District nurse advocacy for choice to live and die at home in rural Australia: a scoping study

Nurs Ethics. 2015 Jun;22(4):479-92. doi: 10.1177/0969733014538889. Epub 2014 Jun 29.

Abstract

Background: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care.

Objectives: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge.

Method: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings.

Results: 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role.

Discussion: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas.

Conclusion: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.

Keywords: Advocacy; community; district nursing; end-of-life; holistic; palliative.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Australia
  • Decision Making*
  • Ethics, Nursing
  • Humans
  • Palliative Care / ethics*
  • Patient Advocacy*
  • Rural Health Services