Ambulance staff and end-of-life hospital admissions: A qualitative interview study (original) (raw)
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BMJ supportive & palliative care, 2013
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Presse medicale (Paris, France : 1983), 2018
Most people in France die in the hospital, even though a majority would like to die at home. These end-of-life hospital admissions sometimes occur in the emergency setting, in the hours preceding death. To understand the motives that incite main natural caregivers to transfer terminally ill patients at the end of life to the emergency department. A qualitative study was performed among caregivers of terminally ill patients receiving palliative care and living at home, and who died within 72hours of being admitted to the emergency department of the University Hospital of Besançon, France. Eight interviews were performed; average duration 48minutes. The caregivers described the difficult conditions of daily life, characterised by marked anguish about what the future might hold. Although they were aware that the patient was approaching the end of life, the caregivers did not imagine the death at all. The transfer to the emergency department was considered as a logical event, occurring ...
British Journal of General Practice, 2019
BackgroundEnabling death at home remains an important priority in end-of-life care policy. However, hospital continues to be a more prevalent place of death than home in the UK, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment, associated with inadequate family care provision and insufficient professional care delivery.AimTo understand problems in professional and lay care provision that discourage death at home and lead to hospital admissions at the end of life.Design and settingA qualitative study of admission to a large English hospital of patients close to the end of their life.MethodRetrospective in-depth semi-structured interviews with healthcare professionals (n = 30) and next-of-kin (n = 3) involved in an admission. Interviews addressed why older patients (>65 years) close to the end of life are admitted to hospital. Interviews were transcribed and analysed thematically.ResultsHome-based e...
Palliative Medicine, 2019
Background: Hospitals are important sites of end-of-life care, particularly for older people. A need has been identified to understand best practice in hospital end-of-life care from the service-user perspective. Aim: The aim of this study was to identify examples of good care received in the hospital setting during the last 3 months of life for people dying in advanced age from the perspective of bereaved family members. Design: A social constructionist framework underpinned a qualitative research design. Data were analysed thematically drawing on an appreciative enquiry framework. Setting/participants: Interviews were conducted with 58 bereaved family carers nominated by 52 people aged >80 years participating in a longitudinal study of ageing. Data were analysed for the 21 of 34 cases where family members were ‘extremely’ or ‘very’ satisfied with a public hospital admission their older relative experienced in their last 3 months of life. Results: Participants’ accounts of good ...
Palliative medicine, 2015
Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Exploratory two-stage qualitative study Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. The practice of transferring critically ill patients home to die is a rare event in the United Kingdom...
Palliative Medicine, 2013
The 'dis-ease' of dying: Challenges in nursing care of the dying in the acute hospital setting. A Advances in health care and technology have meant that the way people die has changed dramatically. 1,2 Populations of developed countries are living longer, 3,4 and chronic illness is the leading cause of death. 5 In Australia, population changes have meant that the number of people requiring end-of-life (EOL) care is increasing 6 and that people are more likely to die in institutional settings. 2,7 Australian projections of demand for care at the EOL also suggest that the trend towards institutional care will increase as the number of people dying grows in absolute terms, concurrent with a decrease in informal carers. In 2010, an international white paper ranked the quality of death in 40 countries, 8 and despite Australia ranking second, there is still a growing need to consider care in The 'dis-ease' of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study Abstract Background: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/ resuscitative care. Aims: The aims were to explore nurses' 'recognition of' and 'responsiveness to' dying patients and to understand the nurses' influence on end-of-life care. Design: A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and individual semi-structured interviews for clarification. Setting/participants: This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. Results: Nurses took a passive role in recognising dying, providing active care until a medical officer's declaration of dying. Ward design, nurse allocation and nurses' attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. Conclusion: 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.
Research Square (Research Square), 2023
Background: The Emergency Department (ED) is not always the optimal place for people with palliative care needs but is the most common route for treatment when urgent care is sought. The aim of this study,''REasons for PalLIative Care Admissions (REPLICA)' was to explore the perspectives of ED health care professionals of hospital admission or discharge via the ED for palliative care patients. Methods: This is a sequential mixed methods study comprising i) quantitative descriptive analysis of Hospital Episode Statistics (HES) of palliative care patients (code Z51.5) who were admitted through the ED in a West Midlands Hospital and for the rest of England; ii) in-depth semi-structured interviews with 17 ED staff which were analysed using thematic content analysis. Results: Over the four years (2013-2017), 430,116 people admitted through ED were identi ed with a Z51.5 diagnosis code, 0.6% (n=2736) of whom were from the West Midlands Hospital. The most common reasons for palliative care patients' admission to hospitals across England were for care of chronic kidney disease, cancers and urinary tract infections. Five themes were elicited from the qualitative analysis: 1) Providing palliative care in the ED is challenging, due to factors including lack of training in palliative care and the unsuitable environment. 2) Patients go to the ED due to challenges in community management such as inappropriate referrals and no care plan in place. 3) Health system in uences admission and discharge decisions, including bed availability and being unable to set up community services out-of-hours. 4) Discussion with patient about treatment and end-of-life care needs to be outside of the EDwhilst the patient is still well enough to express their wishes. 5)Improving services for patients with palliative care needs. Recommendations include short training sessions for ED staff and accessing palliative care professionals 24/7. Conclusions: A large number of palliative care patients visit ED and are admitted to hospital for care; there is an urgent need to prevent patients attending the hospital through the establishment of a coordinated and dedicated service to support palliative care patients in the community.
Dying cases in emergency places: Caring for the dying in emergency departments
Social Science & Medicine, 2011
In an ageing society, like the UK, where long-term illness dominates healthcare, there has been a change in the way that the end-of-life is approached and experienced. Advancing technology, inadequate knowledge and inconsistency in palliative care services have complicated the ability to recognise imminent dying and many people access emergency services at the end-of-life. Drawing on ethnographic research exploring end-of-life care in one large Emergency Department (ED), the authors examine the spaces of dying and death, which are created in a place designed to save life, and not necessarily to provide supportive and palliative care. Despite the high need for attention in an emergency crisis, this study shows that the approach taken to care for someone at the end-of-life, and consequently the space in which they are cared for, often falls short of the expectations of the dying patient and their relatives. It is argued that the dying body is seen as dirty and polluted in the sterile, controlled, clinical environment and is therefore 'matter out of place'. Attempts are made to conceal or remove the dying patient, the bereaved relatives and the deceased body protecting the natural order of the ED. Consequently, the individual supportive and palliative care needs of the dying are often overlooked. This paper highlights the needs of patients as death nears in the ED and argues that the critical decisions made in the ED have a significant impact on the quality of care experienced by patients, who spend the last few hours of their life there.