Mid Sweden University

Palliative Care in Sparsely Populated Rural Areas -Collaboration between District Nurses and Doctors U. Näppä1, I. Winqvist1, E. Nässén2

1Mid Sweden University, Department of Health Sciences, Östersund,Sweden, 2Östersund Hospital, Region of Jämtland Härjedalen, Researchand Development Unit, Östersund, Sweden

Background/aims: Palliative care requires major nursing interventions as well as medical interventions, thus the district nurse and the doctor are both central to the palliative team. Sparsely populated rural areas are characterized by large geographic distances and can mean that the different professionals are located a long way from each other, which can pose a challenge to collaboration. The aim of this study was to describe district nurses’ experiences of collaborating with the doctor in charge during palliative home care in sparsely populated rural areas.

Methods: Semi-structured interviews were carried out with ten district nurses. The material was analyzed using inductive content analysis.

Results: The experiences of the district nurses are described under the overarching theme of Experiences of acting as the patient advocate, which is divided into two categories. The category Positive experiences of collaboration generated the sub-categories Pride, Confidence, Support and Mutuality. The category Negative experiences of collaboration generated the sub-categories Inadequacy, Frustration and Shortage of time. Consensus and coherence, or lack thereof, between district nurses and doctors affects how collaboration is experienced. When the doctor shares the district nurse’s holistic approach this generates positive experiences, while collaboration is experienced as negative when the doctor does not make decisions in accordance with what the nurse judges to be beneficial to the patient.

Conclusions: These experiences are probably not unique to this situation and can possibly explain the interprofessional collaboration in other contexts involving interaction between the nursing and the medical professions. An understanding of how collaboration is experienced is necessary to bring about enhanced collaboration, thus an equivalent analysis of doctors’ experiences is therefore suggested for future research.