End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

Abstract

The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be effective, health care professionals who provide hospital care will need to respond to its patient-centered purpose. Health services will also be called upon to train health care professionals to work with dying people in a more participatory way and to assist them to develop the clinical processes that support shared decision making. Health professionals who manage clinical workplaces become central in reshaping this practice environment by promoting patient-centered care policy objectives and restructuring health service systems to routinely incorporate patient and family preferences about care at key points in the patient's care episode.

Surgical nurses’ attitudes towards caring for patients dying of cancer - a pilot study of an educational intervention on existential issues

“…There are high expectations on nurses’ flexibility to meet patients’ and their families’ diverse needs in order to provide the best care possible (Plant et al . ; Sorensen & Iedema ). Not only do nurses provide a great deal of emotional support, they are also expected to assist patients in making difficult choices and decisions near death (Haisfield‐Wolfe ; Kuuppelomäki ).…”

The provision of end-of-life care by medical-surgical nurses working in acute care: A literature review

“…Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries (Jacobs et al, 2002; Sorensen & Iedema, 2011), and nurses are key players in the provision of end-of-life (EOL) care. Considering their continued presence at the bedside, nurses are expected to care holistically for terminally ill patients/families while they adjust to and live through the trajectory of the terminal illness (Fitzgerald, 2007).…”

“…Considering their continued presence at the bedside, nurses are expected to care holistically for terminally ill patients/families while they adjust to and live through the trajectory of the terminal illness (Fitzgerald, 2007). However, the high-tech acute care environment of hospitals has been recognized as suboptimal for EOL care (Jacobs et al, 2002; Sorensen & Iedma, 2011), and in such a context a comprehensive approach to care can be very difficult for nurses to accomplish due to: (a) the very fast pace of the environment, (b) the biomedical culture focused on active treatment and cure (Summer & Townsend-Rocchiccioli, 2003), and (c) the cultural reluctance to discuss sensitive issues surrounding dying and the death itself (Willard & Luker, 2006; O'Gorman, 1998). In that regard, the perceived cultural norms in acute care settings can have a strong influence on staff behaviors, attitudes, and beliefs toward dying patients (Wilson & Kirshbaum, 2011), even more so when these norms ignore the consequences and suffering that caring for dying individuals can create in healthcare professionals (Willard & Luker, 2006).…”