The alleviation of suffering lies at the core of compassionate end-of-life care, yet
little is known about the lived experience of suffering. Motivated by a series of
reports on poor care of older people in hospital, this study addresses suffering
in older people at the end of life in an acute hospital ward in the United
Kingdom. Methods were developed from a synthesis of ethnographic fieldwork
and phenomenological interpretation.
Data were collected using participant observation on an acute care ward for
older people in a hospital in Northern England, over 186 hours between June
and August 2015. Data included field notes, documents, photographs and
informal interviewing. Staff and patient participants were identified using
theoretical sampling. Data were analysed using a hermeneutic approach
involving a continuous process of analysis, further data collection, posing of
problems and questions, and interpretation. This cyclical approach to the data
enabled the development of interpretive perspectives which could then be
further explored in the field.
Findings suggested that care for older people was shaped by competing
ideologies of care and organisational regulatory processes. Particularly when
there was ambiguity regarding prognosis, there was a tendency for care to
default to a ‘rescuing’ acute care model. Through exploring the experiences of
individual patients and placing these in the context of cultures of care, I suggest
that iatrogenic suffering was a significant concern that often went unrecognised.
Patient-centred goals must be more focused upon avoidance of iatrogenic
suffering. Recommendations include innovations in clinical education and multiprofessional working.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/17231 |
| Date | January 2017 |
| Creators | Green, Laura I. |
| Contributors | Oyebode, Jan, Capstick, Andrea |
| Publisher | University of Bradford, Faculty of Health Studies |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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