Encountering loneliness in palliative care: institutional blind spots and the everyday work of Finnish health social workers

This article examines how loneliness becomes visible in the everyday work of health social workers in palliative care and how institutional structures shape this visibility. Drawing on interviews from health social workers, professional guidelines, and policy documents, the study explores how loneliness is coordinated, recognised, and understood within Finnish palliative care practices. Guided by Institutional Ethnography, the analysis identifies three key findings: loneliness as an institutional blind spot, lack of attention to psychosocial needs, and assumed availability of family caregivers. The results illustrate how institutional texts and organisational frameworks shape care practices in ways that overlook the social dimensions of dying, despite their centrality in the work of health social workers. Although loneliness is largely absent from official discourse and formal care pathways, it is deeply present in the everyday experiences, observations, and practical challenges faced by professionals. The article shows that a gap exists between institutional priorities and everyday care and argues that psychosocial concerns need to be recognised more clearly in palliative care.