End-of-life care in a hospital setting : an ethnographic study

Abstract

The UK is renowned for excellence in end-of-life care. Yet research findings, concerns in the media and formal complaints to the NHS have highlighted problems with end-of-life care on hospital wards leading to calls for better and more compassionate care. This thesis critically analyses the practice of end-of-life care on hospital wards. Data are presented from an ethnographic study. Data collection comprised non-participant observation of 280 hours on two acute hospital wards and 36 semi-structured interviews with sixteen staff members, eleven relatives and nine patients thought to be deteriorating and approaching the end-of-life. Data were analysed using a constructivist grounded theory approach drawing on symbolic interactionism. The data are presented through three overarching themes: Care, Decision-Making and Language and Meaning. This thesis provides an in-depth account of the practice of end-of-life care on hospital wards from the perspectives of patients, relatives and healthcare professionals. The concept of ‘care’ is constituted by many different components: physical and metaphysical, objective and subjective. Relationships are the medium by which care is delivered and are a key component of care itself. What it means to care well when making decisions and communicating at end-of-life is unpacked, revealing the importance of ongoing dialogue to enable a shared understanding between patients, relatives and healthcare professionals. This thesis encompasses both practical and philosophical approaches to provide a unique perspective on end-of-life care. It highlights current challenges in the provision of end-of-life care on hospital wards and considers how these can be better understood to deliver optimal care. If end-of-life care in hospitals is to be improved, strategies must consider the views of all those directly involved, the current reality of end-of-life care provision, as well as the different components of care and the varied levels at which they operate.