Providing end of life care in the emergency department: A hermeneutic phenomenological study

Ellie Burnitt; Laurie A Grealish; Julia Crilly; Katya May; Jamie Ranse

doi:10.1016/j.auec.2024.01.002

Providing end of life care in the emergency department: A hermeneutic phenomenological study

Australas Emerg Care. 2024 Feb 2:S2588-994X(24)00002-2. doi: 10.1016/j.auec.2024.01.002. Online ahead of print.

Authors

Ellie Burnitt¹, Laurie A Grealish², Julia Crilly³, Katya May⁴, Jamie Ranse⁵

Affiliations

¹ School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia. Electronic address: ellie.burnitt@health.wa.gov.au.
² School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Gold Coast Health, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
³ School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Mental Health, Griffith University, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia.
⁴ School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia.
⁵ School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia.

PMID: 38310030
DOI: 10.1016/j.auec.2024.01.002

Abstract

Background: Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department.

Methods: A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken.

Findings: Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department.

Conclusions: Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.

Keywords: Emergency department; Emergency nursing; End of life; Hermeneutics; Older persons; Phenomenology.