Acute hospital care
From its origins outside mainstream health care in the 'hospice movement', palliative care is re-emerging as an integrated part of mainstream health care delivery (NCHSPCS 1996; Llamas et al. 2001), with the acute hospital setting playing a dominant role in the provision of care for patients with palliative care needs. Some authors have questioned the transferability of palliative care to the acute hospital setting. The benefits of palliative care are described as being context-specific, particularly with regard to the caring relationships and collegial commitment of team members in a hospice setting, which may not be as effective when transferred to the acute care setting (Rumbold 1998). Furthermore, the biomedical approach of acute hospitals is considered to over-emphasize the medical and physical aspects of care in the delivery of palliative care (Rumbold 1998; Street 1998). Hospice care is, however, not accessible to everyone (NCHSPCS 2000) and nurses on wards within the hospital setting continue to have responsibility for a significant number of patients with palliative care needs and their families. In general, as many as 90 per cent of people may need some in-patient hospital care in their last year of life and 55 per cent of all deaths in the UK occur in hospital (Ramirez et al. 1998). This suggests that there is a need for skilled and compassionate palliative care for patients with palliative care needs within the hospital setting whatever challenges this environment may pose.
In this chapter, I focus on the provision of general and specialist palliative care services within the hospital setting and the challenges faced by nurses when attempting to integrate the principles and practices of palliative care in this setting. General palliative care is described as a vital and integrated part of the routine clinical practice delivered by the usual professional carers of the patient and family with low to moderate complexity of palliative care need. Specialist palliative care services are provided by professional carers who specialize in palliative care for patients and their families with moderate to high complexity of palliative care need (NCHSPCS 2002). The chapter is divided into four sections. First, I examine the prevalence of