Research paper
The experiences of emergency nurses in providing end-of-life care to patients in the emergency department

https://doi.org/10.1016/j.aenj.2014.11.001Get rights and content

Summary

Background

Managing death in the emergency department is a challenge. Emergency nurses are expected to provide care to numerous patient groups in an often fast-paced, life-saving environment. The purpose of this study was to describe the experiences of emergency nurses in providing end-of-life care, which is the care delivered to a patient during the time directly preceding death.

Method

Data were collected from 25 emergency nurses during three focus group interviews. The interviews were transcribed and analysed using the qualitative techniques of grounded theory.

Results

Ten categories emerged from the data that described a social process for managing death in the emergency department. The categories were linked via the core category labelled ‘dying in the emergency department is not ideal’, which described how the emergency department was an inappropriate place for death to occur. To help manage the influence of the environment on end-of-life care, nurses reported strategies that included moving dying patients out of the emergency department and providing the best care that they could.

Conclusion

The results of this study highlight nurses’ belief that the emergency department was not an appropriate place for death to occur. Despite being frequently exposed to death and dying, the actions and attitudes of emergency nurses implied the need or desire to avoid death 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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      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.

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