Caring for the terminally ill: the district nurse's perspective

Abstract

This study aimed to explore the role of the district nurse in terminal care in order to understand and clarify the work that district nurses undertake in this area. District nurses view themselves as having a central and valued role in terminal care, yet studies have highlighted concerns that they may not have the necessary skills to provide effective terminal care. In order to target the educational and developmental needs of district nurses the role of the district nurse in terminal care was explored using a qualitative approach. Six semi-structured interviews, including the use of vignettes, were undertaken with district nurses from one community trust. Interviews were all taped and transcribed verbatim. Transcriptions were analysed using coding and categorizing with constant comparison of recurring themes. Common themes relating to how district nurses viewed their role in terminal care were then developed. The district nurses viewed their role as centring on the development of a relationship with the client and family. The relationship was a foundation to understanding and knowing the clients' and families' needs and was the medium through which all other care was given. The focus of care was determined by those needs identified through the relationship. Care needs identified within the study were complex and difficult to distinguish but fell within four themes: (1) emotional; (2) social; (3) physical; (4) informational. The importance of the relationship between the district nurse, the terminally ill client and the carer has not been clearly identified before and this study points towards the importance of formal structures to be put in place within palliative care and the provision of district nurse training to allow the opportunity and skills for this relationship to be fostered and developed.

Families' Importance in Nursing Care

“…Variability in the findings from this review of literature indicate that although nurses claim that families are important, this belief is not always supported by the evidence. Findings from Hallgrimsdottir (2000), Jansson et al (2001), Astedt-Kurki et al (2001a, 2001b, Berterö (2002), and Wright (2002) found that nurses consider it important to establish a good relationship with the family. However, nurses hold constraining and facilitative beliefs about including families in nursing care (Benzein, Johansson, & Saveman, 2004;Hertzberg et al, 2003;Leahey & Harper-Jaques, 1996).…”

Improving communication with palliative care cancer patients at home – A pilot study of SAGE & THYME communication skills model

“…In some studies, DNs report that they have good communication skills and provide skilled psycho-social assessment to cancer patients Wright, 2002;Kennedy, 2005). Other evidence suggests however that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time for this work (Dunne et al, 2005;Aitken, 2006;Addington-Hall et al, 2006;Griffiths et al, 2007).…”

"Moving Swiftly On." Psychological Support Provided by District Nurses to Patients With Palliative Care Needs

“…Through the chat, they believed that they could indirectly assess patients' needs: that patients would ''let things out'' when off their guard. 18 Although getting to know patients and assessing them implicitly is a skilful district nursing strategy, 35,36 and observing patients over time in their own environment is also an important district nursing skill, 35 problems arise when an indirect approach is the only assessment strategy used by district nurses, because interpretations may be faulty and based on their own discomfort rather than the patients' concerns. 22 Despite the district nurses' reticence, patients appeared to be willing to share their feelings, but the district nurses used avoidance and blocking strategies when patients showed signs of distress.…”

“…16,17 District nurses in the United Kingdom also spend a lot of time with cancer patients ''supporting'' them at home, but it is unclear how skilled they are at detecting psychological concerns and providing basic psychological support. In some studies, district nurses report that they have good communication skills 18 and provide skilled psychological and emotional support to cancer patients. 6,14 Other evidence suggests, however, that district nurses lack confidence in communication skills 19,20 and in meeting cancer patients' psychological needs.…”