District nurses experiences in providing terminal care in rural and more urban districts. A qualitative study from the Faroe Islands.

HOME care services; WORK; PATIENTS' families; COMMUNITY health nurses; RESEARCH funding; QUALITATIVE research; FOCUS groups; INTERPROFESSIONAL relations; MEDICAL personnel; PALLIATIVE treatment; DECISION making; THEMATIC analysis; FAMILY-centered care; RURAL conditions; METROPOLITAN areas; NURSES' attitudes; TERMINAL care; TERMINALLY ill; PHENOMENOLOGY; FAMILY support; EXPERIENTIAL learning; HEALTH care teams

Objective: To explore district nurses' experiences in providing terminal care to patients and their families until death in a private home setting. Design, setting and subjects: Qualitative study. Data derived from focus group discussions with primary nurses in The Faroe Islands. Results: Four themes were identified: 'Challenges in providing terminal care', 'The importance of supporting families', 'Collaborative challenges in terminal care' and 'Differences between rural districts and urban districts'. The nurses felt that terminal care could be exhausting, but they also felt the task rewarding. Involving the family was experienced as a prerequisite for making home death possible. Good collaboration with the local GPs was crucial, and support from a palliative care team was experienced as helpful. They pointed out that changes of GP and the limited services from the palliative care team were challenging. Structural and economic conditions differed between urban and rural districts, which meant that the rural districts needed to make private arrangements regarding care during night hours, while the urban districts had care services around the clock. Conclusion: Our findings underline the complexity of terminal care. The nurses felt exhausted yet rewarded from being able to fulfil a patient's wish to die at home. Experience and intuition guided their practice. They emphasised that good collaboration with the GPs, the palliative care team and the families was important. Establishing an outgoing function for the palliative care team to support the nurses and the families would increase the scope for home deaths. Working conditions differed between rural and urban districts. KEY POINTS: District nurses are key providers of care for people dying in a home care setting. Collaboration with family is essential for making home death possible. Taking care of dying patients is experienced as exhausting but also meaningful. There is a need for an outgoing palliative care team to include all patients regardless of disease. [ABSTRACT FROM AUTHOR]

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