Homecare Nurses' Attitudes Toward Palliative Care in a Rural Community in Western Quebec

Antonia Arnaert, PhD, MPA, MSc, RN; Robbyn Seller, PhD, MA, BA; Megan Wainwright, BA


Journal of Hospice and Palliative Nursing. 2009;11(4):202-208. 

In This Article

Abstract and Introduction


Homecare nurses in rural areas play a key role in providing patients with continuous, personalized, and holistic care. However, palliative care for terminally ill patients and their families can be difficult to obtain and provide in geographically isolated areas of Canada. This study explored homecare nurses' attitudes toward palliative care in a rural community in Western Quebec. A qualitative design was used, which incorporated semistructured interviews and a focus group with five homecare nurses within the community's health and social service organization. Data were analyzed using a thematic content analysis technique. Six themes emerged: (1) experiencing community embeddedness, (2) maintaining patients' quality of life, (3) collaborating with a multidisciplinary team, (4) experiencing emotional and physical isolation, (5) acknowledging the need for professional development, and (6) dealing with organizational issues. Findings identified the need to develop a palliative homecare team and context-specific professional development activities for the nurses.


Canada has a population of just more than 30 million. In 2006, about 20% of Canadians were living in rural communities with fewer than 10,000 inhabitants.[1] While remote rural areas have experienced a decline in population since 2001, rural areas closer to urban centers have seen their populations rise by 4.7%. This rising population, although closer to metropolitan zones, remains geographically isolated from major sources of health and social services.

According to the World Health Organization,[2] all patients and their families living with a life-threatening illness should receive consistent, high-quality palliative care to achieve optimal quality of life. There is growing recognition of the importance of a continuum of care in communities that includes supportive and palliative care.[3] Providing this care remains a challenge for the Canadian healthcare system, particularly for individuals living in rural areas.[4] In many Western countries, palliative services are established,[5] or at least, palliative programs are evolving.[6] In Quebec, despite the provincial policy to promote integrated palliative services for all regions, it is estimated that only 5% to 10% of dying patients have access to these services.[7]

Statistics mask the fact that most terminally ill individuals spend most of their last year of life at home being cared for by their families.[8] The quality of family support depends on the extent to which people have easy access to formal homecare services, particularly home nursing support.[9] Most patients living in rural areas die in a community hospital under the care of their family physician.[10] However, if nursing support is readily available, along with optimal symptom control, patients may die at home more often.[9] In this context, nurses play a primary role in both organizing and delivering continuous, personalized, and holistic palliative care.[11] In addressing the needs of rural palliative patients and their families, nurses are confronted by significant challenges related to the environment and infrastructure; limited access to resources; increased emotional demands of work, which can cause personal strain;[12] and isolation from other healthcare professionals because of geographical distance.[13]

By exploring homecare nurses' attitudes to palliative care in a rural community in Western Quebec, Canada, this research contributes a Canadian perspective to the literature on rural health that is currently dominated by Australian studies.[14] Based on the model of Zanna and Rempel,[15] we understand nurses' attitudes toward palliative care in the context of their expressed emotional and personal issues, beliefs, behaviors, and experiences.


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