A grounded theory study – community palliative care clinical nurse specialists’ experiences when fulfilling their role

Kelly, Jess and Walshe, Catherine and Gadoud, Amy (2026) A grounded theory study – community palliative care clinical nurse specialists’ experiences when fulfilling their role. PhD thesis, Lancaster University.

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Abstract

Background: Community palliative care clinical nurse specialists play a vital role in delivering specialist palliative care in community settings, where continuity and holistic support are critical. While their responsibilities span advanced clinical care, education, and advocacy, the role has evolved significantly in response to increasing patient complexity, changing service models, and policy shifts. This evolution has led to growing role ambiguity, making it harder for community palliative care clinical nurse specialists to navigate expectations and deliver care effectively. Despite their central contribution, there is limited empirical research exploring the lived experiences of community palliative care clinical nurse specialists leaving important gaps in understanding how they perceive, adapt to, and manage the demands of their role Aim: To develop a grounded theory of clinical nurse specialists’ experiences in fulfilling their roles within community specialist palliative care teams. Methods: A constructivist grounded theory approach guided the study. Participants were community palliative care clinical nurse specialists, working in the Republic of Ireland. A combination of convenience and theoretical sampling strategies was employed to recruit participants who could contribute rich, relevant insights to the developing theory. Participants were invited to take part in the study through established professional networks and service contacts, with subsequent recruitment guided by emerging data needs as per theoretical sampling principles. Data were collected through in-depth, semi-structured interviews. Interviews were transcribed and analysed using constant comparative methods. This iterative process supported the identification of core categories and relationships, leading to the development of a grounded theoretical framework. Ethical approval was obtained. Results: Nine community palliative care clinical nurse specialists participated in this study. The effectiveness of the community palliative care clinical nurse specialist role is shaped by a complex interaction of personal qualities, organisational support, and external factors, all of which consist of interconnected elements which shape their experience of the role. Empirical and systematic review findings indicate that community palliative care clinical nurse specialists navigate this balance of personal dedication, organisational challenges, and broader system-level pressures while fulfilling their responsibilities. Facilitators identified include mutual respect among professionals, clear definition of role boundaries, and effective communication networks. In contrast, barriers encompass limited resources, inconsistent understanding of the role among generalist providers, and inadequate succession planning. A theoretical model was developed to illustrate how these personal, organisational, and external factors are interdependent and collectively impact the successful fulfilment of the community palliative care clinical nurse specialist role Conclusion: This study provides new insights into the realities faced by community-based clinical nurse specialists. The resulting theory emphasises the need for strategic investment in education, role clarity, and resource allocation to effectively support these key professionals. Clinical nurse specialists are instrumental in bridging policy and practice, contributing to service innovation, quality improvement, and patient-centred care delivery. Their leadership and advanced clinical expertise position them as vital agents in shaping responsive, sustainable community palliative care models. These findings have important implications for workforce planning, policy development, and the long-term delivery of high-quality, community-based palliative care