Death, dying and end-of-life care provision by doctors and nurses in the emergency department - a phenomenological study

Author: Oluwatomilayo Omoya

Omoya, Oluwatomilayo, 2021 Death, dying and end-of-life care provision by doctors and nurses in the emergency department - a phenomenological study, Flinders University, College of Nursing and Health Sciences

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Background: Prior to the first half of the 20th century, death, dying, and end-of-life care was very much a family and community affair. People died within their own home, often surrounded by family, and loved ones. In later years, death and dying was classified as a social problem, and like most social problems of the time, institutionalisation was believed to be the gold standard of treatment. Death, dying, and end-of-life care have now been brought into institutions such as hospitals. At the same time, there have been significant advancements in the fields of medicine, demography, and pathology. These disciplines have contributed to the classification and control of death and dying. People are now living longer with numerous co-morbidities and there is a significant ageing population. Consequently, there have been increases in the numbers of people who present to emergency departments across Australia seeking access to care at the end of life. Emergency department staff must have the knowledge and skills required to provide end-of-life care in a setting that traditionally contradicts the goals of comfort care. With the increase in demand for end-of-life care in emergency departments, a gap exists in the experiences of how staff provide such care in this setting. As a result of this gap, it is important to understand the lived experiences of emergency department doctors and nurses who provide end-of-life care.

Aim: The aim of this research is to understand the lived experiences of emergency department doctors and nurses concerning death, dying, and end-of-life care provision.

Methodology: A phenomenological research method is used in this thesis. A qualitative methodology has been employed using Han-George Gadamer’s hermeneutic phenomenology. The use of Gadamer’s hermeneutic phenomenology has assisted the researcher to establish an understanding and create meaning out of emergency department staff experiences. Data were analysed using Diekelmann’s seven step analysis to support Gadamer’s phenomenological approach. Gadamer’s key phenomenological concepts of constant dialogue, fusion of horizons, language, experiences, truth, prejudices, and hermeneutic questioning were used.

Findings: An analysis of the 16 interviews resulted in the identification of 4 major themes and 14 sub-themes: (1) ‘providing care with respect and dignity’, with the associated sub-themes of ‘dignifying deterioration and death’, ‘respecting culture, beliefs and values’, and ‘the meaning of the participants’ culture, beliefs, and values’; (2) ‘ethical dilemmas’, with the associated sub-themes of ‘treatment decisions’, ‘relinquishing care’, and ‘experiencing dilemmas’; (3) ‘providing for end-of-life care in an emergency department and the role of the participants’, with the associated sub-themes of ‘role perceptions’, ‘the intensive nature of the role’, ‘emotional burden’, and ‘emergency department-end-of-life role integration’; and (4) ‘experiencing conflict’, with associated sub-themes of ‘time and environment’, ‘family’, ‘advance care planning’, and ‘resolving conflict’.

Conclusion: From the findings, the complexities of decision-making as an overarching theme across all four major themes emerged as a constitutive pattern. This constitutive pattern showed that this study has provided an in-depth interpretation of how emergency department staff navigate the difficulties experienced in balancing complex decisions about treatment options. Gadamer’s fusion of horizons was widely integrated into the study. The findings of this study have significant implications for medical practice, nursing practice, and the overall emergency department governing bodies that focus on improving end-of-life care outcomes for patients, families, and emergency department staff.

Keywords: “ED”,"emergency department" "critical care" '"acute care" “death and dying”, “EOLC”, “end of life care”, “terminal care”, ”medical”, “nursing”, “Palliative care”, “education”, “experiences”, “attitudes”, “knowledge”, and “barriers and facilitators”

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Nursing and Health Sciences
Supervisor: Dr Anita De Bellis