District nurses (DNs)
support patients with
advanced cancer in their homes.
A Qualitative Exploration of District Nurses' Care of Patients With Advanced Cancer: The Challenges of Supporting Families Within the Home.
Source
Author Affiliations: School of Nursing, Midwifery & Social Work, University of Manchester (Ms Wilson and Drs Griffiths and Grande); Supportive & Palliative Care,
University Hospital South Manchester (Mr Connolly); and Centre for
Family Research, University of Cambridge (Dr Ewing), United Kingdom.
Abstract
BACKGROUND::
In
the United Kingdom, district nurses (DNs) support patients with
advanced cancer in their homes. Although evidence suggests that DNs
emphasize the distinctiveness of home rather than hospital settings,
little is known about the specific challenges of delivering care in family-home settings.
OBJECTIVE::
The objective of this study was to explore DNs' experiences of supporting patients within families.
METHODS::
Focus
groups were conducted with 40 DNs from 4 areas in the United Kingdom.
The groups were digitally recorded and facilitated by researchers using a
flexible topic guide.
ANALYSIS::
Verbatim transcripts were analyzed using thematic content analysis.
RESULTS::
Case-load
complexity (household volatility) and family dynamics posed distinct
challenges for nurses supporting patients. Many family members struggled
with accepting the patients' prognosis and were complicit in
withholding information. At times, this foreclosed a consideration of palliative options.
CONCLUSIONS::
Carers provide a great deal of positive supportive care
within the home. However, for some, the home is characterized by
conflict rather than consensus. Complexities surrounding family
relationships pose a distinctive and challenging environment for DNs.
IMPLICATIONS FOR PRACTICE::
Education
and training of DNs should be designed to address the challenges of
supporting patients within the family-home setting.
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