Promoting dignified end-of-life care in the emergency department: A qualitative study
Section snippets
Background
A human being’s dignity lies in the autonomy of a rational being capable of giving him/herself rules of action. For Immanuel Kant [1], this implies recognizing an internal value that makes one susceptible to treat him/herself, and all human beings, as an end and not as the means. The respect towards the dignity of human life is also extended to the process of death, modifying the clinical relationship [2]. The hospitalization of a dying person in the Emergency Department (ED) has implications
Study design
This study used a qualitative focus based on Gadamer’s hermeneutic phenomenological approach. The study took place in two southeastern Spanish hospitals. The total population was comprised of 205 individuals working in both EDs – of whom 98 were nurses, 31 were physicians and 71 were physicians in training.
Participants
The participants met the following inclusion criteria: to be a physician or a registered nurse, have a minimum of two years’ experience working in the ED and give consent for participation.
Results
The final sample comprised 26 participants with an average age of 38.12 years old and an average experience of 14.3 years in looking after patients in the ED. The sociodemographic characteristics of the sample can be seen in Table 2. From the analysis, 150 open codes emerged and 203 quotes were selected. After an interpretation process, these codes were reduced to 12 units of meaning grouped into four subthemes and two main themes (Table 3).
Discussion
This study contributes to understanding the actions and efforts made by physicians and nurses in the ED to preserve individuals’ dignity at the end of their lives. The participants have indicated that the ED is not an appropriate place for dignified end-of-life care. However, influenced by fragmented care, the overburden of the informal caregiver [18] and other clinical, demographic and environmental factors [16], many patients in the terminal phase, often due to acute exacerbation of symptoms,
Conclusions
The ED is not designed for end-of-life care provision, which may have negative effects on the dying patient’s dignity. Among the practices that ED professionals can adopt to minimize these effects are: 1) to care for dying patients with a particular sensitivity and attention to emotional matters, and 2) to take small measures to dignify the surroundings or limit the stay in an environment that is not appropriate for that moment. More far-reaching proposals include redesigning training
Declaration of conflicting interests
The Authors declares that there is no conflict of interest.
Funding
This work was supported by the Ministry of Economy and Competitiveness. Government of Spain. I + D Project FFI2016-76927-P (AEI/FEDER, UE).
Conflict interests
The Authors declares that there is no conflict of interest.
Ethical statement
This research was approbed by Institutional Research Ethics Committee. The participants were all informed about the study and signed an informed consent.
Funding source
This work was supported by the Ministry of Economy and Competitiveness. Government of Spain. I + D Project (FFI2016-76927-P).
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2022, International Emergency NursingCitation Excerpt :Dignity is therefore an inherent value of human beings and must be present in the health care received by patients in emergency services. The phenomenon of dignity in emergency services has been explored from the professionals' point of view [16]. However, there are no studies that analyze the preservation of the dignity of patients with advanced diseases in the emergency services from the experiences of their relatives.
The end-of-life care practices of emergency care nurses and the factors that influence these practices: An integrative review
2022, International Emergency NursingCitation Excerpt :Non-traumatic deaths, particularly that of elderly individuals, were perceived as more likely to be a peaceful death, and less time was spent on curative treatments for patients in this trajectory [6,31,39]. The typical ED was described as noisy, and lacking in space and privacy, thus, an especially prominent obstacle to EOLC [6,9,27,28,30,31,33,38,41,47,48], especially in being able to accommodate grieving family members [38,47,48]. Moreover, high workloads were often cited as reasons why nurses were unable to provide support, interact with EOL patients and families, and provide comfort care appropriately [26,30,31,38,40].
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2022, Social Science and MedicineCitation Excerpt :The majority of qualitative studies conducted their empirical work in an exploratory and descriptive manner and with no reference to an explicit and detailed theoretical framework. However, two qualitative studies used the Dignity-Conserving Care Model (Chochinov, 2002) as conceptual framework (Coenen et al., 2007; Díaz-Cortés et al., 2018). A few other studies located themselves in a symbolic interactionist (Decker et al., 2015; Todd, 2013) or phenomenological tradition (Hopkinson and Hallett, 2002; Karlsson and Berggren, 2011; Oliver and O'Connor, 2015; Volker and Limerick, 2007); one identified as ‘Phenomenographic Study’ (Terkamo-Moisio et al., 2016).