A NEW guide to help healthcare professionals respond to the difficult issues associated with the impending death of a patient should be welcomed by the personnel it targets. It is the latest step in an Irish Hospice Foundation initiative to bring hospice principles into acute and community hospitals and to ensure, among other things, that no one dies alone and in pain. The Hospice friendly Hospitals (HfH) programme has been introduced in 42 settings and has brought many changes in the way issues of death, dying and bereavement are treated.
Hospitals have altered their mortuaries to ensure they facilitate modern design needs. They have made them sensitive to different cultures and religions. Privacy and single rooms for dying people are increasingly being sought. Medical staff are being trained how to communicate on end-of-life matters. Relatives are more likely to receive their loved one’s belongings in a specially designed handover bag. And it is more often accepted that integrated care should extend to the whole family, even after their relative has died.
Importantly, too, the HfH programme is developing ethical framework principles on end-of-life issues. These should champion the rights of patients to participate in decisions affecting them and, above all, should assist medical and related professionals in meeting increasing ethical challenges. At the same time, the HfH is constructing an audit and evaluation system on end-of-life care which is being piloted in a number of hospitals. Pertinent questions are being asked at ward, staff and relatives’ level to ensure there is sufficient data for hospitals to develop their end-of-life services.
The new HfH guide When a Patient is Dying (available at www.hospicefriendlyhospitals.net) highlights the natural instinct to want to do “something” when someone is dying as well as the uncertainty that can follow over what that “something” should be. We often flounder in response: we feel uncomfortable at being reminded of our own mortality or of a recent bereavement.
The process of dying is intense, emotive and personal. Yet most of us would prefer not to think about it. But there must be an understanding of what is happening and of how pending death is diagnosed and managed. Medical and related carers must respond professionally to difficult questions from patients and families. They need to understand issues involved in death certification, transport of the body and the handover of patients’ belongings. Vitally too, they must consider the spiritual needs of patients which often go beyond religion.