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Hospital nurses less likely to show respect to patients at end of life


Hospitals have been accused of letting down dying patients after a survey found that staff are less likely to show dignity and respect to people at the end of their lives than their counterparts in hospices.

A survey of bereaved family members found that 87% of doctors and 80% of nurses in hospices showed dignity and respect “all the time”.

But the Office of National Statistics (ONS) research showed that the figures in hospitals fell to 57% for doctors and 48% for nurses.

The data, collated by the ONS to examine end of life care, showed that hospitals were also the most common place for people to die.

Imelda Redmond, Marie Curie Cancer Care’s director of policy and public affairs, said: “This is the first time bereaved relatives have been given a voice. Families have told us, in large numbers, that their loved ones do not always get the care they need or deserve at the end of life.

“Hospitals are letting people down at a crucial time and this poor care is leaving behind memories of loved ones being treated with little dignity and respect, and dying in pain. This is simply not good enough.

“Good quality care can be provided at the end of life. The care received in hospices and at home was highly regarded by relatives.

“We only have one opportunity to get end of life care right.

“There is no reason why we can’t provide a dignified and respectful death, regardless of setting, location or diagnosis. It is now time to learn from these findings and make improvements.”

The survey, commissioned by the Department of Health, also found that three-quarters of people in England thought the care given in the last three months of life was good, excellent or outstanding.

Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters Coalition, said: “Although it is encouraging that three-quarters of people who have been bereaved reported in this survey that the care received had been outstanding, excellent or good, it’s a real concern that the quality of care people who are dying receive appears to vary so hugely, with hospitals performing especially badly.

“There is absolutely no excuse for not treating people who are dying with dignity and respect, which is why it is disturbing that hospital staff appear to be failing to do this consistently.

“We need a new deal for people who are dying, with mandatory end of life training for all staff and much more done to listen and act upon people’s preferences about where they want to be cared for at the end of life, which for most people is in their home and not in hospital.”

Care services minister Paul Burstow said: “All people, regardless of their age or condition, should get the best quality care at the end of life.

“(This survey) reveals a wide variation in the quality of care across the country.

“There is more to be done to improve both the way care is co-ordinated for people in their own homes and the quality of care in hospital.

“We are already working with hospices, the NHS and social care to pilot new ways of working and put in place a secure funding system to support palliative care.

“These results will help health and social care to benchmark the care they deliver and learn from the best.”


Readers' comments (22)

  • In an ideal work, nurses within the acute setting would have more time to spend with end of life patients. However, I think we do the best we can with what we've got - ever increasing paperwork, ever increasing patient caseload. We had the LCP thrust upon us with inadequate training. Proper training from the relevant departments would help but won't remove the fact that we don't always have the necessary time needed to provide the best end of life care.

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  • Can't see this one being well received on this site !

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  • We haven't got time is too often the easy way out of any argument, but perhaps what we should be saying is that we are being asked to do too much with too little in the way of resources. Adding some more mandatory training isn't going to improve things either. Training and education is great, but until managers are put in place who actually want strategies to succeed we are always going to have resource issues.

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  • time can be made and dignity and respect should always be part of a nurses job. Imagine that the patient is one of your loved ones, how would you feel if they were not treated with respect and dignity.

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  • This is a dreadful generalisation,let's not forget that the survey also suggests that 20% of hospice nurses don't show respect and dignity 'all the time'.

    Where I work the staff show dignity, compassion and kindness to all our patients. Hospital staff are not failing consistently, what a horrid thing to suggest.

    When a patient is dying we always offer the best care possible, we try our hardest to get them home if that is their wish and have excellent communication between the palliative team, social services, district nurses etc. Sadly some patients will die in hospital before they get home, that is out of our control I'm afraid.

    Perhaps the reason hospitals are the most common place for people to die is because hospitals are full of sick people.

    I imagine most, if not all, nurses and doctors would welcome more hospice beds and more hospital based 'end of life beds'.

    There are also patients who do not wish to die at home, they feel the family could not cope emotionally. There are families who admit they cannot cope.

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  • If hospital staff are so bad then how come we receive so many thank you cards and financial donations from bereaved families.

    I do agree that training should be put in place especially for the medical staff who sometimes don't seem able to accept that a patient is dying. Families and patients often find this difficult too, especially in hospitals where some people believe everyone gets better and goes home.

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  • my mother passed away on a public ward. It noisy, full of visitors, and no side rooms available. Given the chance I would have had her at home. The staff did their best under those conditions. It was what it was, a public ward. If I wanted to, I could say there was a lack of respect there also. But I recognised the situation for what it was. The reality was my mother died in the clinical equivalent of a factory. That's where the lack of respect lay if any.

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  • This is very demoralising for hospital nurses to read, we try our best but we don't have the staff, side-rooms or medical help available when we always need it. It is not ideal to die on a busy acute ward but it happens, it is not the nurses fault but the way hospitals are built, staffed and poorly managed.

    I am surprised that only 80% of hospice staff always got it right, I'd have thought it should be nearer 100% as this is their speciality and they have much better nurse-patient ratios and have a much calmer atmosphere.

    I don't think it is very fair to say that hospital staff don't offer their patients dignity and respect.

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  • Surely we need to know what is meant by not being treated with respect and dignity - I am a District Nurse - we score well and its not that we have loads of time but we are able to prioritise dying patients and not suffer interuptions from call bells etc while with the person. Hospital is such a generalisation - some department are likely to seem worse than others. Is it that patients are in the wrong place - what if a ward put all their energy into facilitating discharge and then the patient takes a turn for the worse - that must be a hard shift in focus to cope with. We aim to have people die at home if its predicted but sometimes that is not possible and unlike District Nursing services and hospitals hospices don't just keep on taking patients - we could all improve our services if we were able to limit the patients we admit - unfortunately dying is not something you can put on a waiting list. I know of patients whose preferred place to die is the hospice but they won't admit in an emergency and presumably are not subject to having to discharge anyone in a hurry because someone sicker has come around. Hospices are also known to be off putting to patients from ethnic minorities as they are deemed very much a white christian organisation - maybe that makes it easier for them to know what people want as they don't need to have as much knowledge as nurses who deal with a large ethnic diversity. I would just love it if for once a report was spun towards those who have done well with an investigation about how they do it with the aim of sharing good practice. Actually at home in our area we do have access to 'hospice at home nurses' who can help with palliative patients - why don't hospices put care of the dying teams into hospitals to support wards who find themselves dealing with a dying patient?

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  • Surely we should be looking at preferred place for care at end of life? Hospitals are for active intervention and treatment, end of life care requires a vastly different approach not just for people at the end of life, but for their loved ones.
    On the Friday we begged the consultant to discharge Mum so she could die at home but all he said was it was too late and he would re evaluate on Monday, which was too late for her and for us as she died on the Monday morning but at least we had a side room!! There was only one nurse( and she was on night duty) who had undertaken training in end of life care and took on the role of advocate for Mum...

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