title: Exploring the Management of Death: Emergency Nurses' Perceptions of Challenges and Facilitators in the Provision of End-of-Life Care in the Emergency Department.
abstract: BACKGROUND
  The importance of end-of-life (EOL) care for dying patients and their families is well described; however, little research has been performed in emergency settings. The purpose of this study was to explore emergency nurses' perceptions of challenges and facilitators in the care of patients at the EOL.
  
  
  METHODS
  A mixed-methods design using survey data (N = 1,879) and focus group data (N = 17). Data were collected on questions regarding care of the EOL patient in the emergency department, specifically nurses' perceptions of the care of these patients; educational content needs; barriers to safe and effective care; and the availability of resources.
  
  
  RESULTS
  High scores on the quantitative survey showed a high mean level of consistently positive attitudes and beliefs toward caring for dying patients and their families and loved ones (131.26 ± 10.88). Analysis of the focus group transcripts uncovered 9 themes, reflecting concerns around comfort and challenges with EOL care, appropriate training for nurses, and the availability of resources to provide this type of care in the emergency setting. Also noted was dissonance between the nature of emergency care and the nature of EOL care.
  
  
  CONCLUSIONS
  Emergency nurses are comfortable providing EOL care in the emergency setting but note that challenges to providing good care include lack of space, time, and staff. Other challenges involve the mismatch between the goals of emergency care and those of EOL care, as well as the emotional burden of caring for the dying, especially when the appropriate resources are lacking.
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA. Electronic address: lwolf@ena.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Wolf
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Altair M
authors.initials: AM
authors.lastname: Delao
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Cydne
authors.initials: C
authors.lastname: Perhats
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Clark
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moon
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Baker
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Carman
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Zavotsky
authors.affiliation: Des Plaines, IL; Louisville, KY; San Antonio, TX; Richmond, VA; Durham, NC; New Brunswick, NJ; Boston, MA.
authors.forename: Gail
authors.initials: G
authors.lastname: Lenehan
mesh_terms: D001291:Attitude of Health Personnel; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*
keywords: Emergency department; End-of-life care; Mixed methods; Nursing