"Symbiotic niceness": constructing a therapeutic relationship in psychosocial palliative care

The concept of symbiotic niceness illustrates a mutually shared advantage in the nurse-patient relationship. This relationship is premised on the co-production of niceness through the doing of psychosocial care. This paper presents an account of 'symbiotic niceness' produced in palliative care nurses' talk. The data are collected from two hospices and one general hospital for the dying. The analysis of talk demonstrates how psychosocial care can be understood as the collaborative practice of 'niceness' in the daily activities of participants, and how they collaboratively achieve reciprocal and therapeutic relevance for their talk. Participants co-engage in a 'selling game'. Through the activities of selling, a set of personal assets that constitute their personal Curriculum Vitae (CV) are revealed. It suggests that nurses' assets, when combined with patients' assets, function as marketable 'products' to produce an impression of nice patients and professionals. This in turn leads to the production of an impression of 'nice' organisations. Impression management is presented as a key strategy for the production of marketable niceness. Through the co-performance of niceness in talk, both nurses and patients are constructed as people who are somewhat charismatic, friendly, informal, understanding and concerned. This paper argues that underpinning the co-enactment of symbiotic niceness is the sharedness of patients' and nurses' experiences and a reciprocal notion of therapeutic help. It serves as a means of managing relations between palliative care nurses and dying patients. Symbiotic niceness thus represents a core component of professional and patient identity which works to maintain social orderliness as well as to advance personal, professional and organisational aspirations.