice of nursing
Practical issues in choice of pc
Practical issues: not influential when chose but are now (nursing)
Practical issues: not influential when chose but are now (pc)
Practical issues: not want to work near home
Appendix 10 Coding Frame
15 of 24
Thesis: Caring Towards Death
901.
902.
903.
904.
905.
906.
907.
908.
909.
910.
911.
912.
913.
914.
915.
916.
917.
918.
919.
920.
921.
922.
923.
924.
925.
926.
927.
928.
929.
930.
931.
932.
933.
934.
935.
936.
937.
938.
939.
940.
941.
942.
943.
944.
945.
946.
947.
948.
949.
950.
951.
952.
953.
954.
955.
956.
957.
958.
959.
960.
961.
Ann V Salvage (2010)
Practice nursing compared with hospice
Pre-nursing course
Preparatory training school (PTS)
Private hospital work
Privilege/honour
Privileged position of the trusted nurse
Proud to be a nurse
Psychosocial issues: interest in
Push factors: arrogant surgeons (acute)
Push factors: from cancer care
Push factors: from district nursing
Push factors: from NHS
Push factors: from other specialties/jobs
Quakers
Qualifications needed for nursing courses
Qualifications planned
Qualities required in palliative care
Qualities which develop with experience
Reducing/has reduced hours
Religion: affiliation: has affiliation but not completely comfortable
Religion: affiliation: mixed religious affiliation stated
Religion: affiliation: no religion
Religion: affiliation: specific religion
Religion: agnostic
Religion: all religions worship the same God
Religion: as factor (palliative care)
Religion: aware of/believes in something else/higher realms
Religion: belief in angels
Religion: believe we have a spirit/soul
Religion: churchgoer
Religion: desires to have faith
Religion: deterrent to hospice initially
Religion: false religiosity in other people (example)
Religion: has an effect on how I work
Religion: has made enquiries/seeking a truth
Religion: having faith has advantages (for me)
Religion: having faith has advantages (sees in others)
Religion: helps me see death as a process not an end
Religion: history: brought up religious/not now
Religion: history: brought up religious/now different religion
Religion: history: brought up religious/still practices same religion
Religion: history: has become less religious
Religion: history: has become more moderate
Religion: history: has become more religious
Religion: immediate family religious
Religion: important to me
Religion: is a reassurance to me
Religion: link with career/job
Religion: meditation = prayer
Religion: minister in family
Religion: mother's fanaticism has helped me to say no
Religion: mother's fanaticism: negative results (dreams etc) but also pos
Religion: no need to go to church/can pray anywhere
Religion: no religious reasons for being here
Religion: not believe only one God
Religion: not religious but spiritual
Religion: nurses need not be/can be caring but not have faith
Religion: open to all beliefs/not contradict/non judgemental
Religion: parents religious
Religion: patients of the same religion like to talk
Religion: patients: all faiths accommodated
Appendix 10 Coding Frame
16 of 24
Thesis: Caring Towards Death
962.
963.
964.
965.
966.
967.
968.
969.
970.
971.
972.
973.
974.
975.
976.
977.
978.
979.
980.
981.
982.
983.
984.
985.
986.
987.
988.
989.
990.
991.
992.
993.
994.
995.
996.
997.
998.
999.
1000.
1001.
1002.
1003.
1004.
1005.
1006.
1007.
1008.
1009.
1010.
1011.
1012.
1013.
1014.
1015.
1016.
1017.
1018.
1019.
1020.
1021.
1022.
