Emergency nurses' suggestions for improving end-of-life care obstacles.
BACKGROUND
More than 123 million ED visits are reported annually. Many patients who arrive for care to help extend their lives instead die while in the emergency department. Emergency departments were designed to save lives rather than to provide optimal end-of-life (EOL) care. Emergency nurses care for these dying patients and their families. The purpose of this study was to determine what suggestions emergency nurses have for improving EOL care.


METHODS
Emergency nurses were asked which aspects of EOL care they would like to see changed to improve how patients die in emergency departments. Of the 1000 nurses surveyed, 230 provided a total of 295 suggestions for improving EOL care. Content analysis was used to identify categories of qualitative responses. Responses were coded individually by research team members and then compared with ED EOL literature. Clusters of data were formulated to form themes with sufficient data returned to reach saturation.


RESULTS
Five major themes and four minor themes were identified. The major themes were increasing the amount of time ED nurses have to care for dying patients, allowing family presence during resuscitation, providing comfortable patient rooms, providing privacy, and providing family grief rooms.


CONCLUSIONS
Large numbers of patients seek care in emergency departments. Emergency nurses are often called on to care for dying patients and their families in this highly technical environment, which was designed to save lives. Emergency nurses witness the obstacles surrounding EOL care in emergency departments, and their recommendations for improving EOL care should be implemented when possible.
College of Nursing, Brigham Young University, Provo, UT 84602, USA. renea@byu.edu
Renea L
RL
Beckstrand
R Daniel
RD
Wood
Lynn C
LC
Callister
Karlen E
KE
Luthy
Sondra
S
Heaston
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D016529:Emergency Nursing / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D011368:Professional-Family Relations; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*; D014481:United States