Introduction: The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected.
Aim: This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED.
Methods: Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically.
Results: 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected.
Conclusions: ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.
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http://dx.doi.org/10.1016/j.ienj.2019.100789 | DOI Listing |
Oncologist
December 2024
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan 333, Republic of China.
Background: Worldwide patient-caregiver concordance on cognitive prognostic awareness (PA) has been extensively examined, but concordance on sufficient (ie, cognitive and emotional) death preparedness is unexplored. We comprehensively examine the evolution of patient-caregiver concordance on death preparedness over the patient's last 6 months.
Materials/methods: This study re-examined data from 2 cohort studies on 694 dyads of cancer patients and their caregivers recruited from a single medical center in Taiwan.
Ann Surg Open
December 2024
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK.
Objective: To synthesize evidence of surgical treatment intensity, defined as a measure of the quantity of invasive procedures, received by patients in patients with cancer within a defined time period around the 'end of life' (EoL).
Background: Concern regarding overly 'aggressive' care or high health care utilization at the EoL, particularly in cancer, is growing. The contribution surgery makes to the quality and cost of EoL care in cancer has not yet been quantified.
JCO Oncol Pract
December 2024
Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
Purpose: We previously demonstrated that early completion of portable medical orders, known as Medical Orders for Life-Sustaining Treatment (MOLST), was associated with lower-intensity care at the end of life (EOL) for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The purpose of this study was to investigate the impact of a MOLST form completed before hospitalization on the cost of inpatient care during the last 30 days of life for patients with AML and MDS.
Methods: We conducted a retrospective study of 271 adult patients with a diagnosis of AML or MDS who died between January 1, 2014, and December 31, 2019, and received care for their hematologic malignancy at the University of Rochester Medical Center (URMC).
Emerg Med J
December 2024
Emergency Medicine, Cork University Hospital, Cork, Ireland.
Background: Patients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish setting, there is limited literature on the provision of EoLC in EDs and this study, therefore, aimed to evaluate the perceptions of emergency medicine (EM) clinicians regarding the provision of EoLC in EDs in Ireland.
Methods: The End-of-Life Care in Emergency Department Study was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Ireland.
J Palliat Med
December 2024
Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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