Letting go : a qualitative study of acute care and community nurses' perceptions of a 'good' versus a 'bad' death

This paper presents one aspect of an interpretative study exploring nurses' perceptions of the care provided to end-stage heart failure (ESHF) patients in community and hospital settings. One overarching theme related to nurses' perceptions is the need to facilitate a ‘good’ death for ESHF patients. The nurses voiced considerable opinion on what should occur to realise a ‘good’ death and, by comparison, described what they perceived as a ‘bad’ death. Of significance, was the need to plan for death if it were to be considered ‘good’.The nurses advocated ‘letting go’ of vain hopes for a cure and facilitate time in the dying process. This could allow for earlier involvement of the palliative care team. Although nurses in acute care and community settings provided clear descriptors of what constituted a ‘good’ or a ‘bad’ death, a ‘good’ death was more prevalent in community settings. Medical professionals' reluctance to diagnose ESHF and their tendency for curative medical treatments to patients even when death was imminent impeded palliation and contributed to a ‘bad’ death. Contradictory approaches to end-of-life care by palliative and cardiac teams ultimately impacted on the end-of-life trajectory experienced by the patient and family.