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.