'Scripts’ for dying at home—displayed in nurses', patients’ and relatives’ talk

Abstract

Perceptions and expectations reflecting what constitutes a 'good' death that seem to exist in Western societies are explored and compared with those presented by five symptom control team nurses at their home visits to 54 terminally ill cancer patients. These perceptions and expectations are termed 'scripts' for dying and are derived from the nurses', patients' and relatives' audio-recorded conversations over a 3-month period. The elements of the 'scripts' used were identified as: (a) control of physical symptoms, (b) acceptance of cancer and its prognosis, (c) preservation of hope and 'will to live', (d) mobility and 'fighting back', (e) enjoyment of life, (f) a peaceful death at home. How these components are determined from the conversations are presented and the responses of the patients to the nurses' 'scripts' are analysed. The dilemmas created by putting the 'scripts' into action for nurses, patients and relatives are discussed.

A qualitative analysis of the information needs of informal carers of terminally ill cancer patients

“…This is perhaps an extreme example. However, it accords with the findings of Riggans (1992) who comments on the comfort people take from a relationship with a professional who appears to be understanding and sympathetic, and more especially with Hunt's (1989) contention that failure on the part of professionals to show such sympathy and understanding can be devastating to vulnerable people.…”

“…(1991) showed how highly informal carers of patients with stroke rated information, while Cobb (1976) and Shields (1984) see information as being a vital part of social support. Hunt (1989) and Riggans (1992) lend weight to this opinion, noting the value placed by families on sympathetic communication from professionals. Divisive information‐giving, where some members of a family are told something which is withheld from others, can therefore diminish the mutual support mechanisms which patients and carers can provide for one another ( Stedeford, 1981a,b; Chaitchik et al ., 1992 ).…”

Nurses’ and patients’ perceptions of expert palliative nursing care

“…1994). A high standard of care is necessary to achieve a good death, particularly in the areas of pain and symptom control (Hunt 1992). Indeed, a pervasive concept amongst healthcare professionals and patients was a ‘pain free death’ (Wilkes 1993, McNamara et al.…”

“…Current evidence reveals that there is lack of consensus between healthcare professionals and patients on what constitutes a good death, and the lack of studies on patients' views of a good death make it difficult to draw conclusions in this area. Nevertheless, the literature shows that healthcare professionals perceive a good death to be a physical and psychological process affecting a person's quality of life (Stephen 1991/1992, Hunt 1992, Wilkes 1993, McNamara et al 1994. A high standard of care is necessary to achieve a good death, particularly in the areas of pain and symptom control (Hunt 1992).…”

“…Nevertheless, the literature shows that healthcare professionals perceive a good death to be a physical and psychological process affecting a person's quality of life (Stephen 1991/1992, Hunt 1992, Wilkes 1993, McNamara et al 1994. A high standard of care is necessary to achieve a good death, particularly in the areas of pain and symptom control (Hunt 1992). Indeed, a pervasive concept amongst healthcare professionals and patients was a 'pain free death' (Wilkes 1993, McNamara et al 1994.…”