“Resuscitate and Push”: End-of-Life Care Experiences of Healthcare Staff in the Emergency Department – A Hermeneutic Phenomenological Study

Abstract

Objective Care in the emergency department focuses significantly on delivering lifesaving/ life-sustaining clinical actions, often with limited attention to health-related suffering even at the end-of-life. How healthcare staff experience and navigate through the end-of-life phase remains minimally explored. Thus, this study aimed to uncover the lived experiences of emergency department staff at the end-of-life. Methods van Manen’s hermeneutic phenomenological approach was used. Nineteen healthcare staff were purposively recruited and interviewed. Interviews were audio-taped, transcribed verbatim, and thematic categories formulated. The existential lifeworld themes (corporeality, relationality, spatiality, and temporality) were used as heuristic guides for reflecting and organizing the lived experiences of participants. Results The overarching category, ‘ resuscitate and push’, was captured as corporeality (resisting death and dying); relationality (connectedness to the body of the patient; and lacking support for family and self); spatiality (navigating through a liminal space and lack of privacy for patients); and temporality (having limited to no time for end-of-life care and grieving). The end-of-life space was unpleasant. Although participants experienced helplessness and feelings of failure, support systems to help them to navigate through these emotions were lacking. Grief was experienced covertly and concealed by the entry of a new patient. Conclusion End-of-life in the emergency department is poorly defined. In addition to shifting from the traditional emergency care model to support the streamlining of palliative care in the department, staff will require support with navigating through the liminal space, managing their grief, and developing a better working relationship with patients/ families.

Experiences of Nurses Caring for Children Under Five Years with Burns at a Teaching Hospital in Ghana

“…The mere fact they watch these children cry in pain stresses them so much. This study finding is consistent with 29 who identified Grief, sadness and helplessness as critical themes that emerged from a similar study.…”

Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

“…This is dissimilar to a previous study that assessed perspectives of promoting advance directives among nurses working in a hemodialysis room, in which more than 65% of those nurses were worried that discussing advance directives with patients might cause annoyance or discomfort [10]. A possible reason might be that as critical care nurses are frontline care providers who care for critically ill patients, they understand that advance directives would be one of the options to provide better end-of-life care and they have to face many patients with terminal illnesses and dying patients [19,20]. Also, we identified that compared to nurses who work in medical ICUs, those who work in cardiac and respiratory ICUs have lower motivation to promote advance directives.…”

Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives

“…Death is not welcomed in many societies 39 ; however, stroke patients' extensive struggles, avoidance over discussion of death, and communication difficulty at a late stage necessitate early action. Delineating the late stage survival situation and caregiving burden may outweigh some barriers of initiating PC early on, such as patients and family members' lack of awareness and professionals' reluctance to open difficult conversations 40,41 . Health professionals are in a unique position with expertise to initiate advance care planning to fully introduce PC 40 .…”

“…Delineating the late stage survival situation and caregiving burden may outweigh some barriers of initiating PC early on, such as patients and family members' lack of awareness and professionals' reluctance to open difficult conversations. 40,41 Health professionals are in a unique position with expertise to initiate advance care planning to fully introduce PC. 40 To fill in the huge human resource gaps in PC service, professionals should be trained in a culturally and contextually appropriate approach to hone skills in physical care, communication, emotional support, and cognitive stimulation.…”