BMJ 1994;309:583-586 (3 September)

Education and debate

Care of dying patients in hospital

M Mills, H T O Davies, W A Macrae 

Greater Glasgow Health Board, Glasgow G1 1PT Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY Department of Anaesthetics, Ninewells Hospital and Medical School, Dundee DD1 9SY Correspondence to: Miss Mills, 39 Netherblane, Blanefield G60 9JW.

Abstract

Objective : To study the process of care of dying patients in general hospitals.
Design : Non-participant observer (MM) carried out regular periods of continuous comprehensive observation in wards where there were dying patients, recording the quantity and quality of care given. Observations were made in 1983.
Setting : 13 wards (six surgical, six medical, and one specialist unit) in four large teaching hospitals (bed capacity 504-796) in west of Scotland.
Subjects : 50 dying patients (29 female, 21 male) with mean age of 66 (range 40-89); 29 were dying from cancer and 21 from non-malignant disease.
Results : Final period of hospitalisation ranged from 6 hours to 24 weeks. More than half of all patients retained consciousness until shortly before death. Basic interventions to maintain patients' comfort were often not provided: oral hygiene was often poor, thirst remained unquenched, and little assistance was given to encourage eating. Contact between nurses and the dying patients was minimal;20distancing and isolation of patients by most medical and nursing staff were evident; this isolation increased as death approached.
Conclusions : Care of many of the dying patients observed in these hospitals was poor. We need to identify and implement practical steps to facilitate high quality care of the dying. Much can be learned from the hospice movement, but such knowledge and skills must be replicated in all settings.

Clinical implications

  • Clinical implications

  • More than half of terminally ill patients in Britain die in an institution, most in a general hospital

  • Studies have suggested that the care of dying patients in hospital is inadequate

  • Observations of 50 dying patients in four large hospitals showed that patients' symptoms were not adequately controlled and many received inadequate nursing care

  • Patients received only minimal attention from most senior medical and nursing staff, their oral hygiene was often poor, their thirst remained unquenched, and they were given little encouragement to eat

  • The skills developed in hospices must be learnt in hospitals if terminally ill patients are to die with minimal discomfort


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Care of dying patients in hospital
Nicholas Albery
BMJ 1994 309: 1579. [Extract] [Full Text]

Why care of the dying is still poor
Ann Blackburn
BMJ 1994 309: 1579. [Extract] [Full Text]

Care of dying patients in hospital Palliative care teams have helped
M Bennett, D Alison, and K Simpson
BMJ 1994 309: 1017. [Extract] [Full Text]

Things have improved
P Stone, C Phillips, A Mabbott, and P Langstone
BMJ 1994 309: 1017. [Extract] [Full Text]

Guidelines have improved care
M Stevenson
BMJ 1994 309: 1017. [Extract] [Full Text]

Care may not be recorded in the notes
I Haslock
BMJ 1994 309: 1017-101. [Extract] [Full Text]

Carers need support
N Ramsay
BMJ 1994 309: 1017-1018. [Extract] [Full Text]

This article has been cited by other articles:

  • Hanratty, B., Hibbert, D., Mair, F., May, C., Ward, C., Corcoran, G., Capewell, S., Litva, A. (2006). Doctors' understanding of palliative care. Palliat Med 20: 493-497 [Abstract]  
  • Ahmad, S., O'Mahony, M.S. (2005). Where older people die: a retrospective population-based study. QJM 98: 865-870 [Abstract] [Full text]  
  • Rogers, A., Addington-Hall, J. (2005). Care of the dying stroke patient in the acute setting. Journal of Research in Nursing 10: 153-167 [Abstract]  
  • Seymour, J., Payne, S., Reid, D., Sargeant, A., Skilbeck, J., Smith, P. (2005). Ethical and methodological issues in palliative care studies: The experiences of a research group. Journal of Research in Nursing 10: 169-188 [Abstract]  
  • Kessler, D., Peters, T. J, Lee, L., Parr, S. (2005). Social class and access to specialist palliative care services. Palliat Med 19: 105-110 [Abstract]  
  • Blasszauer, B., Palfi, I. (2005). Moral Dilemmas of Nursing in End-of-Life Care in Hungary: a personal perspective. Nurs Ethics 12: 92-105 [Abstract]  
  • Stajduhar, K. I, Davies, B. (2005). Variations in and factors influencing family members' decisions for palliative home care. Palliat Med 19: 21-32 [Abstract]  
  • Mirando, S., Davies, P. D, Lipp, A. (2005). Introducing an integrated care pathway for the last days of life. Palliat Med 19: 33-39 [Abstract]  
  • Higginson, I. J (2004). It would be NICE to have more evidence?. Palliat Med 18: 85-86  
  • Davidson, P., Introna, K., Daly, J., Paull, G., Jarvis, R., Angus, J., Wilds, T., Cockburn, J., Dunford, M., Dracup, K. (2003). Cardiorespiratory Nurses' Perceptions of Palliative Care in Nonmalignant Disease: Data for the Development of Clinical Practice. Am J Crit Care 12: 47-53 [Abstract] [Full text]  
  • Jubb, A M (2002). Palliative care research: trading ethics for an evidence base. J. Med. Ethics 28: 342-346 [Abstract] [Full text]  
  • Kite, S (2002). Upstream from death. JRSM 95: 529-530 [Full text]  
  • Smith, R. (2000). A good death. BMJ 320: 129-130 [Full text]  
  • Rogers, A, Karlsen, S, Addington-Hall, J M (2000). Dying for care: the experiences of terminally ill cancer patients in hospital in an inner city health district. Palliat Med 14: 53-54  
  • Fordham, S., Dowrick, C. (1999). Is care of the dying improving? The contribution of specialist and non-specialist to palliative care. Fam Pract 16: 573-579 [Abstract] [Full text]  
  • Donohoe, M. T. (1998). Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses. Arch Intern Med 158: 1596-1608 [Abstract] [Full text]  
  • Seale, C., Kelly, M. (1997). A comparison of hospice and hospital care for people who die: views of the surviving spouse. Palliat Med 11: 93-100 [Abstract]  
  • Charlton, R. (1995). Dying for palliative care. BMJ 310: 1007-1007 [Full text]  
  • Johnston, G., Abraham, C. (1995). The WHO objectives for palliative care: to what extent are we achieving them?. Palliat Med 9: 123-137 [Abstract]  
  • Albery, N. (1994). Care of dying patients in hospital. BMJ 309: 1579-1579 [Full text]  
  • Blackburn, A. (1994). Why care of the dying is still poor. BMJ 309: 1579b-1579 [Full text]  
  • Bennett, M, Alison, D, Simpson, K (1994). Care of dying patients in hospital Palliative care teams have helped. BMJ 309: 1017-1017 [Full text]  
  • Stone, P, Phillips, C, Mabbott, A, Langstone, P (1994). Things have improved. BMJ 309: 1017a-1017 [Full text]  
  • Stevenson, M (1994). Guidelines have improved care. BMJ 309: 1017b-1017 [Full text]  
  • Haslock, I (1994). Care may not be recorded in the notes. BMJ 309: 1017c-101 [Full text]  
  • Ramsay, N (1994). Carers need support. BMJ 309: 1017d-1018 [Full text]  
Access all current jobs at BMJ Group
Whats new online at Student BMJ
Listen to the latest BMJ Interview