Reflections on the Experience of Community Health Nurses in Palliative Care: A Qualitative Approach.

There is a major demographic shift with increase in non-communicable diseases even in low- and middle-income countries. Many self-limiting illnesses are burdensome to people when they have limited access to health care system and poor family support. The aim of the study explores experiences of community health nurses in palliative care delivery in a primary health care setting. The study was conducted in Community Health Nursing Department, College of Nursing, CMC, Vellore. A qualitative research using a grounded theory approach was done which included in-depth interviews and focus group discussions from community health nursing faculty. This study used a deductive and inductive approach that stressed the process rather than the meaning of the studied phenomenon. The in-depth interviews lasted for 45 min-1 ½ h for each participant; focus group discussions were held in two sessions lasting for 2 ½ h. The group interviews were transcribed to verbatim. All transcripts were read multiple times to ensure correctness of the transcription by the authors to get an overall impression of the material before the initial coding. Authenticity, credibility, critical appraisal and integrity were demonstrated throughout the study. This study enlightens the experiences of the health care providers on palliative care delivery at the primary care setting and explores barriers, challenges and facilitators for delivery of good palliative home care. Totally, 15 subthemes were grouped under five major themes; community support, family support, acceptance of services, barriers and gaps in care. The in-depth interviews provided an insight into the experiences of the participants on successful collaborative services, caregivers fatigue and the barriers in providing services in the home care setting. Focus group discussion showed that a holistic approach to patient care in primary care setting is possible by community health nurses and a collaborative care from the secondary and tertiary care settings will bring down the non-compliance to the therapeutic regimen.