Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Catherine Ward-Griffin/ Carol McWilliam

Abstract

The purpose of this study was to critically examine gender relations in the sociopolitical context of hospice palliative home care for clients with cancer and their family caregivers. Using a critical feminist lens, I employed critical ethnography as a methodology to uncover taken-for-granted attitudes, beliefs, and practices that shape health and health care experiences within the culture of end-of-life at home. The study addressed the following research questions: (a) How do gender relations shape health and health care experiences within the socio-political context of hospice palliative home care for clients with cancer and their caregivers?; (b) How do gendered processes operate to produce gender relations and potential gender inequities in this context?; and (c) What are the social mechanisms and consequences that (re)produce gender (in)equities in hospice palliative home care?

Purposeful sampling was used to gather information-rich data from six triads consisting of a client with cancer, his/her family caregiver and primary nurse. I employed ethnographic methods of interview, observation, and document review to gain in-depth knowledge of the patterns and dynamics of gender relations. Twenty-five semi-structured interviews were conducted with clients, family caregivers, and nurses. Observations of nine home visits by the nurse contextualized gender social relations in this setting. Program, professional, and public communication documents were analyzed to understand how institutional discourses shaped gendered attitudes, beliefs, and practices and everyday health and health care experiences in hospice palliative home care.

A gender-based analysis revealed that institutional discourses influenced Gendered Expectations and Exemptions, disadvantaging both men and women in this context. Ideological gendered processes of Normalizing Gender Relations and Equalizing Gender Relations supported the everyday practices of Regulating Gender Relations. Finally, socially constructed mechanisms of Preservation/Destruction of Gender Stereotypes and Imbalance/Balance of Power (re)produced gender (in)equities. Overall, gender relations and gender inequities were considered low in priority and status within the culture of hospice palliative home care. Recommendations have been made related to policy, practice, education, and research.


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