Tuesday, November 4, 2008

Barriers to EOL care in ED

Journal of Emergency Nursing has a paper about perceived barriers to end-of-life care in the emergency department. The study involved a survey of ~300 ED nurses in the US (response rate only ~45%) and simply asked them what they thought were barriers to good EOL care in the ED as well as supports to good EOL care in the ED.  Most of the issues were about workload/time; space issues - privacy, room for grieving families; and goals of care issues (unclear prognoses, docs not communicating well, families not 'accepting' imminent death, etc.).  

What was most interesting to me was that they also looked at the 'supports' for good EOL care - these were mostly still about patient flow/time/space issues and the things which we (this is the global-palliative-care-'we' which probably doesn't exist) tend to think about being important for good EOL care were the lowest ranked on that support list.  Things like:
  • Receiving education necessary to give appropriate end-of-life care to patients and their families
  • Having enough time to prepare the family for the expected death of the patient
  • Talking with the patient about his or her feelings and thoughts about dying
  • And stuff about emotional support for the nurses
Not that what they thought was important isn't - by any means - but it really highlights the dramatically different professional pressures and concerns these nurses face and would need to be worked through to better integrate PC in the ED.  I know some readers of this blog have been through this and am curious if they have any thoughts about this?

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