Social work and end-of-life care

Social work is important in end-of-life care

Challenging unrealistic hopes for dying patients – facilities and skills needed

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Emily Madsen makes a comment on my post of a few months ago, about facilities in hospitals for private consultations between relatives and staff; too much talk about private matters goes on in corridors, not surprising when the facilities in hospitals are so outdated and unimproved as suggested by this outside view of my local hospital, taken in 2011 but still untarted-up.

Emily says: Interestingly, my experience in the acute sector has often been the reverse – multiple situations when families have expressed concern at the ongoing medical management plan when patient is clearly dying but no one seems to be able to say it…

You may have missed this, because she’s commenting on something said away back, so I’ve made a new post out of it toSt Helier ward windows highlight what she’s saying.

I do agree with her, but I wonder if one of the reasons why doctors, nurses and social workers in hospitals don’t have these difficult talks about the reality that a patient is dying is that they have no place to sit down with someone and have a conversation, as opposed to passing on a quick bit of information. It also means that there is no experience among relatives of having a thoughtful conversation, except at the patient’s bedside. So medical management plans do not include thinking about what they need to say to relatives. And vice versa, families do not get a chance of a serious conversation in which they can express their fears and have unrealistic hopes challenged.

As a result, many hospital staff do not develop the skill and practice of deciding that they need to raise a difficult topic, picking people up as they visit and then saying: ‘We need to have a talk about something important’ and being able to take them to a private room, give them a cup of coffee/tea and spend time with them talking over their patient’s realistic chances.

It’s not only the facilities, of course. One of the problems is the healthcare bias that favours talking only to patients about their condition, rather than seeing it as their job to engage the relatives, too. That’s why they need more social workers integrated into teams in hospitals.

Link to the original post. Thanks for the comment, Emily.


Written by Malcolm Payne

17 May 2013 at 2:27 pm

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