Do rural primary health care nurses feel equipped for palliative care?M. Cumming A D , F. Boreland B and D. Perkins B C
A Far West Local Health District, NSW, PO Box 457, Broken Hill, NSW 2880, Australia.
B Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, PO Box 457, Broken Hill, NSW 2880, Australia.
C Centre of Excellence in Rural and Remote Primary Health Care Research, PO Box 457, Broken Hill, NSW 2880, Australia.
D Corresponding author. Email: firstname.lastname@example.org
Australian Journal of Primary Health 18(4) 274-283 http://dx.doi.org/10.1071/PY11150
Submitted: 8 July 2011 Accepted: 6 December 2011 Published: 14 August 2012
Community primary health care nurses in rural and remote settings are required to provide palliative care as part of their generalist role. They have limited access to specialist medical and nursing support and sometimes there are no resident GPs. A study consisting of a mailed survey and follow-up interviews was conducted to explore the experiences of these nurses and to determine how personally and professionally equipped they felt for palliative care service provision. Most participants were registered nurses experienced in nursing and in rural and remote settings, who juggled multiple generalist work roles. They had only occasional palliative care patients, and more than half had provided palliative care for a friend or family member. Some nurses found palliative care rewarding, others preferred not to have to do it. However, even those who did not enjoy working with palliative care patients often went beyond the ‘call of duty’ to support a home death if that was what the patient wanted. Three-quarters had attended palliative care education in the last 2 years but 88% wanted more education. Barriers to education included competing work roles, work load, geographical isolation and lack of backfill. Support from managers and peers was considered important, as was accessing timely and relevant clinical support.
Additional keywords: clinical support, education, emotional impact, remote, support, workforce.
ReferencesAustralian Bureau of Statistics (2007) ‘2006 census of population and housing’. Cat. no. 2068.0. Available at http://www.abs.gov.au/websitedbs/d3310114.nsf/51c9a3d36edfd0dfca256acb00118404/074b029ae7f4f3c7ca25721300145003!OpenDocument [Verified 12 April 2012]
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.CrossRef |
Chisholm M, Russell D, Humphreys J (2011) Measuring rural allied health workforce turnover and retention: what are the patterns determinants and costs? The Australian Journal of Rural Health 19, 81–88.
| Measuring rural allied health workforce turnover and retention: what are the patterns determinants and costs?CrossRef | 21438950PubMed |
Crawford GB (2000) Palliative care on Kangaroo Island. The Australian Journal of Rural Health 8, 35–40.
| Palliative care on Kangaroo Island.CrossRef | 1:STN:280:DC%2BD3MzgvVSkuw%3D%3D&md5=091b24e9b111320737090b40f4ae74b7CAS | 11040578PubMed |
Department of Health and Ageing (2010) ‘National palliative care strategy: supporting Australians to live well at the end of life.’ (Commonwealth of Australia: ACT)
Dunne K, Sullivan K, Kernohan G (2005) Palliative care for patients with cancer: district nurses’ experience. Journal of Advanced Nursing 50, 372–380.
| Palliative care for patients with cancer: district nurses’ experience.CrossRef | 15842444PubMed |
Evans R, Stone D, Elwyn G (2003) Organising palliative care for rural populations: a systematic review of the evidence. Family Practice 20, 304–310.
| Organising palliative care for rural populations: a systematic review of the evidence.CrossRef | 12738700PubMed |
Goodridge D, Duggleby W (2010) Using a quality framework to asses rural palliative care. Journal of Palliative Care 26, 141–150.
