RESUMO
INTRODUCTION: Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. OBJECTIVES: This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. METHODS: Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: Two themes emerged: "Negotiating healthcare systems" which described the needs for multidisciplinary supports and "The caring experience" which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system.Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. CONCLUSION: Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.
RESUMO
BACKGROUND: Increasing patient diversity, as a result of growing global interaction, has necessitated that nursing academics better prepare nursing students to provide culturally appropriate and respectful care to their patients, particularly in culturally diverse countries such as Australia. One approach to improve cultural awareness of nursing students is a cultural immersion placement, and this paper describes such an experience which has been embraced by undergraduate participants. Purpose of this paper was to describe experiences, cultural awareness and challenges encountered by final year undergraduate nursing students undertaking a 22-day cultural immersion placement in Nepal. The researchers accompanied one group of students per year on this trip, which was repeated for three consecutive years. Describing and reflecting on the lived experience of nursing students engaged in this cultural immersion placement has helped to discern how this experience affects the cultural awareness of undergraduate nursing students and helps to decrease the challenges for similar placements in the future. DESIGN AND METHODS: To gain insight into the way this initiative impacted on the development of the participant's cultural competence, a qualitative descriptive design was chosen. Semi-structured interviews were carried out over three consecutive years with final year undergraduate nursing students upon their return from Nepal over three consecutive years. Data analysis followed standard suggestions for a systematic, unbiased approach to dealing with the condensed text, and was analysed using thematic analysis. RESULTS: The findings suggested that this experience, albeit of limited duration, provided a significant contribution to students' understanding of cross-cultural awareness in the context of providing health care. CONCLUSIONS: There was a strong implication from the outcomes that this cultural immersion placement should be permanently integrated into the undergraduate nursing course. There was, however, indication that there is room for added reflection and advantages to be made from the experience.
