Research paperThe experiences of emergency nurses in providing end-of-life care to patients in the emergency department
Introduction
The care of dying patients in the Emergency Department (ED) is an important and challenging issue.1, 2, 3, 4, 5 EDs are high-stress, fast-paced and often chaotic environments. The role of contemporary EDs is to provide treatment for people following a traumatic or acute injury or illness. Such an environment creates a unique set of challenges that impacts emergency nurses’ ability to provide quality end-of-life (EOL) care. With advances in medical technologies, people are growing older and living longer with their chronic illnesses and co-morbidities. Consequently EDs are increasingly caring for patients in need of palliative and EOL care.2, 3, 4 However, little is known about how people die and the care provided to patients at the EOL in EDs in Australia.
Section snippets
Background
EDs are commonly perceived as the scene of care where patients present suddenly and unpredictably following a traumatic or acute event with life-threatening illnesses or injuries. Subsequently, death in the ED is typically associated with sudden and traumatic circumstances or as a result of a failed resuscitation. However, with advances in medical technologies, people are growing older and living longer, and an increasing number of the elderly and people with advanced chronic illnesses are
Aim
This study aimed to describe the experiences, attitudes and beliefs of emergency nurses in providing EOL care to patients. In particular, this study aimed to examine how emergency nurses managed EOL in the ED and responded to the needs of dying patients in facilitating a good death.
Methods
A qualitative descriptive study informed by symbolic interactionism and grounded theory was used in this study. Semi structured focus group interviews were used to collect the data. The interview questions were designed to prompt participants to discuss definitions of EOL care, identify what types of patients receive and/or need EOL care, how care was provided, if they had experienced good and/or bad EOL care, and why that was the case.
Participants were recruited from three EDs within an
Results
The aim of the data analysis was to identify a social process about the core issue and strategies used by emergency nurses when providing EOL care. Data were collected from 25 emergency nurses by focus group interview. The categories that emerged from the data described a social process, ‘death not in the ED’, that emergency nurses applied to reduce the likelihood of death occurring in the ED. The categories were linked by a core category, identified as ‘dying in the ED is not ideal’.
Death not in the ED
The results of this study highlight that participants believed that the nature of emergency work creates a unique set of obstacles that results in the inability to provide good EOL. This study supports several other studies findings that suggest that the ED is ‘not an appropriate place for death’ because the environment is busy, noisy and lacking in privacy and specific palliative care expertise.1, 2, 5, 14, 18 Similar to the findings of this study, several other studies identified a lack of
Conclusion
The purpose of this study was to describe the experiences, attitudes and beliefs of emergency nurses in providing EOL care to dying patients. In particular, this study aimed to examine the social process that emergency nurses implemented to manage death in the ED.
The first major finding of this study was the identification that the ED was not the ideal place for death to occur based on environmental and attitudinal obstacles. The second major finding was that dying patients were moved out of
Funding
This study received no funding.
Authors’ contributions
KD, JM and SL designed, conducted and analysed the data. KD prepared the draft manuscript. All authors contributed and approved the final manuscript for publication.
Provenance and conflict of interest
There are no conflicts of interest. This paper was not commissioned.
Acknowledgment
The authors acknowledge the emergency nurses who volunteered their time and expertise to participate in this study.
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Missed nursing care in emergency departments: A scoping review
2023, International Emergency NursingEmergency department staff perceptions of their roles in providing end of life care
2023, Australasian Emergency CareCitation Excerpt :Like the findings in this study, current research has shown that nurses are responsible for all the physical, emotional, and spiritual care of the patients and their families when a patient was dying [15,19]. Although the focus of the studies from the literature were often based on some aspects of care, for example one study looked at the roles of doctors and nurses regarding spirituality [19], and another focused on the impact of high workload and environmental disadvantages [15], but like this current study nurses reported that the demands of their role caused a significant emotional burden. Emotional burden experienced by doctors and nurses in this study referred to a state of taking on the feelings (loss, pain, grief, sadness) of another person [20].
The end-of-life care practices of emergency care nurses and the factors that influence these practices: An integrative review
2022, International Emergency NursingCitation Excerpt :Angry and distraught family members complicated the delivery of comfort care to the patient at the EOL [26,31,33,38,46]. Families that expressed extreme emotions took the nurse’s attention away from the dying patient [26,33,38,40,45,46]. The trajectory of the patient’s death also influenced EOLC practice.
End-of-life care in emergency departments: A national cross-sectional survey of emergency care nurses
2022, Australasian Emergency CareCitation Excerpt :Moreover, items in the palliative values scale attained the highest mean scores among the scales of Factors influencing EOLC provision, indicating a positive attitude towards EOLC amongst emergency care nurses. However, as highlighted in previous literature [24,38,39,42], in light of various organisational, environmental, and personal barriers, this generally positive attitude towards EOLC may not necessarily translate to frequent engagement in EOLC practices. Participants who perceived greater support from colleagues and managers reported more frequent engagement in EOLC practices.
The perspective of professional caregivers working in generalist palliative care on ‘good dying’: An integrative review
2022, Social Science and MedicineCitation Excerpt :From the perspective of professional caregivers, such futile treatments caused more misery than benefits for the patients, and consequently their cessation was found as a means of reducing pain and suffering (Adesina et al., 2016; Becker et al., 2017; Beckstrand et al., 2006; Bennett and Proudfoot, 2016; Bratcher, 2010; Cagle et al., 2017; Cipolletta and Oprandi, 2014; Costello, 2006; Demir et al., 2017; Díaz-Cortés et al., 2018; Dillon et al., 2018; Endacott et al., 2016; Fernández-Sola et al., 2017; Kongsuwan et al., 2010; Kupeli et al., 2016; McCallum and McConigley, 2013; Nagoya et al., 2016; Srinonprasert et al., 2019). However, professional caregivers described how this ideal may be counteracted by strong expectations of physicians or the patients' families in medicine, a lack of acceptance of death (Beckstrand et al., 2006; Cipolletta and Oprandi, 2014; Decker et al., 2015; Demir et al., 2017; Díaz-Cortés et al., 2018), or by the ‘logic’ of certain care contexts that focus on saving lives (McCallum and McConigley, 2013). These may lead to futile treatments from the perspective of professional caregivers.