Vol. 3 No. 2 (2024): evolution of vascular access

Highlanders: a qualitative study to explore the experiences of home care nurses in rural areas in Italy

Nicolas Capitani
Servizio Infermieristico Domiciliare di Vergato, AUSL Bologna, Bologna, Italy
Laura Rasero
Associate Professor in Nursing Sciences, Department of Health Sciences, University of Florence, Florence, Italy
Yari Longobucco
Assistant Professor in Nursing Sciences, Department of Health Sciences, University of Florence, Florence, Italy
Camilla Elena Magi
Research Fellow in Nursing Sciences, Department of Health Sciences, University of Florence, Florence, Italy; Department of Biomedicine and Prevention Faculty of Medicine, University of Rome Tor Vergata, Roma, Italy
Paolo Iovino
Assistant Professor in Nursing Sciences, Department of Health Sciences, University of Florence, Florence, Italy
Stefano Bambi
Associate Professor in Nursing Sciences, Department of Health Sciences, University of Florence, Florence, Italy
Diletta Calamassi
SOC Formazione Empoli. Ausl Toscana Centro, Empoli, Italy

Published 2024-06-01


  • Nurse,
  • Home care,
  • Rural-mountainous areas,
  • Perceptions,
  • Criticality,
  • Satisfaction
  • ...More


Introduction and aim: Home care in rural areas is characterised by peculiarities linked to both the type of care of the patient and his/her family and the context in which it is provided. International studies have highlighted the need for specialised training and advanced clinical skills to work in this field. Currently, there are no studies in the literature that explore the experiential feelings of Italian nurses who provide home care in rural areas. Setting: Rural areas in Italian Apennine District. Participants: Italian home care nurses in the selected areas. Design: Qualitative study using a transcendental phenomenological approach. Semi-structured interviews were conducted face-to-face, and audio was recorded with home care nurses.
Results: Eleven nurses (mean age, 53 years) were interviewed. Four themes supported by nine codes emerged: "Entering your homes" (Stepping lightly; a matter of trust; key professional); "Being home care nurses in rural areas" (Working alone, autonomy, responsibility and gratifications; ideal characteristics of home care nurse); "Love and hate toward doctors" (Family doctors; ANT doctors); "The territory: the Apennines and mountainous areas" (working in rural areas; healthcare professionals).
Discussion and conclusions: The risks for home careers in rural areas are related to the vastness of the territory, long car journeys, the harsh climate in winter, and pets in the homes. The beauty of the area, the close relationship established with the families in charge, and daytime working hours are reasons for great professional and personal satisfaction. Some modalities and forms of collaboration with general practitioners can be improved.