Ann V Salvage (2010)
Religion: patients: can be very scared if no belief
Religion: patients: careful not to express beliefs to patients
Religion: patients: if patient has strong faith, I focus on it more
Religion: patients: importance of knowing patients' beliefs/needs (example)
Religion: patients: nurses‟ role in patients‟ religion/spirituality
Religion: patients: sharing with patients of same faith can be powerful (eg)
Religion: patients: talking to nurses re whether if blve should encourage pats
Religion: patients: what you tell patients depends on your relationship
Religion: prays
Religion: some don't have beliefs so why do ? (implied religious motivation)
Religion: some nurses I work with are quite religious/spiritual
Religion: some nurses very anti
Religion: some things I do might be seen as not very Christian
Religion: strong belief
Religion: strong belief but not go to church
Religion: unable to think of because mother was religious maniac
Religion: you can't have strong convictions either way in hospice
Religion: young deaths challenge beliefs
Religious orientation (Quaker) as factor (nursing/pc)
Research on palliative care: doing
Resources: allow good care
Resources: allow holistic care
Respondent wanting not to sound/look bad/present negative image
Respondent: anxiety at giving me the right information
Respondent: apologises for not having interesting story
Respondent: becomes upset
Respondent: comments on Ann's understanding/awareness
Respondent: expresses interest in research
Respondent: finds question difficult
Respondent: gives conflicting information in interview
Respondent: links Ann's history with her choice of PhD subject
Respondent: misinterprets question
Respondent: refers to Ann's experience
Respondent: shows familiarity with literature
Resuscitation: negative comments
Return to nursing course: has done
Rewards
Ringing/calling in to get hospice job
Role model: female nurse (non-relative)
Role model: female nurse (relative)
Role model: male nurse
Role model: negative
Role: having a clear role as factor (nursing)
Saunders: Cicely
School: bright but not do well because family problems
School: did not consider nursing when there
School: did relevant work experience
School: did well/easy
School: encouraged to do other careers
School: had another career in mind
School: lazy
School: no career plans/not know what to do
School: not encouraged to do nursing/actively discouraged
School: not like/not do well
School: school not see as suitable male career
School: school tells parents below average intelligence/not expect much
School: school was biased towards nursing
School: subjects enjoyed
School: wanted hospital work experience but not get
Self-ascribed personality: negative
Self-ascribed personality: neutral/ambiguous
Appendix 10 Coding Frame
17 of 24
Thesis: Caring Towards Death
1023.
1024.
1025.
1026.
1027.
1028.
1029.
1030.
1031.
1032.
1033.
1034.
1035.
1036.
1037.
1038.
1039.
1040.
1041.
1042.
1043.
1044.
1045.
1046.
1047.
1048.
1049.
1050.
1051.
1052.
1053.
1054.
1055.
1056.
1057.
1058.
1059.
1060.
1061.
1062.
1063.
1064.
1065.
1066.
1067.
1068.
1069.
1070.
1071.
1072.
1073.
1074.
1075.
1076.
1077.
1078.
1079.
1080.
1081.
1082.
1083.
Ann V Salvage (2010)
Self-ascribed personality: positive
Self-disparagement: academic
Self-disparagement: other
Self-work: has done much
SEN/SRN: differences in training
SEN: wishes had been
SENs and drugs: changes in role
SENs/SRNs: less/more academic
SENs/SRNs: unaware of the difference
SENs: always with patients (SRNs with doctors/drugs)
SENs: basic medicines/SRNs: scary drugs
SENs: considered 'bedside' nurses (SRNs management oriented)
SENs: underdogs
Single parenthood
Special: hospice nurses as
Spiritual interests
Spiritual needs of patients: importance of
Spiritual: describes self as
Spirituality: central to Cicely Saunders conception of hospice
Spirituality: not equal to religion
Spirituality: not particularly spiritual
Staff patient ratios: allow time/good care
Staff patient ratios: figures
Staff patient ratios: good
Staff patient ratios: make it easier to give good care
Staffing structure: hospice
Stress: caused in acute by not being able to do a good job
Stress: from young people dying
Stress: leads to demote herself
Stress: not death and dying/from high-tech
Stress: not death and dying/inability to give optimum care
Stress: not death and dying: caused by returning to nursing
Sudden decision to go into nursing
Support as factor
Support: what supports in remaining
Surgical: contrasted with hospice
Surgical: liked
Surgical: liked but not holistic
Surgical: not like
Talking to patients: value should be put on
Tall ship experience: more useful than A-levels
Teaching experience: nursing
Teaching experience: other
Teamworking
Technology: dislike/not good at
Technology: gives nursing/medicine kudos
Technology: we do technical things but our aims are different
Television programmes as factor (nursing)
Theatre work: liked
Theory/practice: combined in role
Thinking outside the box
Time/touch: important healers
Time: on earth: a blink in eternity
Time: at the end: focus is on important things
Time: Cicely Saunders: time at end of life is more important than other
Time: depends on resources
Time: even the shortest period can make a difference (example)
Time: hospice makes you realise how precious it is
Time: hospice time difficult to get used to
Time: hospice time is special time
Time: if short, family care can suffer
Appendix 10 Coding Frame
18 of 24
Thesis: Caring Towards Death
1084.
