title: Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting.
abstract: BACKGROUND
  Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting.
  
  
  METHODS
  This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis.
  
  
  RESULTS
  Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather.
  
  
  CONCLUSIONS
  These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve access to important services and ways to support them while providing palliative care to rural individuals.
authors: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. kaasal@mcmaster.ca.
authors: S
authors: S
authors: Kaasalainen
authors: Queens University Belfast, Belfast, Northern Ireland. brazilk@mcmaster.ca.
authors: K
authors: K
authors: Brazil
authors: School of Geography, McMaster University, Hamilton, Ontario, Canada. williams@mcmaster.ca.
authors: A
authors: A
authors: Williams
authors: University of Alberta, Edmonton, Alberta, Canada. wilson@ualberta.ca.
authors: D
authors: D
authors: Wilson
authors: School of Nursing, McMaster University, Hamilton, Ontario, Canada. willison@mcmaster.ca.
authors: K
authors: K
authors: Willison
authors: McMaster University, Hamilton, Ontario, Canada. marshall@mcmaster.ca.
authors: D
authors: D
authors: Marshall
authors: McMaster University, Hamilton, Ontario, Canada. taniguchi@mcmaster.ca.
authors: A
authors: A
authors: Taniguchi
authors: Univeristy of Chicago, Chicago, Illinois, USA. phillipsc@uchicago.ca.
authors: C
authors: C
authors: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008875:Middle Aged; D024802:Nurse's Role; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care / Q000458:organization & administration*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult