Conflict Experienced by Nurses Providing End-of-life Care in Emergency Departments in Japan

Abstract

Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.

Emergency care nurses' perceived self‐competence in palliative care and its predictors: A cross‐sectional study

“…This study identified that non‐married nurses had a lower PC self‐competence than married nurses. Previous studies have similarly reported that single nurses experienced stronger conflicts and bear a greater emotional burden when facing difficulties during work than married nurses, owing to a lack of family support (Satake & Arao, 2019). As less experienced members of the team, it is challenging for single nurses to develop optimal patients' PC plans with other professionals and manage conflicts arising in the care of dying patients and their families.…”

“…On the contrary, nurses who had interactions with dying patients considered they did not have enough time to provide ongoing PC due to a heavy workload. This is a common misconception (Satake & Arao, 2019). This finding is in line with previous studies among hospice nurses (Barnett & Adams, 2020) and oncology nurses (Nguyen et al, 2014; Shen et al, 2019).…”

“…On the contrary, nurses who had interactions with dying patients considered they did not have enough time to provide ongoing PC due to a heavy workload. This is a common misconception (Satake & Arao, 2019).…”

“…However, an ED is a chaotic and dynamic workplace, providing resuscitative efforts to an individual with a sudden illness. Challenges for emergency care nurses in providing optimal palliative nursing included time constraints, understaffing, poor design, poor communication and deficient PC training (Alqahtani & Mitchell, 2019; Gloss, 2017; Satake & Arao, 2019). Healthy work environments are multifaceted, and research investigating how healthy work environments influence PC competence is limited.…”

End of life – The nurses’ perspective

“…2 Thus involving the nurses in the multidisciplinary decision making of EOL care will be beneficial.Nurses play a very important role in EOL care by providing family care and collaborating with the rest of the medical team. 5 Working as a nurse within the wider ICU team requires good collaborative and communication skills and few studies have focused on how we foster these skills to enhance EOL care in the ICU. Little is known about the role of nurses in end of life in the critical care setting, and therefore a grounded theory study in this area is needed to further understand this important role.…”