Promoting dignified end-of-life care in the emergency department: A qualitative study

https://doi.org/10.1016/j.ienj.2017.05.004Get rights and content

Highlights

  • The emergency department is not designed for end-of-life care provision.

  • Physicians’ and nurses’ perceptions can contribute to promoting dignity.

  • Dignifying treatment and redesigning environmental conditions is key.

Abstract

Background

Preservation of a dying person’s dignity in the emergency department (ED) is fundamental for the patient, his/her relatives and healthcare professionals. The aim of this study was to explore and interpret physicians’ and nurses’ experiences regarding conservation of dignity in end-of-life care in dying patients in the ED.

Methods

A qualitative study based on the hermeneutic phenomenological approach, was carried out in the emergency department of two general hospitals. A total of 16 nurses and 10 physicians participated in the study. Data collection included 12 individual in-depth interviews and 2 focus groups.

Results

The findings revealed that two themes represent the practices and proposals for the conservation of dignity in the emergency department: dignified care in hostile surroundings and the design of a system focused on the person’s dignity.

Conclusion

Dignifying treatment, redesigning environmental conditions, and reorienting the healthcare system can contribute to maintaining dignity in end-of-life care in the ED.

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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