Liverpool Care Pathway is an integrated care pathway (ICP) designed to ensure the provision of high-quality end-of-life care. However, the ICP has come under substantial criticism, suggesting that its use is related to poor care. This study explores nurses’ use of the ICP to dying patients in Norwegian nursing homes. We conducted a qualitative study using an abductive, mystery-focused method to analyze the experiences of 12 registered nurses. Our findings show that the nurses experienced the ICP as a very useful tool in end-of-life care, although they were actually working independently of the ICP in the provision of ongoing bedside care for the dying patients. This can be understood as following: (I) the ICP is not compatible with the complex problems of dying patients; therefore, nurses must tinker with the ICP in order to give dying patients proper and dignified care; (II) the ICP is a myth with symbolic power, legitimizing care makes nurses positive towards the ICP; and (III) using the ICP as a loosely coupled system creates novel effects on nursing practice. In this study, we have shown how the ICP creates a common culture through a process of individual and collective sensemaking, which we labelled clinical mindlines.


Integrated Care Pathway, Liverpool Care Pathway, End-of-Life Care, Reflexive and Creative Methodology, Mystery as Method, Abductive Reasoning

Author Bio(s)

Marianne Brattgjerd is enrolled as a PhD student at Nord University`s programme for PhD in Professional Praxis. Her areas of research are practical knowledge, sociology of professions, standardization, elderly care, death and dying. Correspondence regarding this article can be addressed directly to: marianne.brattgjerd@nord.no.

Rose Mari Olsen, PhD, is associate professor of Health Science at the Faculty of Nursing and Health Sciences, Nord University. Her areas of research are health services (patient safety, integrated care, patient transfers), geriatrics and elderly care. She leads the research group “Patient safety, documentation and information exchange” at Nord University. Correspondence regarding this article can also be addressed directly to: rose.m.olsen@nord.no.

Inger Jorun Danielsen, PhD, is associate professor in nursing at the Faculty of health sciences, UiT The Arctic University of Norway. She has a PhD in professional praxis. Her areas of research are practical knowledge, and especially how practitioner’s clinical knowledge are constructed within the context of healthcare practice. Correspondence regarding this article can also be addressed directly to: inger.danielsen@uit.no.


The authors wish to thank the nurses who participated in the study, and the contact person at the Norwegian Competence Center in Palliative Care who helped recruiting the nurses in this study.

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