Defining dignity in end-of-life care in the emergency department

Abstract

Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.

Characterization, conservation and loss of dignity at the end‐of‐ life in the emergency department. A qualitative protocol

“…We trust that the emerging themes will be able to contribute to comprehending the phenomenon of the dignity in end‐of‐life care in the Emergency Department. Previous studies have shown that dignity in end‐of‐life care should be understood as a person's inherent value, where socio‐environmental conditions and conscious actions/attitudes are also involved as attributes of dignity (Fernández‐Sola et al., ). Other studies have identified the main problems that, according to professionals, affect dignity in the ED.…”

“…Not recognizing the imminence of death, the lack of knowledge or the inadequacy of palliative care all continue to contribute to the dying patient's arrival in the ED. However, the ED is a space designated for looking after those who are acutely ill, where death is associated more with the failure of science than an unavoidable stage of life (Fernández‐Sola et al., ).…”

“…Although research in this field is exhaustive, phenomenological studies have demonstrated their value in exploring patients’ experiences at the end of life in areas such as critical care (King & Thomas, ). The Gadamerian hermeneutic phenomenology (Gadamer, ), which includes concepts like “pre‐understanding” and “fusion of horizons” as the nuclear axis of the interpretation phenomenon; together with Chocinov's model (Chochinov, , ; Chochinov, Hack, McClement, Kristjanson, & Harlos, ; Fernández‐Sola et al., ), which explains the phenomenon of dignity at the end of life in categories such as “problems related to illness”, “dignity‐conserving repertoire” and “social dignity inventory”, have proven to be appropriate theoretical and methodological frameworks for the study of dignity in end‐of‐life care.…”

“…Various studies have already noted the need to define dignity, identify its loss and promote its preservation in places such as the ED (Beckstrand, Wood, Callister, Luthy, & Heaston, ; Sepúlveda et al., ). Some phenomenological studies have already incorporated the experiences of healthcare professionals, mostly ED physicians and nurses (Díaz‐Cortés et al., ; Fernández‐Sola et al., ; Granero‐Molina, Díaz‐Cortés, Hernández‐Padilla, García‐Caro, & Fernández‐Sola, ). However, it is necessary to research the phenomenon in other contexts and to incorporate the experiences of the patients and their relatives.…”

Patient Dignity at The End-Of-Life: Is it Possible in Critical Care?

“…Focused on attending to acute, life-threatening pathologies, caring for a dying patient in the ED can lead to problems related to stress, communication, fear and loneliness, and carries the risk of losing privacy, confidentiality and dignity [12]. For physicians and nurses, the dignity of a dying person in the ED is a value inherent to the person, as is respecting his/her autonomy, allowing accompaniment and respecting human rights [14]. The loss of this dignity may result from the dying person being exposed to a "cold" world, improvised care, a lack of physical space in which to die, family members' obstinacy and/or a lack of a palliative care culture in the ED [15].…”