1085.
1086.
1087.
1088.
1089.
1090.
1091.
1092.
1093.
1094.
1095.
1096.
1097.
1098.
1099.
1100.
1101.
1102.
1103.
1104.
1105.
1106.
1107.
1108.
1109.
1110.
1111.
1112.
1113.
1114.
1115.
1116.
1117.
1118.
1119.
1120.
1121.
1122.
1123.
1124.
1125.
1126.
1127.
1128.
1129.
1130.
1131.
1132.
1133.
1134.
1135.
1136.
1137.
1138.
1139.
1140.
1141.
1142.
1143.
1144.
Ann V Salvage (2010)
Time: if short, physical problems take priority
Time: if someone deteriorates suddenly/dies too quickly have problems
Time: importance of last few weeks/months
Time: important because people are doing/may be doing things for last time
Time: ingrained in staff very important to grab the moment (example)
Time: lack of as catalyst for focus on achieving as much as possible
Time: lack of in hospice leads to focus on physical needs
Time: needed for holistic care
Time: only one chance to get it right
Time: paradox of: hospice is slower but huge pressure/urgency
Time: personal experience shows how important it is
Time: prerequisite for empathic care
Time: restrictions on (in hospice) mean hard to provide best care
Time: spending time with a patient as indication that all is well
Time: things can change from minute to minute
Time: valued in hospice
Time:dying is a one off/never to be experienced again
Training as factor: (other than placement) (pc)
Training: academic turn led to forgetting basic principles
Training: aspects disliked (excluding specialties)
Training: aspects liked (excluding specialties)
Training: attitude more important than age
Training: can't teach all you need/learn on the job
Training: changes (non-specific)
Training: characteristics: now
Training: characteristics: then
Training: death and dying hard to teach
Training: death and dying: can't remember if any input
Training: death and dying: describes input
Training: death and dying: no input
Training: death and dying: some input
Training: death: personal experience of helps
Training: deaths were of elderly people/too ill to form relationship with
Training: deaths: few
Training: deaths: many
Training: degree chosen
Training: did nursing as mature student
Training: different formats
Training: diploma chosen
Training: disability made it difficult to get in
Training: good at academic not mean good at practical
Training: hospice visit/talk/lecture
Training: London chosen/seen as best
Training: made sacrifices to do
Training: no pay: deterrent when friends were earning
Training: not prepare for palliative care
Training: option module in palliative care:took
Training: personal difficulties during
Training: placement (not hospice) led to job
Training: placement: hospice
Training: placement: hospice as factor (pc)
Training: placement: hospice enjoyed
Training: placement: hospice not offered
Training: placement: oncology ward as factor (pc)
Training: placement: others enjoyed
Training: placements: available now not then
Training: sponsored/seconded
Training: specialties disliked
Training: specialties liked
Training: supernumerary but not in reality
Training: wanted neonatal/children but put off by placement
Appendix 10 Coding Frame
19 of 24
Thesis: Caring Towards Death
1145.
1146.
1147.
1148.
1149.
1150.
1151.
1152.
1153.
1154.
1155.
1156.
1157.
1158.
1159.
1160.
1161.
1162.
1163.
1164.
1165.
1166.
1167.
1168.
1169.
1170.
1171.
Ann V Salvage (2010)
Training: wanted to give up/nearly had to
Travelling: after training
Travelling: before training
Travelling: inspired by young patient
University: chose not to/not want
University: did nursing
University: did other course
University: few degrees when I trained
University: nobody did then
University: not considered
University: not encouraged
University: originally intended to but didn't
University: parents tried to persuade but set on nursing
University: wanted to but not able
Values: clearly relevant to nursing
Values: general
Values: other comments
Values: religious
Vet: compared with nursing
Vocation
Work experience: length of/age at doing
Work experience: seldom leads to career
Young nurse in hospice: first job
Young nurses: reasons entering hospice as factor (attributed) (pc)
Young nurses: their experience is useful with new patient groups
Young/inexperienced nurses compromise ability to give good care
Young/inexperienced nurses entering hospice work
Coding Frame Part 2
1172.
1173.
1174.
1175.
1176.
1177.
1178.
1179.
1180.
1181.
1182.
1183.
1184.
1185.
1186.
1187.
1188.
1189.
1190.
1191.
1192.
1193.
1194.
1195.
