'We've Taken on a More Advanced Clinical Role': A Multimethod Study of Community Nurses' Extended Roles in Palliative Care.

Abstract

AIM: To explore community nurses' experiences of changes to their roles in palliative and end-of-life care. DESIGN: An e-survey was followed by focus groups. METHODS: Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison. RESULTS: As well as two new roles-prescribing and verifying death-many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult. CONCLUSION: While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends. IMPACT: Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up. REPORTING: We adhered to relevant EQUATOR guidelines, using the SRQR checklist. PATIENT OR PUBLIC CONTRIBUTION: Our Public and Clinician Advisory Group helped shape questions and commented on findings.