The significance of social environments in the care of the terminally ill

Abstract

This thesis examined the social environments of persons afflicted with a terminal illness in order to understand what significant effects such environments have on the terminally ill and their families. The terminally ill were defined as those persons diagnosed as having a fatal, incurable illness for whom nothing more in a curative way could be done. For the purposes of this paper, since they constitute the majority of the terminally ill, only those afflicted with cancer were subjects of this investigation. This study began after medical intervention and prognosis had taken place and focused upon subsequent care. It was undertaken in the Wellington area and carried out with the permission of the general practitioners in charge of the cases and the Community Health Service. Observations and interviews with terminally ill patients were undertaken over a six-month period. Two independent but parallel developments have contributed to the model of health care operating in Wellington for the care of the terminally ill cancer patients. Hospice-concept care programs appear to have evolved in the Wellington area coincidental with 1) the creation of the oncology nurse specialty position by the Community Health Service and 2) the practice of admitting overflow cancer patients from Wellington Hospital to the then Calvary Hospital, now The Mary Potter Hospice, and the establishment of Te Omanga Hospice in Lower Hutt. The health services program of home care achieved a fit with a voluntary hospice-concept of care and a service model evolved which has provided a significant terminal care environment for dying patients. It was found in the study that the role of the oncology nurse may be overdemanding. Further, that general practitioners spent less time with terminally ill patients than nurses resulting in a shift in dependence of patients from doctors to nurses, which may be responsible for role strain in doctors and role ambiguity in nurses. The establishment of two hospices, which appeared to fill a deep need in terminally ill patients and their families, was supported by voluntary agencies and was not structurally integrated into the health care delivery system. The findings may have implications for individuals, families, medical personnel and health care planners.