  1. Lenthall S, Wakerman J, Opie T, et al. What stresses remote area nurses? Current knowledge and future action. Australian Journal of Rural Health. 2009; 17:208-213.
  2. McCleery E, Christensen V, Peterson K, Humphrey L, Helfand M. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses [Internet]. Washington (DC): Department of Veterans Affairs (US); 2014 Sep.
  3. Montour A, Baumann A, Blythe J, Hunsberger M. The changing nature of nursing work in rural and small community hospitals. Rural and remote health. 2009; 9:1-13.
  4. Lauder W, Sharkey S, Reel S. The development of family health nurses and family nurse practitioners in remote and rural Australia. Aust Fam Physician. 2003;32:750-2.
  5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 395:497-506.
  6. de Oliveira AR, de Sousa YG, Alves JP, de Medeiros SM, Martiniano CS, Alves M. Satisfaction and limitation of primary health care nurses’ work in rural areas. Rural and Remote Health. 2019; 19:1-10.
  7. Kilpatrick K, Jabbour M, Tchouaket É, Acorn M, Donald F, Hains S. Implementing primary healthcare nurse practitioners in long-term care teams: A qualitative descriptive study. J Adv Nurs. 2019;75:1306-1315.
  8. Molinari D, Monserud M. Rural nurse job satisfaction. Rural and remote health. 2008; 8:1-12.
  9. Molinari DL, Monserud M, Hudzinski D. A new type of rural nurse residency. The Journal of Continuing Education in Nursing. 2008; 39:42-46.
  10. Owens RA. Nurse practitioner role transition and identity development in rural health care settings: a scoping review. Nursing Education Perspectives. 2019; 40:157-161.
  11. Ploeg J, Kaasalainen S, McAiney C, et al. Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study. BMC Nursing. 2013; 12:1-11.
  12. Weymouth S, Davey C, Wright J, et al. What are the effects of distance management on the retention of remote area nurses in Australia? Rural and remote health. 2007; 7:1-15.
  13. Gysin S, Sottas B, Odermatt M, Essig S. Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study. BMC Family Practice. 2019; 20:1-11.
  14. Woo B, Koh K, Zhou W, Wei Lim T, Lopez V, Tam W. Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study. Journal of Clinical Nursing. 2020; 29:1623-1634.
  15. Giorgi A. Concerning the phenomenological methods of Husserl and Heidegger and their application in psychology. Collection du cirp. 2007; 1:63-78.
  16. Luft S. Subjectivity and Lifeworld in Transcendental Phenomenology. Northwestern University Press; 2011.
  17. LoBiondo-Wood G, Haber J. Methods and critical appraisal for evidence-based practice. Nursing Research: Text and Study Guide Package. 2013;290.
  18. Chiari P, Mosci D, Naldi E. Evidence-Based Clinical Practice: La Pratica Clinico-Assistenziale Basata Su Prove Di Efficacia. McGraw-Hill; 2011.
  19. LoBiondo-Wood G, Haber J, Titler MG. Evidence-Based Practice for Nursing and Healthcare Quality Improvement. Elsevier Health Sciences; 2018.
  20. Mortari L, Zannini L. La ricerca qualitativa in ambito sanitario. In: La Ricerca Qualitativa in Ambito Sanitario. Carocci editore; 2017:1-271.
  21. Polit DF, Beck CT, Palese A. Fondamenti Di Ricerca Infermieristica. McGraw Hill education; 2018.
  22. Artoni M. Richards, L. & Morse, JM. Fare ricerca qualitativa. Prima guida. Encyclopaideia. 2009;13(26).
  23. Colaizzi PF. Psychological research as the phenomenologist views it. Published online 1978.
  24. Errasti‐Ibarrondo B, Jordán JA, Díez‐Del‐Corral MP, Arantzamendi M. Conducting phenomenological research: Rationalizing the methods and rigour of the phenomenology of practice. Journal of advanced nursing. 2018; 74:1723-1734.
  25. Arcidiacono C, Di Martino S. Psicologia di Comunità per le Città. Rigenerazione Urbana a Porta Capuana. Published online 2016.
  26. Mastrilli P, Nicosia R, Santinello M. Photovoice: Dallo Scatto Fotografico All’azione Sociale. F. Angeli; 2013.
  27. Creswell J. Research design: Qualitative inquiry and research design. Published online 2013.
  28. Marek KD, Baker CD. Nurse home visit programs for the elderly. Annual review of nursing research. 2006; 24:157-178.
  29. Pesko MF, Gerber LM, Peng TR, Press MJ. Home health care: nurse–physician communication, patient severity, and hospital readmission. Health services research. 2018; 53:1008-1024.
  30. Siva R, Sadan V, Alexander G, Immanuel S, Joy P. Reflections on the experience of community health nurses in palliative care: A qualitative approach. Indian Journal of Palliative Care. 2021; 27:330.
  31. DiCicco-Bloom B, Cunningham RS. Complex patients and interprofessional relationships: Perceptions of primary care nurse practitioners and primary care physicians. Journal of the American Association of Nurse Practitioners. 2015;27(11):646-652.
  32. Kilpatrick K, Jabbour M, Fortin C. Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective? Journal of Clinical Nursing. 2016; 25:619-630.
  33. Kilpatrick K, Tchouaket E, Fernandez N, Jabbour M, Dubois CA, Paquette L, et al. Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes. BMC Fam Pract. 2021;22:76.
  34. Yodfat Y, Fidel J, Eliakim M. Analysis of the work of nurse-practitioners in family practice and its effect on the physicians’ activities. Journal of Family Practice. 1977; 4:345-350.
  35. Barnard A, Hollingum C, Hartfiel B. Going on a journey: understanding palliative care nursing. International journal of palliative nursing. 2006; 12:6-12.
  36. Tanyi RA, McKenzie M, Chapek C. How family practice physicians, nurse practitioners, and physician assistants incorporate spiritual care in practice. Journal of the American Academy of Nurse Practitioners. 2009; 21:690-697.
  37. Yuguero O, Marsal JR, Buti M, Esquerda M, Soler-González J. Descriptive study of association between quality of care and empathy and burnout in primary care. BMC medical ethics. 2017; 18:1-8.
  38. Elsom S, Happell B, Manias E. Nurse practitioners and medical practice: opposing forces or complementary contributions? Perspectives in Psychiatric Care. 2009; 45:9-16.
  39. Fong J, Buckley T, Cashin A, Pont L. Nurse practitioner prescribing in Australia: A comprehensive literature review. Aust Crit Care. 2017; 30:252-259.
  40. Kumar R, Roy P. Deregulation of allopathic prescription and medical practice in India: Benefits and pitfalls. J Family Med Prim Care. 2016; 5:215.
  41. Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ. Nurses as substitutes for doctors in primary care. Cochrane Database Syst Rev. 2018;7:CD001271.
  42. Maier CB. Nurse prescribing of medicines in 13 European countries. Hum Resour Health. 2019;17(1):1-10.
  43. Pearson M, Papps E, Walker RC. Experiences of registered nurse prescribers; a qualitative study. Contemp Nurse. 2020; 56:388-399.
  44. Roemer R. The nurse practitioner in family planning services: law and practice. Family planning/population reporter; a review of State laws and policies. 1977; 6:28-34.
  45. Stilwell B, Greenfield S, Drury M, Hull F. A nurse practitioner in general practice: working style and pattern of consultations. J R Coll Gen Pract. 1987; 37:154-157.
  46. Tognoni G. Infermieri prescrittori. Assistenza infermieristica e ricerca. 2006; 25:146-148.
  47. Figura M, Arcadi P, Vellone E, Pucciarelli G, Simeone S, Piervisani L, Alvaro R. Living in a multicultural context: Health and integration from the perspective of undocumented Mediterranean migrants, residents, and stakeholders in Italy. A qualitative-multimethod study. J Adv Nurs. 2024 Epub ahead of print.
  48. Brennan EJ. Towards resilience and wellbeing in nurses. Br J Nurs. 2017; 26:43-47.
  49. Gu B, Tan Q, Zhao S. The association between occupational stress and psychosomatic wellbeing among Chinese nurses: A cross-sectional survey. Medicine (Baltimore). 2019;98(22):e15836.
  50. Hewitt JB, Misner ST, Levin PF. Health hazards of nursing: identifying workplace hazards and reducing risks. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993; 4:320-7.
  51. Tan CC. Occupational health problems among nurses. Scand J Work Environ Health. 1991;17:221-30.