How nurses manage the transition to comfort-focused care for dying people in the acute hospital setting - A focused ethnography

Colquhoun-Flannery, Elizabeth and Walshe, Catherine and Goodwin, Dawn (2025) How nurses manage the transition to comfort-focused care for dying people in the acute hospital setting - A focused ethnography. PhD thesis, Faculty of Health and Medicine.

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Abstract

Comfort-focused care refers to when all treatment and interventions prioritise the comfort of the dying person instead of the focus being on investigations and interventions to prolong life. A delayed transition to comfort-focused care may leave little time to plan and implement high quality end-of-life care in line with the dying person’s wishes and values. As well as increased suffering experienced by the dying person, a delay in transition to comfort-focused care is associated with moral distress in nurses. In many countries around the world the majority of people die in hospital. Nurses spend more time directly caring for dying people than other healthcare professionals. However, little is known about how nurses manage the transition to comfort-focused care for dying people in acute settings. To begin this study, I conducted a systematically constructed literature review. The review question was: How do clinicians recognise people who are dying and what are the factors that influence this recognition? Recognising dying is an essential step in the transition to comfort focused care. I selected an integrative review methodology to guide the literature review. This enabled the inclusion of a range of research designs, including both qualitative and quantitative research. The analysis and synthesis produced three main categories: ‘Clues and signals’, ‘Recognition by others’, and ‘Culture, system and practice’. There were also three subcategories: ‘Knowing the patient over time’, ‘Intuition and experience’, and ‘Uncertainty’. The findings of this review informed and guided the empirical research that followed.