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Palliative care
Communication
Research

Aims, actions and advance care planning by district nurses providing palliative care: an ethnographic observational study

02 June 2020
Palliative Care
02 June 2020
Volume 25 · Issue 6

Abstract

District nurses are core providers of palliative care, yet little is known about the way that they provide care to people at home. This study aimed to investigate the role and practice of the district nurse in palliative care provision. This was an ethnographic study, with non-participant observation of district nurse-palliative care patient encounters, and post-observation interviews. District nurse teams from three geographical areas in northwest England participated. Data were analysed iteratively, facilitated by the use of NVivo, using techniques of constant comparison. Some 17 encounters were observed, with 23 post-observation interviews (11 with district nurses, 12 with patients/carers). Core themes were ‘planning for the future’ and ‘caring in the moment’. District nurses described how they provided and planned future care, but observations showed that this care focused on physical symptom management. District nurses engaged in friendly relationship building, which allows detailed management of symptomatology, but with little evidence of advance care planning.

Palliative care is provided to those who have life-threatening illness and can be offered from early in the course of an illness through to death and bereavement (Sepúlveda et al, 2002). Palliative care is offered in a range of settings, but it is clear that home care, and possibly death at home, is preferred by most patients (Gomes et al, 2012a). These preferences are reflected in many countries' health policies, which emphasise providing care close to home at the end of life (EoL) (Department of Health and Social Care (DHSC), 2008; Government of Australia, 2010; Meier, 2011), and there is evidence that palliative home care is cost effective (Marie Curie, 2012). Enacting such policies affects care processes and outcomes: home care or contact with a palliative care team appears to be associated with home death (Brogaard et al, 2012; Alonso-Babarro et al, 2013), and there is a shift to home death in many countries (Gomes et al, 2012b).

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Palliative care
District nursing
Advance care planning
Ethnographic study
Symptom management