End-of-Life Care in the Emergency Department (printer-friendly)

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Authors and Disclosures

Author(s)
Laurie E. Scudder, DNP, NP

NP Alternatives, Ellicott City, Maryland Disclosure: Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.

From Medscape Nurses > Viewpoints

End-of-Life Care in the Emergency Department

Laurie Scudder, DNP, NP Posted: 06/14/2011

Palliative and End-of-Life Care in the Emergency Department: Guidelines for Nurses
Norton CK, Hobson G, Kulm E. J Emerg Nurs. 2011;37:240-245
Study Summary

Background. Emergency department (ED) nurses must provide complex care in situations ranging from birth to death and everything in between. Observing that approximately one quarter million deaths per year occur in or en route to an ED, Norton, Hobson, and Kulm emphasize the need for palliative and end-of-life (EOL) care guidelines appropriate for use in this setting. A position statement from the Emergency Nurses Association emphasizes that patients at the EOL and their families deserve care that respects their dignity, including honoring a choice of refusing treatment. The purpose of this study was to synthesize current research on this topic and to propose parameters for ED-specific guidelines. Methodology. Drawing from a number of sources, including the End-of-Life Nurse Education Consortium, palliative and EOL guidelines developed by the American Association of Colleges of Nursing, and the National Consensus Project for Quality Palliative Care, the investigators propose guidelines for the delivery of culturally competent EOL care in the ED. Results. Recommendations were grouped into 4 distinct themes: Dealing with sudden and unexpected deaths in the ED: Sudden death, whether the result of trauma or an unexpected event such as a myocardial infarction, is a common occurrence in the ED; therefore, appropriate and timely action on the part of the healthcare team can have a significant impact on survivors. ED protocols that provide appropriate education for ED nurses on grief responses and providing aid to families are needed. Nurses caring for patients at the EOL should have limited other patient obligations to allow for appropriate attention to the family. Private environments where families can initiate the grieving process should be created. Family-witnessed resuscitation: Although controversial, studies support positive effects of family-witnessed resuscitation (FWR) on family grieving by providing closure, permitting families to see all that was done for their loved one, and making death "real." Patients who have survived a resuscitation attempt also report that they wanted their family members present, although they also voiced concern that this might occur without appropriate support for their loved ones. The researchers recommend the availability of a family support clinician as well as guidelines that allow time for an interdisciplinary discussion with staff members about any reservations related to implementation of FWR. Cultural and spiritual considerations: Providing culturally sensitive care is an important goal, but the investigators also emphasize the need for cultural humility and for nurses and others to recognize the many differences that exist within an individual culture as well as the impossibility of learning the intricacies of all cultures. Thus, nurses should be willing to acknowledge this fact and be open to the patient's and family's needs. Institutional changes: The researchers urge EDs to adopt the Core Principles for End-of-Life Care jointly developed by a number of medical specialty groups. Nurses should advocate for development of EOL protocols and an ethics committee to assist with decision-making in difficult situations. Institutional policies should allow for nurse-to-patient ratios of 1:1 or 1:2 at these times. Finally, EDs should consider developing a multidisciplinary palliative care team to assist staff, patients, and families.

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End-of-Life Care in the Emergency Department (printer-friendly)

http://www.medscape.com/viewarticle/744054_print

Viewpoint

Although the goal of this article was to highlight important considerations for development of ED-specific guidelines for EOL care, Norton and colleagues offer a summary with applicability for virtually all healthcare facilities. Sudden death and situations requiring resuscitation may not be as common in other settings, but they can and do still occur. Comprehensive guidelines for EOL care are available, and nurses who wish to develop protocols specific to their own institution or clinical setting need not reinvent the wheel. Norton and colleagues have succinctly and clearly summarized the most important areas that must be addressed in any useful protocol, in a manner that respects patients and families and allows nurses to do what they do best. Abstract
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