Quality of care is conceptualised by professionals and in policy documents as: compliance with ‘best practice’ guidelines; improving satisfaction rates; fiscal efficiency; and ethical care. ‘Quality’ in palliative and supportive district nursing care has been conceptualised in all these ways. However, the empirical research in this area draws mostly on professionals’ and carers’ views with little research addressing patients’ views. With political rhetoric pushing for a ‘patient led’ NHS, research into how patients conceptualise quality in this area is necessary to both critique this rhetoric and/or facilitate its aims. Therefore, this research investigates patients’ and carers’ views on the quality of palliative and supportive district nursing care.Participants were recruited to an exploratory qualitative study resulting in a convenience sample of twenty six patients (all of district nursing caseloads) and thirteen carers. All participants were over eighteen, able to consent, lived in their own homes, were under the care of district nurses, and had palliative care needs. Eighteen participants had a cancer diagnosis, six had a non-malignant diagnosis, one had co-morbidities, and one participant did not disclosed their diagnosis. Semi-structured interviews were conducted with all participants, five participants were interviewed twice. Post-structuralist theories were used with discourse analysis techniques for the final analysis.The findings identify three of the most influential discourses in relation to the morality and quality of care: Firstly, ‘busyness’, and how its performance by district nurses masks patients’ and carers’ ability to critique care, instead producing a pseudo-quality which fixes patients and carers subjectivities. Secondly, ‘power/knowledge’ and the ways in which it prevents patients and carers accessing care which they need, and altering care to suit their needs. Thirdly, ‘the home’ and how it (re)forms district nursing care and district nursing care (re)forms the home; meaning that actions by district nurses must also consider the impact on the home as well as the patients and carers. In conclusion quality care may be produced by: ceasing to measure quality; involving patients and carers with commissioning and directing palliative and supportive care; supporting groups other than district nurses such as patients, carers and third parties to produce and distribute knowledge about district nursing care; increasing patients’ and carers’ ability to communicate with one another about their care.Further research may investigate: how patients and carers with palliative and supportive care needs may be involved in commissioning; the most appropriate wording and means to distribute knowledge about palliative and supportive district nursing care; ethnographic work to explore how district nursing and the home interact; more detailed theorisation of how the material and the discursive can be accounted for within post-structuralism.

Die Studie evaluiert die Arbeit des Ambulanten Hospiz- und Palliativ-Beratungsdienstes (AHPB) am Hospiz Villa Auguste in Leipzig. Der AHPB betreut Palliativpatienten in der Häuslichkeit. Er versteht sich als Hilfe zur Pflegeüberleitung an Schnittstellen der Versorgung (z.B.: Krankenhaus - Entlassung nach Hause). Ziel der Studie war eine wissenschaftliche Begleitung der Arbeit des AHPB. Seine Struktur-, Prozess und Ergebnisqualität wurden evaluiert. Als ein Schwerpunkt der Studie wurde besonders die Rolle der Angehörigen in der häuslichen Versorgung betrachtet. Es wurde auch untersucht, welche Unterstützung sie von der Brückenschwester erfuhren. Im Rahmen der Interviews wurden sie zur Zufriedenheit mit dem Dienst befragt.

Graft-versus-host disease (GvHD) is a frequent, and often life-threatening, complication after an allogeneic, hematopoietic stem cell transplantation (allo-SCT). It can appear in an acute or a chronic form and presents different grades of severity. Particularly, the severe forms of GvHD are often responsible for a change of the curative intent for allo-SCT into a palliative goal of care. For this non-systematic review, we conducted a focused literature search in the MEDLINE database via PubMed to examine whether patients with severe forms of GvHD might have special needs and burdens from a supportive and palliative care perspective. To draw a comprehensive picture of this patient group, we included findings on quality of life (QoL) and physical symptoms and function as well as psychological and spiritual well-being. In most domains, patients with severe forms of GvHD showed greater impairment and a higher symptom burden compared to patients with milder forms of GvHD. However, we could not identify any studies that specifically investigated patients with severe forms of GvHD. Further research in this field is necessary to guarantee the highest standard of care for this very special patient group.