1196.
1197.
1198.
1199.
1200.
1201.
A&E: image: sexy (becoming)
A&E: nurses have different outlook
Acute: agency nurses used a lot (in it for the money)
Acute: deaths not planned/expected
Acute: doctors poor at communicating with patients
Acute: get up and go
Acute: more high-tech
Acute: more hope
Acute: nurses coming from find it hard to slow down
Acute: nurses coming from have difficulty learning appropriate attitude/way of caring
Acute: nurses complain but do nothing to change things
Acute: nurses dynamic/bored with hospice/not cope with emotion
Acute: nurses insensitive/uncaring
Acute: target-focused
Acute: technology takes nurses from patients
Acute: trained nurses can't nurse
A-levels: hard to move between subjects
Alternative medicine: hospice nurses interested in
Alternative medicine: interested in
Ann: feeds back from previous interviews
Ann: relates her own experience
Ann: upset by memories
Anorexic daughter
Attraction: combined holistic care with academic values/interest
Attraction: curious about mystical place patients go to
Attraction: hands-on
Attraction: hospice less stressful than acute
Attraction: how palliative care staff interacted
Attraction: job with a purpose
Attraction: lack of hierarchy
Appendix 10 Coding Frame
20 of 24
Thesis: Caring Towards Death
1202.
1203.
1204.
1205.
1206.
1207.
1208.
1209.
1210.
1211.
1212.
1213.
1214.
1215.
1216.
1217.
1218.
1219.
1220.
1221.
1222.
1223.
1224.
1225.
1226.
1227.
1228.
1229.
1230.
1231.
1232.
1233.
1234.
1235.
1236.
1237.
1238.
1239.
1240.
1241.
1242.
1243.
1244.
1245.
1246.
1247.
1248.
1249.
1250.
1251.
1252.
1253.
1254.
1255.
1256.
1257.
1258.
1259.
1260.
1261.
1262.
Ann V Salvage (2010)
Attraction: less pressured
Attraction: multidisciplinary
Attraction: nurses cared for
Attraction: opportunity to use skills
Attraction: original work was not going on elsewhere
Attraction: patients treated with dignity
Attraction: principles of good care can best be applied here
Attraction: religious element
Attraction: smaller setting
Basic nursing: enjoys
Being in hospital as factor in return to nursing
Being with: valued in hospice
Careers advice: advised to do something else
Careers advice: had
Careers advice: none but had already decided on nursing
Careers: other previous: health-related
Challenge: enjoys
Changes in hospice: earlier diagnosis
Changes in hospice: financial restrictions
Changes in hospice: less nurses
Changes in hospice: more efficient
Changes in hospice: more mainstream
Changes in hospice: more patient-led
Changes in hospice: nurses less knowledgeable/slacker/inadequately trained
Changes in nursing role: making patients do things for themselves
Changes in nursing: faster pace
Changes in nursing: lower entry qualifications
Changes in nursing: more medicalised
Changes in nursing: not so easy to change specialty
Changes in nursing: nurses more technically skilled
Changes in nursing: professionalisation/more academic
Choice of specialty: initially chose hospice but followed advice to get experience
Colleagues: critical of (un-named)
Colleagues: negative comments
Community nurse specialist: has worked as
Community nurse specialists: autonomous
Community palliative care work: has done
Cost: hard to deal with own grief
Counselling in hospice nursing
Death: associated with scary images
Death: how of dying: not death is a concern
Death: I don't know whether it is end or beginning
Death: not being with the ones you love
Death: patients: scary if believe nothing else
Death: patients: should be allowed to die how they want to
Death: post-mortem experience helped deal with
Death: tragic loss of someone
Death: when relatives have slipped out
Degree: now doing
Desire for meaningful work as factor (pc)
Desire for new challenge as factor (pc)
Desire to care for people as factor (nursing)
Desire to help people live before they die as factor (pc)
Desire to help/care for people as factor (pc)
Desire to learn/understand more about illness as factor (nursing)
Desire to provide better death as factor
Desire to work with people as factor (nursing)
Desire to work with people as factor (pc)
Dissatisfaction with other career as factor (nursing)
District nursing: wanted to do but could not afford drop in salary
Doctor: not want
Appendix 10 Coding Frame
21 of 24
Thesis: Caring Towards Death
1263.
1264.
1265.
1266.
1267.
1268.
1269.
1270.
