Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department

Abstract

There have been significant advancements in the fields of medicine, demography, and pathology. These disciplines have contributed to the classification and control of death and dying. People are now living longer with numerous comorbidities, and there is a significant aging population. Consequently, there have been increases in the numbers of people who present to emergency departments across Australia seeking access to care at the end of life. Emergency department staff must have the knowledge and skills required to provide end-of-life care in a setting that traditionally contradicts the goals of comfort care. With the increase in demand for end-of-life care in emergency departments, a gap exists in the experiences of how staff provide such care in this setting. As a result of this gap, it is important to understand the lived experiences of emergency department doctors and nurses who provide end-of-life care. The aim of this research is to understand the lived experiences of emergency department doctors and nurses concerning death, dying, and end-of-life care provision. Data were analyzed using Diekelmann's 7-step analysis to support Gadamer's phenomenological approach. Results indicate that challenges exist in the decision-making process of end-of-life care in emergency departments.

Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life

“…Demographical data were provided in numbers to describe the characteristics of the sample. 7,10 Qualitative data were analysed using seven stages of interpretative analysis (Table 1). 24 This method of analysis fits with the aims of a qualitative interpretive approach which is to fully understand people's lived experiences, in this case ED doctors and nurses, and the insights that arise from those experiences.…”

“…The focus on advance care planning, goals of care, and ACDs was part of a larger study about the experiences of ED doctors and nurses in providing end‐of‐life care. Demographical data were provided in numbers to describe the characteristics of the sample 7,10 . Qualitative data were analysed using seven stages of interpretative analysis (Table 1).…”

“…could potentially benefit from advance care planning led by ED clinicians. 8,10 Despite this, a recent Australian study found that only 13% of older adults who present to the ED had an ACD in place. 9 Similar statistics were reported in other developed countries such as the USA, where only 21% of patients who presented to the ED had an ACD documented, and only 37% of patients with a terminal illness diagnosis had advance care discussions in the month before death, although there are known benefits of having an ACD.…”

“…ED clinicians have been shown to be able to successfully predict prognosis at the end phase of life even up to a year before the dying phase 9 . Research has shown that a significant number of patients with advance illnesses could potentially benefit from advance care planning led by ED clinicians 8,10 . Despite this, a recent Australian study found that only 13% of older adults who present to the ED had an ACD in place 9 .…”