The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

Abstract

Acute care and palliative care are described as different incompatible organisational care cultures, with contrasts and contradictions. Few studies have observed the actual meeting between these two cultures. Purpose: To study the meeting and interaction of two different organisational care cultures, palliative care and curative acute wards, when a palliative care consultation team introduces consulting services to acute wards regarding end-of-life palliative care. Methods: An ethnographic study design was used, including observations, interviews and diary entries. A palliative care consultation team visited surgical and internal medicine wards during one year. An integrative bedside education approach was used, where physicians and nurses experienced in PC tried to embed PC principles and interventions into daily practice. The analysis was inspired by Spradley’s ethnography.Results: Three themes were found in the study: 1) Values, illusions, and wording in the acute care culture; 2) Didactic challenges and strategies, and 3) The palliative illusion becomes a fusion. On the acute wards, fast “turn over” was the goal of care: to treat patients quickly and send them home. Primary health care team members believed that they gave dying patients good care, a conclusion not supported by the palliative care team, who identified values problems and a knowledge shortage among all primary team members. Because the primary team did not have time for reflection regarding patients’ whole situation, and wanted to do as much as possible before “giving up”, their patients could be one hour from death before the primary team provided palliative care. After one year, primary team members wanted the palliative care consultation team to continue, since they felt they could not handle dying patients on their own.Conclusion: Palliative care consultation team make changes about end- of- life care when working with primary health care team members on acute wards. The didactic challenges are many and require efforts.