Nurses' feelings of 'ownership' of palliative care patients: findings from a qualitative case study

Background: Partnership working between nurses and other health care professionals is encouraged, as is the building of professional relationships with patients and carers. It is suggested these relationships may give nurses control and a sense of ownership of patients; this may affect otherwise valued aspects of teamwork. Issues of ownership were explored in a study of referrals within community palliative care services. Subjects and Methods: Influences on referrals were studied within three primary care organisations using a qualitative case study strategy (incorporating interviews, observations and documentary analysis). Framework analysis techniques were used to facilitate within case analysis and cross case pattern matching. Results: Forty-seven interviews were conducted with a range of generalist and specialist palliative care professionals (nurses, doctors, allied health professionals), and 10 interviews with patients. Nurses in particular discussed concepts of ownership of patients. This had positive and negative effects: restricting access to a range of services, but promoting personal continuity of care. Doctors described responsibilities towards patients, which could complicate teamwork with competing feelings of responsibility and ownership from different team members. Discussion: Issues of ownership had an impact on the way nurses conducted their work, motivated by desires to both provide personal continuity to patients and to use knowledge about patients to enhance functional authority within the team. Understanding how these issues impact on care provision is essential when working towards best quality care.