Experiences with a Shared Position Between Specialized and Basic Palliative Care: A Qualitative Study.

Abstract

Objectives: To strengthen palliative care trajectories and enhance nursing competencies, it may be both relevant and beneficial to establish shared nursing positions between specialized and basic inpatient palliative care units. Despite the potential advantages, little is known about how such shared positions are experienced in practice. The aim of the study is to explore and describe experiences with a shared nursing position between a specialized palliative care unit and a basic palliative care unit.

Methods: Field notes and qualitative interviews were conducted in 2021 with a specialized palliative care nurse (n = 1), managers (n = 2), and colleagues (n = 5). The collected material was analyzed using Kvale and Brinkmann's qualitative analysis approach, allowing for an in-depth understanding of experiences across different organizational levels.

Results: Mutual learning was experienced across the two units. Patient trajectories were experienced to improve when the specialized nurse followed patients across both settings, ensuring greater continuity, collaboration, and coherence in care. In such cases, the nurse reported professional satisfaction and a sense of meaning in her work. However, several challenges were also identified. A lack of continuity was reported especially in the specialized palliative care unit. The dual affiliation was experienced as energy-draining and demanding, often leading to role conflicts, feelings of inadequacy, and limited co-determination.

Conclusions: The study points to both opportunities and limitations in shared nursing positions across palliative care units. While mutual learning and patient continuity were strengthened, the dual role also introduced professional strain.

Implications for nursing practice: Based on the findings, we need to consider whether the responsibility for shared learning and the optimization of palliative trajectories should be placed exclusively on individual staff members through shared positions. In addition, systematic, targeted models for collaboration between basic and specialized palliative care could be developed and tested to optimize palliative care pathways.