Living and dying at home in rural Australia: District nursing advocacy

Health policies promoting choices for people living and dying in rural Australia are challenged by limited resources and access. District nurse advocacy may promote the individual values, choices and goals of people at home. The lack of evidence to guide district nursing end-of-life advocacy was confirmed by reviewing the existing literature. A pragmatic sequential mixed methods exploratory study was designed to answer the question of how district nurses advocate successfully for the end-of-life goals of rural Australians, with the objective of developing a practice model. In Phase 1 of the study, the reflection-action process of nurse agency theory informed the collection of written and in-depth interview narratives from seven rural Victorian district nurses. Interpretive descriptive analysis of the data produced findings that were tested in the Phase 2 survey of rural district nurses (n=91) from across Australia. The survey questionnaire included psychometric scales and open-ended questions. Data analysis with descriptive statistics and interpretative description confirmed and complemented the findings. The final data integration provided conceptual inferences suitable to compare with the existing literature and inform the development of a practice model of successful rural district nurse end-of-life advocacy. The model presents advocacy based on respect for people and their rights and values. The vulnerability experienced in the end-of-life arouses emotional responses that motivate respectful district nurses to advocate for the self-determination of goals. Willing investment in person-centred relationships, specialised rural knowledge, and feeling supported enable the development of emotional intelligence to inform the reflection/action of moral agency for district nurse advocacy success. Advocacy action increases access to choice through the use of holistic assessment, communication, and organisation to empower and support people successfully in self-determined goals. The model expands understanding of advocacy as a nursing-care philosophy that builds capacity for care choice and increases satisfaction with the rural end-of-life experience.

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the Department of Nursing and Midwifery, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bundoora.

The public version of this thesis does not contain all material submitted for examination.