Nursing the dying within a generalist caseload: a focus group study of district nurses

BACKGROUND: Community nurses (members of UK District Nursing teams) have a key role in the provision of palliative care in the community in the UK. However, their views about delivering palliative care within their generalist workload have not been assessed. OBJECTIVES: To explore community nurses' perceptions of their palliative care role, and their provision of such care within the context of their wider generalist workload. DESIGN: Focus group study. SETTING: Four Primary Care Trusts in London, UK. PARTICIPANTS: A purposive sample of 51 community nurses. METHODS: Nine focus groups (four to seven participants in each) were conducted between 2003 and 2004. Data were analysed using the framework approach. RESULTS: We identified five broad themes. Community nurses felt they had a central role in the provision of palliative care to patients at home. Many felt this role was not recognised by other health care professionals and managers. Palliative care was identified as unpredictable and time-consuming within a pressurized context characterised by staff shortages and consequent lack of time. Whilst rewarding, palliative care took its toll on nurses' emotions, compounded by a perceived lack of formal support. Finally, undertaking palliative within a generalist workload created additional pressures for community nurses. CONCLUSIONS: The integration of palliative care into routine generalist caseloads generated workload stresses in time and emotion. Community nurses felt their palliative care role and its impact on workload was not adequately acknowledged. Palliative care specific support mechanisms and ways of working may be necessary to meet patients' and professionals' expectations of effective, compassionate care at the end of life.