Abstract
BackgroundEnd-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland.MethodsThis was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach.ResultsThree quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication.ConclusionsAcute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
Highlights
End-of-life care (EoLC) is an experience that touches the lives of everyone
Despite many people expressing a preference to die at home [5], research has indicated that four in ten (43%) of all people in Ireland die in an acute hospital with 6% dying in a hospice [6]
This paper reports on the qualitative analysis of four open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland [37]
Summary
End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Often basic nursing care needs and symptom control are not adequately managed [7, 9, 15] It is generally accepted from studies carried out to date that good care at end of life is characterised by the careful management of pain and other symptoms, patient dignity and independence, family involvement and support, awareness of death and good communication with healthcare professionals [16,17,18,19,20]. The hospital’s physical environment is recognised as an important factor in the care of those seriously ill and at end of life [3, 16, 21, 22] These factors reflect the multifaceted and complex nature of EoLC which encompasses physical, medical, social, spiritual and psychological experiences [17, 23, 24]
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