title: Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care.
abstract: BACKGROUND
  Emergency nurses care for dying patients daily. The process of dying in an emergency department can be complicated. Research on specific obstacles that impede the delivery of end-of-life care in emergency departments and behaviors that support it is limited.
  
  
  METHODS
  A 70-item questionnaire was mailed to randomly selected ENA members. Subjects were asked to rate items on the size, frequency, and magnitude of obstacles and supportive behaviors that relate to end-of-life care for ED patients.
  
  
  RESULTS
  The perceived obstacles with the greatest magnitude were as follows: (a) ED nurses' work loads being too high to allow adequate time for patient care, (b) poor design of emergency departments, and (c) family members not understanding what "life-saving measures" really mean. The three highest-scoring supportive behaviors were as follows: (a) allowing family members adequate time to be alone with the patient after he or she has died; (b) having good communication between the physician and RN; and (c) providing a peaceful, dignified bedside scene for family members once the patient has died.
  
  
  CONCLUSIONS
  It is hoped that the results of this study will help increase and facilitate the discussions regarding end-of-life care in emergency departments. Realistic initial implications include finding ways to decrease workloads of emergency nurses and increase direct patient care. Another important implication would be the improvement of ED designs. Further research in the area of end-of-life care in emergency settings is recommended.
authors.affiliation: Brigham Young University, College of Nursing, 422 SWKT, PO Box 25432, Provo, UT 84602-5432, USA. renea_beckstrand@byu.edu
authors.forename: Renea L
authors.initials: RL
authors.lastname: Beckstrand
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Smith
authors.forename: Sondra
authors.initials: S
authors.lastname: Heaston
authors.forename: A Elaine
authors.initials: AE
authors.lastname: Bond
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016529:Emergency Nursing / Q000193:education / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007374:Interior Design and Furnishings; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D011368:Professional-Family Relations; D012944:Social Support; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration / Q000523:psychology; D013997:Time Factors; D014481:United States; D016526:Workload / Q000523:psychology