ABSTRACT
Background: Hospitals are the most frequent place of death in Germany (47%), but at the same time, the least preferred one - for both patients and their relatives. To optimize care in the dying phase by using a bottom-up approach, the StiK-OV project aims to implement and evaluate specific measures on different non-palliative wards at two university hospitals. In the first phase of the project, we assess the current state of care in the dying phase on different wards. Method(s): We conducted an online survey with national health care professionals consisting of seven open questions on important aspects, facilitators, barriers and needs for improvement as well as Covid-19 pandemic specifics regarding care in the dying phase. Qualitative data was analyzed thematically. Result(s): Of 67 participants, 66% work in clinical practice as nursing staff (52%) and physicians (30%) and 34% in management or administration. As relevant topics of care in the dying phase, we identified involvement of relatives, symptom control, patient-centeredness, professional competencies, as well as time, space and human resources. Participants state a need for improvement regarding these topics. During the pandemic, involvement of relatives and patient-centeredness were difficult to maintain due to visiting restrictions and higher workload, resulting in patient isolation and dying in loneliness. Discussion(s): The survey revealed common topics of importance which should be targeted by ward-specific measures. Difficulties due to the pandemic have to be accounted for to achieve optimal care in the dying phase under exceptional circumstances. Conclusion(s): The survey gave insights on care in the dying phase from the perspective of health care professionals that can help to develop and implement situation-specific measures to significantly improve the quality of care during the dying phase in hospitals. A bottom-up approach aims to increase the staff motivation to implement respective measures.
ABSTRACT
Background/aims: Hospitals are the most frequent place of death in Germany (47%) but also the least preferred one - for both patients and relatives. The project 'StiK-OV' aims to optimize care for dying patients in hospitals using a bottom-up approach. Therefore specific measures on non-palliative wards at two university hospitals will be implemented and evaluated. In the first project phase, the current state of non-specialist inpatient care in the dying phase was assessed. Methods: Online survey with national health care professionals in the field of care in the dying phase. The survey consisted of seven open-ended questions on important issues, facilitators, barriers and needs for improvement regarding the care for patients dying in hospitals as well as COVID-19 pandemic specifics. Qualitative data was analyzed thematically. Results: Of 67 participants, 66% worked in clinical practice, 34% in managerial positions. We identified five relevant topics of care in the dying phase: involvement of relatives;symptom control;patient-centeredness;professional competencies;as well as time, space and human resources. Participants aimed to uphold patient-centeredness as a priority in the dying phase despite reporting needs for improvement in all topics: 'Everything that is good for the patient is allowed.' This contrasts with the experience during the pandemic, when involvement of relatives and patient-centerednesswere hard to maintain due to visiting restrictions and high workload - leading to patient isolation and dying in loneliness. Conclusions: The survey revealed common topics on care in the dying phase from the perspective of health professionals to be targeted by ward-specific measures. Difficulties due to the pandemic have to be considered for optimal care in the dying phase under exceptional circumstances. The results can help to develop and implement context-specific measures to improve quality of hospital care during the dying phase.