1271.
1272.
1273.
1274.
1275.
1276.
1277.
1278.
1279.
1280.
1281.
1282.
1283.
1284.
1285.
1286.
1287.
1288.
1289.
1290.
1291.
1292.
1293.
1294.
1295.
1296.
1297.
1298.
1299.
1300.
1301.
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1309.
1310.
1311.
1312.
1313.
1314.
1315.
1316.
1317.
1318.
1319.
1320.
1321.
1322.
Ann V Salvage (2010)
Doctors: hospice ones can lack compassion
Drugs: nurses have to do assessment
Drugs:SENs and
Evidence of psychic/spiritual awareness
Families: pleased with level of care
Feels stuck
Gender: boys favoured educationally over girls
Gender: has been discriminated against as man: "nurses are women"
Gender: nursing seen by others as suitable career for women
Hands-on: community palliative care nurses do not do
Hands-on: enjoys
Hands-on: important for managers to do
Hands-on: manager: not do
Hands-on: managers generally do not do
Hands-on: who does?
HCAs: proportion of in hospice
Home: close family
Home: difficult home life
Home: parental encouragement as factor (nursing)
Home: parents not close
Hospice is: a gentle place to work
Hospice is: about acceptance of death
Hospice is: about being with people
Hospice is: accepting
Hospice is: more concerned with spirituality than religion
Hospice is: nice working environment
Hospice job: feel I cheated my way into
Hospice nurses: are able to do a lot for patients
Hospice nurses: caring
Hospice nurses: enjoy basic care
Hospice nurses: go above and beyond/go the extra mile
Hospice nurses: good at communicating
Hospice nurses: good listeners
Hospice nurses: good mix of age and experience
Hospice nurses: have caring instilled in them
Hospice nurses: have time for relatives
Hospice nurses: high standards/uncompromising
Hospice nurses: image of: other nurses
Hospice nurses: interested in alternative medicine
Hospice nurses: more hands-on
Hospice nurses: often spiritual (more so than acute)
Hospice nurses: passionate about providing good care
Hospice nurses: question their own practice
Hospice nurses: see the end of the story
Hospice nurses: think holistically
Hospice nurses: well supported in education
Hospice nursing: being alongside people
Hospice nursing: can make it difficult to deal with own grief
Hospice nursing: demanding (non-specific)
Hospice nursing: different from acute palliative care
Hospice nursing: doing what is important for the patient, not worrying about tidiness
etc
Hospice nursing: draining
Hospice nursing: emotionally demanding
Hospice nursing: emotionally demanding: example
Hospice nursing: exhausting (non-specific)
Hospice nursing: gives insight into how people cope
Hospice nursing: hands-on nursing
Hospice nursing: important work
Hospice nursing: individualised care
Hospice nursing: intense
Appendix 10 Coding Frame
22 of 24
Thesis: Caring Towards Death
1323.
1324.
1325.
1326.
1327.
1328.
1329.
1330.
1331.
1332.
1333.
1334.
1335.
1336.
1337.
1338.
1339.
1340.
1341.
1342.
1343.
1344.
1345.
1346.
1347.
1348.
1349.
1350.
1351.
1352.
1353.
1354.
1355.
1356.
1357.
1358.
1359.
1360.
1361.
1362.
1363.
1364.
1365.
1366.
1367.
1368.
1369.
1370.
1371.
1372.
1373.
1374.
1375.
1376.
1377.
1378.
1379.
1380.
1381.
1382.
1383.
