Wendy Ann Webb, Queen’s Nurse, PhD Student and Florence Nightingale Research Scholar, explains the background to her PhD research and a longer article published in the March/April edition of the European Journal of Palliative Care.
Over the past 18 years, I have worked as a palliative care nurse in five different hospices. I have also worked with the homeless community in four different roles. I noticed that homeless people were not being admitted to the hospices where I worked, and I began to wonder where, and whether, they were being cared for at end of life. For my MSc dissertation in 2013, I decided to research end-of-life care within hostels in the UK (Webb, 2015). The findings had a significant impact on me and I knew that my work in this area was far from finished.
Through the interviews conducted with staff from several hostels, I heard how people experiencing homelessness often died undignified deaths in inappropriate, communal, hostel settings where staff received no training or support from healthcare professionals; a finding later affirmed by the landmark Care Quality Commission report ‘A second class ending’ (Care Quality Commission, 2017).
One research participant pointed out how unfair this seemed as: “these people have not had much dignity [in life] anyway”. Another told me that that one dying resident “was found dead [by other residents] in the early hours of the morning”.
Alongside my MSc research, I worked as a volunteer nurse in drop-in clinics for homeless people. As I gently redressed laceration wounds resulting from deliberate self-harm activity and abscess wounds from injecting drugs, clients often shared personal life stories about the trauma of the adverse childhood experiences (ACEs) they had lived through. One man in his 20s, addicted to heroin and with severe mental health issues, shared how he had been raped by his uncle as a child and had watched his own brother murder his mother. I found myself wondering how his life would one day end. I also wondered how I would have coped in any of their shoes. My compassion for people experiencing homelessness deepened and soon I found myself applying for a PhD – determined to make some small difference to the end-of-life experiences of people who have often had such a difficult start in life.
I became aware of the need to find out what matters most for homeless people when they consider their own end of life, so that appropriate, relevant services can be planned for this vulnerable, marginalised group. My PhD research is therefore exploring end-of-life preferences and priorities within the homeless population.
Research data are currently being analysed and I will soon be able to share my findings and interpretations. I hope to be able to stimulate further discussion regarding the types of services required to meet the priorities, and often complex needs of homeless people at the end of life.
Care Quality Commission (2017) A SECOND CLASS. ENDING: Exploring the barriers and championing outstanding end of life care for people who are homeless. Download a copy here.
Webb, W. A. (2015) ‘When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people’, International Journal of Palliative Nursing, 21(5), pp. 236–244. doi: 10.12968/ijpn.2015.21.5.236.
This post relates to the longer article, ‘Exploring end-of-life preferences of homeless people in the UK’ by Wendy Ann Webb, Theresa Mitchell, Brian Nyatanga and Paul Snelling, published in the March/April edition of the European Journal of Palliative Care (EJPC) 2018; 25 (2).
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Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog.