Research to explore nurses' role in end-of-life care

18 April, 2013

The role of nurses in ensuring a 'good death' experience for patients and their families is being explored by researchers with Deakin University’s Centre for Quality and Patient Safety research.

Of the estimated 143,500 Australians who die each year, around 54 per cent (77,500) will die in acute care hospitals.

These figures are expected to rise as our population ages and older people with chronic illnesses are increasingly admitted to hospital when their end-of-life care becomes unmanageable at home. It is also projected that overseas-born older Australians will be overrepresented in these hospital admissions.

With nurses at the forefront of providing acute hospital care, their involvement in end-of-life decision making can 'make or break' the dying experience for patients and their families, making effective communication that crosses cultures all important, Deakin’s Professor Megan-Jane Johnstone said.

"With older Australians from a wide range of cultural backgrounds forming a large proportion of people spending their final days in acute care hospitals, it is imperative that nurses, and the health care system as a whole, accommodate cultural worldviews on death and dying, even if these differ from the prevailing and more commonly accepted views," she said.

Among the key challenges nurses face in caring for people from different cultural and language backgrounds is understanding and connecting in a meaningful way with them.

"Culture is about meaning and ‘meaning making’," Professor Johnstone said.

"If nurses don’t inquire about or try to understand the meanings people attribute to their end-of-life care experience this can sometimes result in patients and families being approached in the 'wrong way' and 'wrong care' being given. In either case this could have devastating consequences for patient and family alike – even though unintended.

"Ultimately, all patients and their families should experience a 'good death', one that is free of avoidable distress and suffering for the patients, families and caregivers; generally accords with the patients’ and families’ wishes; and is reasonably consistent with clinical and ethical standards and is culturally appropriate."

Through the project, funded by a Nurses Board of Victoria Legacy Limited Ella Lowe Grant, the researchers will look at the role of nurses and the strategies they employ in end-of-life decision making involving people from culturally diverse backgrounds.

"We are interested in understanding nurses’ 'death literacy'; how do they broach the subject of death and address the concerns that the subject may evoke in the patient, the patient’s family, co-workers or even themselves," Professor Johnstone said.

"What we find with this project will form the basis of further investigation of the link between nurses' end-of-life decision making and the appropriate 'good death' experience of patients and families from culturally diverse backgrounds."