“Picking up the pieces”—Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area

Abstract

Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients’ strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context.

Bereaved family members' perspectives on suffering among older rural cancer patients in palliative home nursing care: A qualitative study

“…In our sample, all family members highlighted their ill relatives' urgent wish to stay at home and to be surrounded by familiar people. Similar findings emphasise the importance of having a sense of belonging (Appelin, Brobäck, & Berterö, ; Melin‐Johansson et al., ) and feelings of physical, social and autobiographical insideness related to being at home in a rural context (Devik et al., ).…”

“…Palliative home nursing care in rural areas can offer older persons with advanced cancer many benefits, included increased senses of comfort, security and identity (Devik, Hellzen, & Enmarker, ). By contrast, long distances and limited health‐related human resources pose challenges to providing optimal services in rural contexts (Robinson et al., ).…”

Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

“…Fourteen studies reported in 16 publications, published from 2003 to 2017, were included in this group (Table 12). Of these, three dealt with general practice, 44,45,48 three dealt with a range of primary care services, 36,37,49 three dealt with carers working at residential or supported living homes [33][34][35]43 and two dealt with formal and informal carers of people with ID in residential or family homes. 38,39 The other three studies dealt with audiology services, 42 cervical and cancer screening 40 and sexual health.…”

Corporeidade de adoecidos oncológicos em cuidados paliativos domiciliares: a vivência de familiares cuidadores / Corporeality of oncological patients in palliative home care: the experience of family caregivers

“…The state of insignificance that recurred sickness report, happened on the occasion of technicality allied to the understanding that it is just another number/individual being receptacle of dedication, which hurts its particularity. 18 Psycho-spiritual care and human corporeality were verified, mainly linked to religion. With the speech of relatives, it was realized that the maintenance of religion feeds the spiritual body of the entity with cancer.…”

“…Among the sick in palliative care, I look forward to something surprisingly pleasant and exceptional to lead them out of the routine organized daily around technical care. 18 We incorporate during the physical experience the attributions that are assigned to us by the world, and in this way we construct our existence. After the advent of the disease, it is in the corporal domain where the diseases will be expressed, and through the senses the sick people enjoy the experience of pathologies that affect them integrally.…”