Hegney D (1997) Rural nursing practice. In ‘Rural nursing in the Australian context’. (Ed. L Siegloff) pp. 25-44. (Royal College of Nursing Australia: Canberra)
Lenthall S, Wakerman J, Opie T, Dollard M, Dunn S, Knight S, Macleod M, Watson C (2009) What stresses remote area nurses? Current knowledge and future action. The Australian Journal of Rural Health 17, 208–213.
| What stresses remote area nurses? Current knowledge and future action.CrossRef | 19664086PubMed |
Lenthall S, Wakerman J, Opie T, Dunn S, Macleod M, Dollard M, Rickard G, Knight S (2011) Nursing workforce in very remote Australia, characteristics and key issues. The Australian Journal of Rural Health 19, 32–37.
| Nursing workforce in very remote Australia, characteristics and key issues.CrossRef | 21265923PubMed |
McCarthy A, Hegney D (1999) Rural nursing in the Australian context. In ‘Palliative care’. (Eds S Aranda, M O’Connor) pp. 83–101. (AusMed: Melbourne)
McConigley R, Kristjanson L, Morgan A (2000) Palliative care nursing in rural Western Australia. International Journal of Palliative Nursing 6, 80–90.
McGrath P (2010) The living model: an Australian model for Aboriginal palliative care service delivery with international implications. Journal of Palliative Care 26, 59–64.
Nadimi F, Currow D (2011) As death approaches: a retrospective survey of the care of adults dying in Alice Springs Hospital. The Australian Journal of Rural Health 19, 4–8.
| As death approaches: a retrospective survey of the care of adults dying in Alice Springs Hospital.CrossRef | 21265918PubMed |
NSW Health (2006a) Palliative care role delineation framework guideline. GL2007_22. Available at www.health.nsw.gov.au/policies/gl/2007/GL2007_022.html [Verified 11 April 2012]
NSW Health (2006b) NSW local government areas in 2006 by Australian Standard Geographic Classification category based on Accessibility/Remoteness Index of Australia (ARIA+). Available at http://www.healthstats.nsw.gov.au/Search/Location [Verified 11 April 2012]
Palliative Care Australia (2005) ‘A guide to palliative care service development: a population based approach.’ Available at http://www.palliativecare.org.au/Portals/46/resources/PalliativeCareServiceDevelopment.pdf [Verified 11 April 2012]
Penz K, D’Arcy C, Stewart N, Kosteniuk J (2007) Barriers to participation in continuing education activities among rural and remote nurses. Journal of Continuing Education in Nursing 38, 58–66.
Phillips JL, Davidson PM, Jackson D, Kristjanson L, Bennett ML, Daly J (2006) Enhancing palliative care delivery in a regional community in Australia. Australian Health Review 30, 370–379.
| Enhancing palliative care delivery in a regional community in Australia.CrossRef | 1:CAS:528:DC%2BD28Xnt1aitbw%3D&md5=636cea777e39d89c3cfb077efac415c3CAS | 16879096PubMed |
Robinson CA, Pesut B, Bottorff JL, Mowry A, Broughton S, Fyles G (2009) Rural palliative care: a comprehensive review. Journal of Palliative Medicine 12, 253–258.
| Rural palliative care: a comprehensive review.CrossRef |
Rosenberg J, Canning D (2003) Palliative care by nurses in rural and remote practice. An evaluation report Queensland health southern zone. (Centre for Palliative Care Research and Education) Available at http://www.health.qld.gov.au/cpcre/pdf/nurs_rremote.pdf [Verified 30 July 2012]
Sach J (1997) Issues for palliative care in rural Australia. Collegian (Royal College of Nursing, Australia) 4, 22–27.
Trollor J (1993) Clinical focus: rural general practitioners and palliative care. The Australian Journal of Rural Health 1, 23–29.
| Clinical focus: rural general practitioners and palliative care.CrossRef |
Trollor J (1995) Rural general practitioners and palliative care in the north-west of New South Wales. Australian Family Physician 24, 1106–1109.
Wilkes LM, White K (2005) The family and nurse in partnership: providing day-to-day care for rural cancer patients. The Australian Journal of Rural Health 13, 121–126.
| The family and nurse in partnership: providing day-to-day care for rural cancer patients.CrossRef | 15804338PubMed |
Woods D (2001) Models of palliative care for rural palliative care services. 6th National Rural Health Conference. March 2001. Available at nrha.ruralhealth.org.au/conferences/docs/6thNRHC/6_CONPRO.pdf [Verified 11 April 2012]