Psychosocial aspects of terminal care. A preliminary study of nurses' attitudes and behaviour in a general hospital.

American research has shown that dying patients in general hospitals are unpopular with health care personnel who withdraw from them socially while maintaining adequate physical care. Some of the reasons for this may be doctors' control of patient care and their own fears of death or perception of patient death as failure. Most doctors would not permit patients to know of a poor prognosis and this often leads to 'closed awareness' in which both nurse and patient are aware of the eventual outcome, but the nurse is forbidden to discuss this and so cannot encourage 'dangerous' conversation in the patient. This study was designed to replicate some of the American findings and confirmed that nurses are ill-prepared to deal with death, withdraw socially from terminal patients and have no authority to discuss dying. The findings are discussed in terms of nurse education and implications for professional autonomy and responsibility.