The role of district nursing: perspectives of cancer patients and their carers before and after hospital discharge

District nurse advocacy for choice to live and die at home in rural Australia: a scoping study

BACKGROUND

Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care.

OBJECTIVES

The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge.

METHOD

Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings.

RESULTS

34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role.

DISCUSSION

Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas.

CONCLUSION

It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.

Being in-between and lost in the discharge process--an excursus of two empirical studies of older persons', their relatives', and care professionals' experience

The discharge process (DP) is full of well-known risks, and a comprehensive and well-executed DP is especially important for older people with multiple health problems and continuing care needs, as well as for their relatives. Few studies focus on the experiences with the DP by older people in need of home care nursing and their relatives. Therefore, the aim was to deepen the understanding of the DP as a phenomenon described by older people, their relatives, and care professionals. The method is an excursus of the findings of two previously published research studies. By using the Reflective Lifeworld Research approach, the empirical findings were further interpreted with lifeworld theory. The results describe the essential meaning of the phenomenon of DP in relation to healthcare needs. The illness and the DP can be viewed as a course of action where the familiar becomes unfamiliar for older people and their relatives, entailing an insecure future existence characterized by the experience of being in-between. The DP is marked by bodily and existential needs. The older persons and their relatives are lost in the hospital context and trying to influence life and adapt to life circumstances, while being relentlessly dependent on care professionals. Care professionals work from both an organizational and a medical approach. Disharmony and disagreement seem to arise easily among the professionals regarding the planning negatively affecting the patients and their relatives.

More efforts are needed in the DP to empower older people and their relatives to go on with their life at home. The caring practice needs to more clearly meet and address the individual needs of older people and their relatives and their understanding of their illness. It needs to give them lifeworld and life goals to alleviate their suffering and to help them adjust to their new situation.

Getting prepared for life at home in the discharge process--from the perspective of the older persons and their relatives

AIM

To examine how older persons in need of home-nursing care and their relatives experience the discharge process and develop a model that explains the experience.

BACKGROUND

The discharge process has well-known deficiencies and is therefore a challenging issue requiring improvement in many countries. Research focusing on patient-centred factors has attracted very little critical attention.

DESIGN

Grounded theory was used to analyze semi-structured interviews with 26 older persons and their relatives.

FINDINGS

The analysis resulted in a theoretical model that depicts factors determining whether the older persons and their relatives feel prepared or unprepared for life at home at the time of discharge.

CONCLUSIONS

The older persons and/or their relatives felt prepared at the time of discharge if their needs were satisfied in the three significant areas of preparation. Not only were the professionals' skills of the utmost importance in preparing the older persons/relatives, but also the latter's own approach if the professionals were unskilled.

RELEVANCE FOR CLINICAL PRACTICE

A knowledge of the preparation areas and skills can be of use for improving the quality of the discharge process from the older persons' and their relatives' perspective, i.e. through policies, checklists and teaching programmes.

District nurses' involvement in pain care: a theoretical model

AIM

To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients.

BACKGROUND

Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill-equipped, and they experience difficulties during interactions with these patients.

METHOD

This is a qualitative study with a theory-generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method.

RESULTS

The result is a theoretical model of district nurses' involvement in pain care. The model: (1) illustrates three main conditions in the care situation that influence district nurses' involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems.

CONCLUSIONS

The model explains why district nurses sometimes feel powerless or ill-equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation's guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses' involvement in pain care.

RELEVANCE TO CLINICAL PRACTICE

Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case-study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers.

Introduction of the primary care cancer nursing role in a GP practice

Nurses have always had an important role in the care of cancer patients and many specific nursing roles in cancer services have been developed. A qualitative research strategy using semi-structured interviews was adopted in this case-study of the implementation of a primary care cancer nurse (PCCN) role in a general practice. The implementation of the PCCN role is reported in order to shed light on the extent to which integration of the role into existing systems of care had taken place; and to explore facilitating factors and barriers to the implementation of a new primary care role. Three major themes emerged from the data: the management of change; systems of care; and the complexity of professional interfaces. It is evident that the effective implementation of innovative nursing roles in primary care can present many challenges to the role holder and to the health and social care professionals with whom they come into contact. The importance of communication and consultation in the role implementation are emphasized.

A sense of security for cancer patients at home: the role of community nurses

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses' work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse-patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients.

Supporting Cancer Patients With Palliative Care Needs

The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.

Information needs of the informal carers of women treated for breast cancer

Although the vital role of informal carers has been acknowledged in government policy documents in the UK, the information needs of informal carers are not well documented. There is also uncertainty about where carers get their information from and whether they are satisfied with the information they receive. This study aimed to examine the information needs and sources of information for informal carers in the acute cancer setting; the informal carers of a sample of women treated for breast cancer. Both quantitative and qualitative data were collected from semi-structured interviews with 50 informal carers. Measures of information needs and sources were administered in addition to an in-depth exploration of information needs. The priority information needs of carers related to cure, spread of disease and treatments, a similar profile to that found for women with breast cancer in previous work. The main source of information for carers was the person they were caring for, although written information was also valued. Health professionals need to ensure that patients are well informed so that patients can provide information for carers and also need to take advantage of any opportunities to directly assess the information needs of carers to enable them to be more effective in their caring role.

The specialist palliative care nurse: A qualitative study of the patients’ perspective

BACKGROUND

Relatively little is known about patients' perceptions of the work and role of the specialist palliative care nurse. Understanding the patients' perspective can help to evaluate services, improve quality of care, and identify misunderstandings.

OBJECTIVES

To explore the experiences of those who said that they had a 'terminal illness', focusing on patients' perceptions of the work and role of these nurses.

DESIGN

Qualitative study with narrative interviews.

SETTING

England and Wales.

PARTICIPANTS

Forty-one people recruited through those working in hospices, community nurses, general practitioners, support groups, a national newspaper, and a conference on palliative care. Twenty-five people talked about the work of specialist palliative care nurses.

METHOD

Interviews were fully transcribed; followed by a thematic analysis with constant comparison.

RESULTS

Patients valued the nurses' work, particularly their advice on practical matters, information given about their disease, emotional support, advice on symptoms, and help with communication. They were glad that help was readily available. However, some patients who had been referred to the service did not realise that specialist palliative care nurses may be involved at a relatively early stage in a person's illness, and sometimes felt distressed by an early referral. One woman felt she had not had the emotional support she needed and another knew of women who had been upset because these nurses had discussed topics such as place of death 'too early'. However, people recognised the difficulties nurses faced in their work.

CONCLUSIONS

Although our study differs from other studies, particularly in the way people were recruited, our findings support previous studies that have shown that specialist palliative care nurses are highly valued by those who have a terminal illness. It is important for people to understand that these nurses may be involved from the time of diagnosis and that roles have changed.

Referral criteria: making the district nursing service visible

The development of referral criteria has been seen as one of the keys to the proactive enhancement of the district nursing service to ensure equity and efficiency of service provision (Audit Commission, 1999). Referral criteria specify what constitutes an appropriate district nursing referral and who is the best person or service to undertake the care if it is not. With the continued focus of shifting the balance of care away from the hospital and into the community and a historically reactive rather than proactive work force, district nurses in Lothian, Scotland developed referral criteria for the service. This article discusses the drivers for the development of these criteria, how they were developed, and the anticipated difference implementation of the criteria would make to district nursing.