Lived experience of caring for dying patients in emergency room

Abstract

Findings of the study influence nursing policies toward enhancing education of nurses regarding palliative and end-of-life care in emergency settings. These findings can also influence the value of caring-healing environments for critical and dying patients and their families. Policies can focus on practice and education of families particularly about end-of-life care for critical and dying patients.

Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review

“…This was the most common theme to emerge (Bailey et al, 2011b, Bailey et al, 2011c, Grudzen et al, 2011, Wolf et al, 2015, Kongsuwan et al, 2016, Smith et al, 2009, Decker et al, 2015, Chan, 2011, Weil et al, 2015, Marck et al, 2014. Patients are seen as 'living' and the focus is on preserving life, until life ends, therefore there is no period of time where a patient is said to be 'dying' (Bailey et al, 2011c) .…”

“…In a further paper (Bailey et al, 2011c) found that staff felt that the Emergency Department was not appropriate for end of life care and that death was seen as out of place, with the dead body almost seen as taboo, to be hidden away, staff perceiving the body itself to be a physical sign of failure. Failure in the context of Emergency Department death is mentioned by Marck et al (2014) and Kongsuwan et al (2016). One nurse participant is quoted as saying that 'palliative care in the Emergency Department is focusing on saving life' (Kongsuwan et al, 2016), thus denying the possibility of death being seen as a natural part of life.…”

“…Failure in the context of Emergency Department death is mentioned by Marck et al (2014) and Kongsuwan et al (2016). One nurse participant is quoted as saying that 'palliative care in the Emergency Department is focusing on saving life' (Kongsuwan et al, 2016), thus denying the possibility of death being seen as a natural part of life. One study of the views of clinical staff, found that stigma was associated with dying in the Emergency Department, especially if the dying patient was young -'it looks like [the Emergency Department] didn't do their job' (Wolf et al, 2015).…”

“…A lack of time is echoed in the work of Kongsuwan et al (2016) , Decker et al (2015) and Marck et al (2014). Findings indicated that the stress of being unable to provide what the participants describe as a 'peaceful' death ( due to lack of time) was particularly great for the nurses in Kongsuwan et al's study, partly perhaps because, as the writers remark, the study took place in a prominently Buddhist country where the concept of a peaceful death is particularly important to practitioners of the Buddhist faith for spiritual reasons (Kongsuwan et al, 2016). The participants in Deckers (2015) study describe a less than optimal death trajectory as one in which there is no time and no space to care for patients and relatives during and after death in the Emergency Department (Decker et al, 2015).…”

“…The use of distancing behaviours was mentioned in seven of the studies. Caring for carers both during the dying process and following death was seen as particular challenging (Bailey et al, 2011c, Kongsuwan et al, 2016, Decker et al, 2015. A lack of time, and perhaps emotional energy are cited as reasons for this with some staff reporting to use distancing behaviours towards carers because they do not have the time or ability to get more 'involved' (Bailey et al, 2011b, Decker et al, 2015, and some staff report a feeling of almost resentment towards the carers because of a perception that very sick patients at end of life present to the Emergency Department because carers cannot cope (Smith et al, 2009).…”