Caring for the carers: the characteristics of district nursing support for family carers

This paper presents findings from an ethnographic study that examined how qualified district nurses’ conceptualised their role in relation to family carers and how they performed this aspect of their role. A participant observational study involving fieldwork and in-depth interviews with six district nursing teams was undertaken over a 12 month period. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis. District nurses acted on the assumption that family carers would, by choice or default, provide care. Family carer support was conceptualised as a means of promoting self-care and the patient’s independence from nursing services. The rationale for providing family carer support was based largely on service capacity rather than carer needs and preferences. Six characteristics of district nursing support for carers were identified; enabling, supporting, mediating, care substitution, crisis prevention and crisis intervention. Family carers were not recipients of district nursing support in their own right but were dependent upon the cared for person receiving nursing care. This in turn was conditional upon others (general practitioners and hospitals) making appropriate patient referrals. Family carer support was also conditional upon effective communication and family carer receptiveness. As the scope of home-based nursing continues to increase district nurses need to take a more active stance in providing family carer support and adopt a family rather than patient-focused approach in order that family carers might be supported more effectively.