The ‘dis-ease’ of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

Abstract

When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

Family members´ experiences of the end-of-life care environments in acute care settings – a photo-elicitation study

“…In Broad et al’s study (Broad et al, 2013), half of the 16 million deaths reported from 36 countries occurred in hospitals. Acute-care hospitals are thus a common place of death internationally; however they are generally fast-paced, high-tech environments, with care of the dying neither a primary focus nor prioritized (Bloomer, Endacott, O’Connor, & Cross, 2013; Chan, Macdonald, Carnevale, & Cohen, 2017). Several researchers point to deficits in quality end-of-life (EoL) care in acute-care hospitals (Al-Qurainy, Collis, & Feuer, 2009; Oliver & O’Connor, 2015; Reyniers, Houttekier, Cohen, Pasman, & Deliens, 2014), with both organizational and environmental factors contributing to a lack of support for dying persons and their family members (Sheward, Clark, Marshall, & Allan, 2011; Virdun, Luckett, Lorenz, Davidson, & Phillips, 2017).…”

“…Research on family members in acute-care settings mainly concerns problems experienced by family members, e.g., experience of patients’ symptom burden and management, communication and relationships with professional caregivers, involvement in decision making, or their own needs for care (Robinson, Gott, & Ingleton, 2014; Steinhauser, Voils, Bosworth, & Tulsky, 2015; Virdun, Luckett, Davidson, & Phillips, 2015). The tendency to focus on life-sustaining treatment may encourage a disengagement from, and diminish recognition of, the acute-care environment as a setting for EoL care (Bloomer et al, 2013; Chan et al, 2017). …”

The Golden Room: an innovative choice for end of life care (or) Changing the culture to allow for more end of life care options

“…Findings were that nurses generally took a passive role in recognizing dying until a medical officer's declaration of the fact. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role [2].…”

“…It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient [2].…”

Personalets erfaringer i to norske sykehus

“…Dette kan henge sammen med at det ikke finnes noen entydig definisjon av når terminalfasen eller dødsfasen starter (22). Prognostisering og vurdering er vanskelig og krever erfaring (23,24), og det kan vaere vanskelig å skille mellom en akutt syk og en døende pasient (25). Flere studier har også vist at forløpet av andre kroniske sykdommer er vanskeligere å prognostisere enn kreft (26)(27)(28), samt at helsepersonell generelt er for optimistiske med tanke på overlevelse (26).…”