• Jenni Burt, Cathy Shipman, Julia Addington-Hall, and Patrick White.
• Department of Epidemiology and Public Health, UCL, London WC1E 6BT, UK. jenni.burt@ucl.ac.uk
• Int J Nurs Stud. 2008 Oct 1;45(10):1470-8.

BackgroundCommunity nurses (members of UK District Nursing teams) have a key role in the provision of palliative care in the community in the UK. However, their views about delivering palliative care within their generalist workload have not been assessed.ObjectivesTo explore community nurses' perceptions of their palliative care role, and their provision of such care within the context of their wider generalist workload.DesignFocus group study.SettingFour Primary Care Trusts in London, UK.ParticipantsA purposive sample of 51 community nurses.MethodsNine focus groups (four to seven participants in each) were conducted between 2003 and 2004. Data were analysed using the framework approach.ResultsWe identified five broad themes. Community nurses felt they had a central role in the provision of palliative care to patients at home. Many felt this role was not recognised by other health care professionals and managers. Palliative care was identified as unpredictable and time-consuming within a pressurized context characterised by staff shortages and consequent lack of time. Whilst rewarding, palliative care took its toll on nurses' emotions, compounded by a perceived lack of formal support. Finally, undertaking palliative within a generalist workload created additional pressures for community nurses.ConclusionsThe integration of palliative care into routine generalist caseloads generated workload stresses in time and emotion. Community nurses felt their palliative care role and its impact on workload was not adequately acknowledged. Palliative care specific support mechanisms and ways of working may be necessary to meet patients' and professionals' expectations of effective, compassionate care at the end of life.

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