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.

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In a survey of 132 baccalaureate nursing programs in the United States, few had defined spirituality or spiritual nursing care. There is a paucity of literature on spirituality in nursing education. This article describes the integration of spirituality in a baccalaureate nursing program. Interventions such as establishing a trusting relationship, providing and facilitating a supportive spiritual environment, responding sensitively to the patient's spiritual and cultural belief systems, demonstrating caring, acknowledging the importance of "presence" during spiritual distress, and integrating spirituality into the plan of care are reflected in student clinical journal entries.

Oncology nurses are dedicated, experienced, and comfortable handling most issues in EOL care. Recommendations to support oncology nurses include strategies to interact effectively with angry, anxious, or overly optimistic family members as well as involving social work and palliative care staff on the oncology interdisciplinary team. In addition, the information regarding identified obstacles and supportive behaviors in oncology EOL care can be used to facilitate discussion and change within oncology interdisciplinary teams and improve EOL care for patients with cancer and their families.

Having a better understanding of emergency nurses' perceptions of obstacles and supportive behaviors in providing end-of-life care could help decrease the stress of caring for dying patients. Actions could be taken to decrease the highest rated obstacles and increase the ratings of supportive behaviors that may ultimately result in better end-of-life care for dying patients and their families in the emergency setting.