Remote area nurses' perceptions of the enablers and barriers for delivering end-of-life care in remote Australia to Aboriginal people who choose to pass away on their traditional lands

Introduction: Research was undertaken to find out what remote area nurses in Australia believed were the barriers and enablers to an Aboriginal person with a terminal diagnosis passing away. The term ‘passing away’ is preferred to  ‘dying’ within the aboriginal population in order to avoid upsetting someone with the news of the death on their traditional lands, (also referred to as  on country). This research was undertaken to gain  insight into what remote area nurses perceived were enablers and barriers to being involved in the delivery of care to an Aboriginal person with a terminal diagnosis passing away on their traditional lands. It is hoped that this gives remote area nurses, Aboriginal Australians, and service providers a glimpse into what is happening in theremote areas of Australia. Remote area nurses often work in isolated and in extreme geographical locations. This also means that a large proportion  work alongside and with Aboriginal Australians. In addition, remote area nurses are often left to support  people in the communities they work in, under extreme and often under resourced conditions.
Methods: A literature review was undertaken on this subject. And a  four section questionnaire was then developed based on the literature. This included demographic data, and two sections using an ordinal likert scale. The likert scale questions were based on skills remote area nurses felt they used to deal with this situation, and the capacity of the health service to deal with the situation. The scale used was one “Strongly agree”, through to five “strongly disagree”. The last section wa comprised of open-ended questions givingthe respondents the opportunity to make a statement regarding the question. A thematic analysis was then undertaken on the open-ended questions. Categories and themes were developed, and the results discussed. The four part survey was designed to be anonymous with a link to the survey distributed to students enrolled with the School of Indigenous and Remote Health Alice Springs, Flinders University by email, and to CRANAplus for distribution through their networks. CRANAplus is a not-for-profit membership organization for remote area nursing in Australia. It provides education, support and professional services to the remote health work force.  
Results: Remote area nurses felt that the barriers to supporting an Aboriginal Australian with a terminal diagnosis to passing away on their traditional lands are: a lack of support around the delivery of culturally appropriate end-of-life care; a lack of a stable workforce; insufficient cultural knowledge and understanding; and a lack of guidance and support from the family. They felt the enablers were: effective communication with the family and Aboriginal elders providing advice to staff and direction on how they can support the family; the willingness of staff to participate in care; and input from Aboriginal Health Practitioners.
Conclusion: Remote area nurses perceived they lacked support and knowledge from several different areas, bothfrom within the community and outside of the community. Despite the barriers it was shown that remote area nurses can be very resourceful at enabling the processes of supporting Aboriginal people with a terminal diagnosis passing away on their traditional lands.