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

Managing death in the emergency department (ED) 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 (EOL) care in the ED. EOL care is the care delivered to a patient during the time directly preceding death. Data were collected from 25 emergency nurses by focus group interview. The interviews were transcribed and analysed using the qualitative techniques of grounded theory. Ten categories emerged from the data that described a social process for managing death in the ED. The categories were linked via the core category labelled 'dying in the ED is not ideal'. Dying in the ED is not ideal described how the ED was an inappropriate place for death to occur. To help manage the influence of the ED environment on EOL care, emergency nurses described a social process that reported strategies that included moving dying patients out of the ED and providing the best EOL care that they could with the facilities that they had. The presence of contextual determinants related to treatment orders, knowing a patient's wishes, and patient circumstances influenced the application of the strategies. However when the strategies failed, the consequences of death in the ED were based on the inability of emergency nurses to provide a dying patient with a 'good' death. The results of this study highlight emergency nurses' belief that the ED is not an appropriate place for death to occur. The perception of the ED as an inappropriate setting for death suggests the lack of fit of EOL care pathways as a solution to meet the EOL care needs of dying patients in the ED.