Registered nurses’ recognition of and responsiveness to the dying patient in the acute hospital (non-palliative care) ward

Introduction Changes in society, an ageing population and improvements in healthcare have changed how and where people die, with more people dying in acute hospitals than ever before. Where palliative care clinicians are considered specialists on dying, non-palliative care clinicians, such as nurses working in acute care are now required to care for an increasing number of dying patients. Aims The aims of this study were to explore registered nurses’ recognition of and responsiveness to dying patients in acute hospital (non-palliative care) wards in Australian acute hospital settings, and to understand nurses’ influence, if any, on the provision of end of life care. Method The research aims were examined using a sequential exploratory mixed methods design, which included two phases of research - a large qualitative study and a smaller quantitative study. Phase One used non-participant observation to gather data on how registered nurses recognised when a patient was dying, and how they subsequently responded to the dying patient. Following the observation (20 episodes), focus groups (2) and individual interviews (2) were used to further explore and clarify the observation data. Phase Two utilised a survey to measure attitudes of registered nurses and final year (pre-service) medical students toward care of the dying patient. Results Results were analysed and then considered in light of ‘death anxiety’ theory. Phase One findings indicated that nurses found recognising dying difficult and took a passive role in this respect. Responding to the needs of a dying patient in the context of an acute hospital ward was difficult, impacted by ward culture and design, patient acuity and nurse workload, allocation practices, and the emotional and educational preparation of nurses. These findings suggest that death anxiety, while not measured directly, could be a significant contributor to nurse behaviour, and may have contributed to the perception that nurses had a negative attitude towards caring for a dying patient. Phase Two findings, however, indicated that nurses and final year (pre-service) medical students demonstrated highly positively attitudes towards care of the dying; nevertheless issues similar to those highlighted in Phase One were also identified in the survey analysis. Conclusion The study suggests that recognising dying is difficult for nurses. When dying is recognised, nurses’ passivity often results in a delay in their change of care focus from curative to end-of-life care. This study also suggests that many nurses are not adequately prepared to care for and support the dying patient. There is also a noticeable lack of emotional and educational support for nurses in this study, particularly those who may be inexperienced in end of life care. Other variables such as ward culture, design, nurse allocation, patient acuity and nurse workload impacts negatively on a nurse’s responsiveness to the dying patient. While death anxiety was not the primary focus of this study, nor was it measured, this study suggests that death anxiety may have impacted significantly on the care provided to the dying patient in the acute hospital setting.