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'It can be hard for acute units to change their mindset to care for the dying'

  • Comments (11)

A report has found that relatives and carers are less satisfied with the experience of having a loved one be cared for in an acute hospital setting than in a hospice or at home.

The DH commissioned survey found that bereaved family members found that 87% of doctors and 80% of nurses in hospices showed dignity and respect “all the time” but that in hospitals this fell to 57% for doctors and 48% for nurses.

 Marie Curie Cancer Care and National Council for Palliative Care and the Dying Matters Coalition rightly call for better end-of-life care and express disappointment  that increased training has not improved care.

Sadly the reality is that the dying person will be unlikely to  receive the same quality of care in the acute setting as they do in a hospice but there is a reason for that.

Hospices’ work is focused on and dedicated to the physical, emotional, spiritual and social needs of those with a life-limiting or terminal illness. Acute units are dedicated to preserving life and striving to get patients well enough to be discharged.

As a result it can be hard for acute units to change their mindset to care for the dying. Acute units are busy noisy places that are struggling to provide the level of care they aim to with the current level of resources.

It can be hard for staff working in acute care to accept that a patient is not going to survive. Nurses can feel that they have ‘failed’ and so they can be reluctant to redirect the energy of their work away from preserving life to ensuring that a dying person is comfortable.

Surveys like these should not be used to criticise staff for their shortfalls but should be used to enquire why the system is not working. Issues such as these are generally a system failure not that of individual staff.

Hospital nurses need support and resources to be able to offer end-of-life care as it requires significant skills offer to such care within the often frenetic life that is the acute ward.

  • Comments (11)

Readers' comments (11)

  • Anonymous

    The survey is to compare how things are happening across different settings, etc - it was not performed to 'criticise staff'. However, it is intended to be repeated, so that trends across time can be looked at.

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  • michael stone

    The system working harder to keep patients who shouldn't in them, out of acute units, is probably the best approach. I'm sure there are still a fair number of 'dying patients' who end up being taken to hospital as the yare dying, when they would not want that to happen.

    I can't fault what you wrote, and that survey is indeed about comparing care, not criticising clinicians.

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  • Anonymous

    'They' say a 'rose is a rose' - surely 'a nurse is (similarly) a nurse'. Is the author instead suggesting that a nurse is not always a nurse? That compassion and care are not a part of the nurses' repetoire when working in acute care? If so, it seems to be suggested that nurses no longer do even the basics well - being, instead, more focussed on acute and, perhaps, rehabilitative care, If this is true - what a shame and what an indictment on nurses and, of course, doctors too.

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  • Anonymous

    I'm a student nurse and I was on an acute elderly ward, where one of the ladies on the LCP. The nurses were uncomfortable with talking about things to the patients daughter, they did not even like swabbing out the patients mouth and moistening her lips, it was as if they were unsure of what to do,everytime I swabbed the patients mouth and lips I would chat to her and she would squease my hand as a thankyou. I and the sister on the ward were the only ones who approached the daughter and encouraged her to talk to her mum and help her to make her as comfortable as possible. Even just listening to her as she reminissed about her mum. The poor patient died on a very busy noisy ward ,surrounded by curtains but at least her daughter and the priest was present at the end. I think the nurses just did not feel comfortable or confident in what to do or say.

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  • Anonymous

    Is it because in an acute hospital no-one is allowed to die? We over treat patients who are clearly at their lifes end. Do acute hospitals somehow see it as a failure if a person dies?

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  • Anonymous

    We regularly care for dying patients on our ward. We strive to give the best end of life care we can and try to involve family when possible. Our palliative care team are very supportive if over stretched. The problem comes with prioritising. A dedicated unit such as a hospice can plan their care delivery in a very different way to us. Dying with dignity is very important but in the acute setting saving lives will allways take priority. We chose our specialties in nursing. I would not expect a hospice to deal with acute post op patients anymore than I would expext a plumber to fix my TV so why are people acting surprised that an acute ward is not the best place to conduct end of life care?

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  • Anonymous

    There have been many untoward events in recent times ranging from the Stafford disaster to the death by neglect of 22year old man in a London teaching hospital. There have been scandalous events involving the care of elderly people and miscalculated doses of medical given to neonates. Maternity
    patients have not escaped either.

    The media understandably have jumped on these issues and have succeeded in generated much public debate. Nurses and Doctors , as a result of this media storm, no longer enjoy the unquestioning confidence of the public.

    Until the NMC's "Code of Practise" is adhered to ( in the case of Doctors ---the GMC's "Good Medical Practice" guidelines) public confidence will continue to be eroded.

    The public debate involves more than anxiety about the use of the LCP or dying on an acute ward but demonstrates fear about what actually happens to people once they are hospitalised. (ie. Will I or my relative be exposed to neglect and incompetence? will I be "allowed" to die?)

    Nurse on another thread here tells a story which will without doubt, now published, will reinforce the public's opinion that Doctors and Nurses are not worthy of trust.

    The caring professions are facing a huge challenge, regaining the public's trust will not be easy. A start can be made if each Nurse and Doctor made a determined effort to stamp out all bad practice.

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  • Anon 10.38
    All a part of the right-wing agenda to tarnish the NHS, The machinations of a criminally insane poisoner and the complex ( but needless) death of the young man from neglect are not the norm for the NHS but people are affected by the constant scaremongering that their local hospital is more dangerous than downtown Damascus. Very few positive stories about the NHS since the election.

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  • Anonymous

    What 'mindset' are we being accused of having?

    This article and some comments suggest that we don't care about patients who are dying.

    Many of us can accept that patients are dying, we don't all feel we have failed. We have the knowledge, experience and skills to recognise when a patient is not going to survive.

    It is not unusual for patients to die in hospital, they have been doing it for years. We also have our own relatives and friends who have died in hospitals.

    We offer excellent care to patients, they are pain-free, comfortable, clean, warm and quiet - their relatives are looked after with food and drink and spiritual advice.

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  • Anonymous

    Anonymous | 14-Jul-2012 8:59 am

    excellent post. it seems many hospital deaths which are sadly inevitable are now being rooted out and used by the press to report poor care and negligence.

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