PhD Thesis: Too close to home: the lived experiences of rural Queensland nurses who have cared for people with cancer who have died

Aitken, Ann (2016) Too close to home: the lived experiences of rural Queensland nurses who have cared for people with cancer who have died. PhD thesis, James Cook University.

https://researchonline.jcu.edu.au/49721/

Abstract

Rural nurses are not specialist oncology nurses; rather they are specialist– generalists. Specialist oncology nurses working in specialist units accept that the loss of a patient from cancer is something that will happen as a regular part of their working experience. Specialist nurses also enjoy a large degree of anonymity away from their workplace that allows them to leave their work and patients behind them at the end of their working day. Anecdotal evidence suggests that many rural nurses would not choose to care for patients with cancer as a long-term career choice, but because of the nature of their work they accept the task of meeting the often advanced needs of these patients and their families. In many instances rural and remote nurses caring for patients with cancer may be caring for friends and in some cases, family.

For the past 25 years I have worked alongside nurses caring for patients with cancer in both metropolitan and rural and remote settings. More recently I have observed rural nursing colleagues caring for their friends and supporting them with compassion and skilled care to a good death. Many staff experience this several times in a year, and many times over during their time in that rural setting. Anecdotally, there is little opportunity to recover from the stress of providing that care or from the loss of a friend, before nurses are called on to support another.

This study used the phenomenological methodology of van Manen to examine and understand the lived experience of rural nurses who have cared for people with cancer who have died. In-depth interviews were conducted with nurses from across Queensland, providing them with the opportunity to share their feelings and experiences of caring for people with cancer, and of the effect of the death of their patient. Common themes have been highlighted and explored, with the three main phenomenological themes being:

1. Accepting the need to adopt progressive ways of delivering nursing care.
2. Learning different ways of relating to patients and families.
3. Seeking to achieve a work–life balance.

There are several sub-themes in each main theme.

The results of this research will lead to recommendations relating to staff support in rural settings for nurses caring for patients with cancer. This will provide team leaders and members alike in rural settings with information that may be used to identify and manage situations that may lead to staff distress. Among other aspects, recommendations relate to grief management, ways to separate home and work situations to ensure that staff members receive time apart from the care of the patient, and ways to manage the expectations of the patient, their family and the community in general in the rural setting. The identification of themes relating to this subject may also provide reassurance for nursing staff in similar situations who may have in the past struggled with their own feelings and reactions to the loss of a patient with cancer. The themes raised in this research might also be applied to areas outside of the care of patients with cancer, to include the support of nursing staff in rural settings who care for patients with chronic and complex illness who also have extended or frequent stays in hospital.