Ann V Salvage (2010)
Hospice nursing: inter/multidisciplinary
Hospice nursing: keeps you grounded
Hospice nursing: nursing in a purer form
Hospice nursing: physically exhausting
Hospice nursing: relies on teamwork
Hospice nursing: showing genuine love and concern for patients
Hospice nursing: slower/quieter
Hospice nursing: supporting people can drag you down
Hospice nursing: symptom control
Hospice nursing: took demotion to do
Hospice nursing: took sideways step to do
Hospice nursing: very different from other specialties
Hospice nursing: very worthwhile area to work
Hospice nursing: what good basic nursing should be
Hospice nursing: working with things that really matter
Hospice: future: concern about
Hospice: initial ignorance of
Hospice: treats patients as individuals not conditions
Hospices: a female dominated environment
Hospices: funded adequately to provide equipment etc
Hospices: where I can learn skills to take elsewhere
Ill at ease socially interest in psychosocial issues nursing palliative care
ITU: dislike
ITU: was not appreciated by other staff
Macmillan nurse: has worked as
Manager: became despite wanting to remain a nurse
Martyr: being
Mature entrant: hospice first job
Medical model: in relation to increasing overlap between oncology/palliative care
Medicine: hi-tech
Mediums: belief in (some)
Mediums: knows people who have used
Memories: importance of for relatives
Men in nursing: homosexuals not attracted to hospice
Mental health nurses compared with hospice nurses
Midwifery: left because constantly on call
Motivations (attributed) better SPRs
Motivations (attributed) close relationships with patients (pc)
Motivations (attributed) desire to do good hands-on care
Motivations (attributed) desire to learn how to provide good death
Motivations (attributed) dissatisfaction with NHS
Motivations (attributed) easy place to work
Motivations (attributed) fits their philosophy of caring/nurturing
Motivations (attributed) nurses get a lot of satisfaction from helping people
Motivations (attributed) to be at bedside
Motivations (attributed) to give care
Motivations (attributed) to give care as it should be given
Motivations: I don't know why I went into it (nursing)
Motivations: makes me feel important (nursing and palliative care)
Motivations: need to be needed (pc)
Motivations: to take care of people (nursing)
Multidisciplinary working
NHS cuts: less nurses being trained
Nurses as mediators between doctors/patients
Nursing image (initial) brilliant job
Nursing image (initial) encompassed the things I liked
Nursing image (initial) for middle-class people - not for me
Nursing image (initial) fulfilling
Nursing image (initial) worthwhile job
Nursing: initial ignorance
Oncology: increasing overlap with palliative care
Appendix 10 Coding Frame
23 of 24
Thesis: Caring Towards Death
1384.
1385.
1386.
1387.
1388.
1389.
1390.
1391.
1392.
1393.
1394.
1395.
1396.
1397.
1398.
1399.
1400.
1401.
1402.
1403.
1404.
1405.
1406.
1407.
1408.
1409.
1410.
1411.
1412.
1413.
1414.
1415.
1416.
1417.
1418.
1419.
1420.
1421.
1422.
1423.
1424.
1425.
1426.
1427.
1428.
1429.
1430.
1431.
1432.
1433.
1434.
1435.
1436.
1437.
1438.
1439.
1440.
1441.
Ann V Salvage (2010)
Orthopaedics: boring
Patient empowerment (general)
Patients: relationships with: enjoys
Pay: better in UK than Australia
Pay: lack of while training as disincentive (nursing)
Pay: nursing not chosen because of
Personal crisis as factor (palliative care)
Personal experience of death: renews focus/enthusiasm
Personal experience of hospice as factor (palliative care)
Personal experience of illness/hospitalisation (family member) as factor (nursing)
PIN number
Placement (post-training) as factor (palliative care)
Planning: for nurse training
Power of words
Practical issues: other specialties
Pre-nursing course: looked interesting as factor (nursing)
Principles of good palliative care (definition)
Project 2000
Psychic experiences
Push factors: from surgical
Religion: a lot of religious people in hospice work
Religion: affiliation: confused
Religion: considered entering convent when at school
Religion: describes conversion
Religion: differentiated from spirituality
Religion: history: become more inclusive in religious beliefs
Religion: history: has become more spiritual than religious
Religion: history: never been religious
Religion: history: not brought up as religious
Religion: history: not brought up as religious: is now
Religion: history: religious as child
Religion: patients: can be neglected if lack of time
Religion: patients: I talk more about it than I used to
Religion: patients: religious needs well catered for
Respondent: criticises other respondents
Respondent: expresses anxiety about confidentiality
Respondent: finds interview helpful
Return to nursing course: why required
Returned to nursing as mature
Role models: nursing
Role models: palliative care
School: encouraged to do nursing
Sister is nurse
Stress: feels stressed
Tasma, David
Technology: antithesis of caring/communication
Technology: never fazed me
Training: chose SEN
Training: chose SRN
Training: death and dying: covered more now than in the past
Training: death and dying: hospital death badly done
Training: death and dying: seeing pattern as factor
Training: difference between degree/diploma
Training: dilemma: degree or diploma?
Training: enjoyed
Training: not what I expected
Training: stressful
Wife is nurse
Appendix 10 Coding Frame
24 of 24