Nurses' experience of providing home‐based palliative care in the country setting: An integrated literature review

Abstract

Aims The aim of the study is to explore the experiences of nurses providing home‐based palliative care for patients who live in country settings. Methods This study is an integrated literature review. Electronic databases, specific journals of interest, and reference lists were searched using key words and Boolean operators. Descriptive thematic analysis was undertaken to identify main themes and subthemes. Critical appraisal of the articles was conducted using the qualitative Critical Appraisal Skills Program guidelines. Primary research articles published in English, in peer‐reviewed journals from 1990 to 2017, were included. Results Twelve articles were included in this review. Two main themes emerged including the nature of nursing in country communities and nurses' emotional responses. The first main theme had the subthemes of community connections, geographical distance and isolation, organizational deficits, lack of education, and resources. The second main theme consisted on five subthemes including feeling rewarded, autonomy and professional isolation, hope and hopelessness, frustration, and fear. Conclusion Literature is sparse reporting the lived experience of nurses providing palliative care in country areas for patients wanting to die at home. An increase in demand for a home‐based palliative nursing service will require additional funding globally to meet this increase in the future.

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

“…For instance, evidence shows that palliative care education, in general, and palliative care nursing education, specifically, are paramount to ensure access to adequate palliative care, particularly in countries with populations living in rural and remote areas. 50,66–72 A possible explanation for within-country variations could be that some respondents, although identified as experts by their peers, were not well aware of the situation in their countries. Moreover, within-country variations mostly occurred in countries with larger number of respondents or having an administrative structure that permits the establishment of regional frameworks and regulation.…”

“…For instance, evidence shows that palliative care education, in general, and palliative care nursing education, specifically, are paramount to ensure access to adequate palliative care, particularly in countries with populations living in rural and remote areas. 50,[66][67][68][69][70][71][72] A possible explanation for within-country variations could be that some respondents, although identified as experts by their * Not in all European countries were respondents unanimous in their judgement of whether a certain level of education was available. The decision rule on how we dealt with unanimous information is provided above in the text.…”

The burden in palliative care assistance: A comparison of psychosocial risks and burnout between inpatient hospice and home care services workers

“…Indeed, this syndrome has been linked to severe psychological and physical outcomes such as cardiovascular diseases and depression (Salvagioni et al, 2017). In recent years, researchers have found burnout to be a common experience among palliative care professionals, affecting general health, job satisfaction, and quality of health care delivered (Vachon, 2008;Kearney et al, 2009;Martins Pereira et al, 2011;Koh et al, 2015;Abernethy et al, 2016;Rizo-Baeza et al, 2018).…”

“…Scientific research has recently expanded its focus on different palliative care contexts, finding higher risk of burnout among home care professionals compared to colleagues employed in inpatient hospice and hospital-based settings (Koh et al, 2015; Parola et al, 2017). In delivering palliative care at home, workers may be exposed to similar or even higher levels of established psychological risk factors such as responsibility for a large number of patients, lack of support from colleagues and supervisors, isolation, insufficient time to deal with care complexity, fewer acute care resources, precarious and underpaid employment contracts, and threats to personal safety (Ganann et al, 2019; Rabbetts et al, 2020). Additionally, home setting may deprive workers of common safety devices, thus increasing risks of musculoskeletal disorders and needlestick injury, and may expose home care staff to additional serious or life-threatening risks as unhygienic conditions, bloodborne pathogens, hostile animals, aggressive behaviors, or even weapons (NIOSH, 2010).…”

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

“…Nurse practitioner coordinated palliative care appears to enable more integrated care which extends the potential for collaborative primary care and may be effective in reducing hospitalisations [ 54 , 55 ]. Providing physical care to patients, managing symptoms and educating families are often roles undertaken by Specialist Nurses [ 56 ].…”