A major focus of the NZ Health Strategy is providing “care closer to home”. This aligns with the aspirations many New Zealanders have to be cared for, and die, at home. It also puts the spotlight upon primary palliative care services within community settings, which was indeed a key focus of the recent NZ Ministry of Health Palliative Care Action Plan. However, investment needs to be guided by best evidence and currently very little is known about the extent and nature of primary palliative care provision in the community. There is a particular gap in knowledge and understanding about the role District nurses play in this regard.
Exploring this is important because the district nurse role in New Zealand is changing, with an increasing focus on the practical aspects of care. This move away from a holistic patient-centred approach to task-based episodic patient care has the potential to impact significantly on the way in which palliative care is provided. However, no previous research has explored the implications of the changing nature of the district nurse role for palliative care provision. Crucially, little is known about the contribution district nursing currently makes, and has the potential to make, to the end of life experiences of people with life limiting illness and their family and whānau being cared for at home.
It is therefore really exciting to have been awarded funding to explore this important issue in partnership with two of our key stakeholders – Auckland and Counties Manakau District Heath Boards. The grants have been awarded by the Cancer Research Society and the A+ Trust. We will use a range of methods – including secondary analysis of routinely collected data and qualitative interviews with patients, families/whānau and staff – to explore the following objectives:
- To describe access and utilisation of district nursing services in the last year of life and associations with socio-demographic (age, gender, ethnicity, deprivation, living situation, locality) and clinical (diagnosis, presence of multi-morbidities, dementia) factors.
- To explore patient and family experiences of district nursing in the last year of life
- To explore the role of the district nurse within an integrated model of palliative care
- with other primary health and social care services including but not limited to general practice teams, Māori health providers, allied health, and tertiary hospital services
- with specialist palliative care providers including hospice services (inpatient and community) and hospital palliative care services
- To use the findings to develop a new model of community palliative care which draws on co-design principles to ensure patients and families/whānau are at the centre of service redesign.
The project will be led by Jackie Robinson, with other investigators including Merryn, Tess, Lisa and one of our latest collaborators with particular expertise in data linking and analysis – Jinfeng Zhao. For more information, please contact Jackie: firstname.lastname@example.org.