Overcoming the barriers to optimal end of life care in the emergency department.

The focus of care in the emergency department (ED) is on saving or sustaining life, but some patients admitted to the ED die in the ED. Nurses whose focus is on saving lives may therefore find themselves providing end of life care to patients and their families in a stressful and distressing environment. Providing optimal end of life care involves reflecting on what a good death looks like and how patients can be supported to have a good death. This article describes the barriers to optimal end of life care in the ED and prompts nurses to think about how they can enhance their practice when caring for dying patients and their families.

Self-care while undertaking qualitative nursing research.

BACKGROUND: Nursing research is usually carried out by registered nurses with some experience of practice. However, nurses may find that the role of the nurse researcher is very different from that of the practising clinical nurse and has its own challenges. AIM: To explore the differences between the two roles and offer some guidance to nurses carrying out qualitative research, particularly research into sensitive topics. DISCUSSION: Nurses need to be aware of various issues that could affect their ability to carry out nursing research and be emotionally traumatic. CONCLUSION: There is a general need for greater awareness about the potential risks of carrying out qualitative research into sensitive topics. IMPLICATIONS FOR PRACTICE: Nurse researchers must consider self-care when planning a research project, assessing their role, personality, background, personal experiences and stress triggers, and ensuring peer and supervisory support, reflection and a healthy lifestyle.

A focused mapping review and synthesis of current practice in qualitative end of life research with the bereaved.

BACKGROUND: Nursing research is dedicated to improving care, but research into end of life care can be challenging because of a possible reluctance by researchers to invite bereaved people to take part in studies. AIM: To use a focused mapping approach to explore the recruitment to studies of grieving and bereaved people. DISCUSSION: There is no 'gold standard' method of recruitment and no best way to approach participants. The outcome of each method, measured by the percentage of potential participants recruited, appears to be unrelated to the approach used. CONCLUSION: There is no evidence that participation in research harms those who have recently been bereaved, but there is evidence of benefits from participating. IMPLICATIONS FOR PRACTICE: Researchers should not feel they need to protect the bereaved from participating in research and can invite bereaved individuals to join a study without worrying about causing them harm.

Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review.

AIM: The aim of this integrative literature review was to explore the quality of the dying and death experience in the Emergency Department from the perspective of staff and carers. BACKGROUND: Death in the Emergency Department is common. Understanding the quality of the death and dying experience of patients and their family members is crucial to building knowledge and improving care. DESIGN: Systematic integrative literature review reported following the PRISMA guidelines. DATA SOURCES: Pubmed, Cumulative Index to Nursing and Allied Health Literature, Magonline (internurse), and the Cochrane library. Articles used were published in English during 1990- 2017. REVIEW METHOD: Appraisal and thematic analysis. RESULTS: Sixteen articles are included. Eight themes emerged from the literature: care in the Emergency Department is about living not dying, staff perceive that death is a failure, staff feel underprepared to care for the dying patient and family in this environment, there is limited time for safe standards of care, staff stress and distress, staff use of distancing behaviours, the care of the dying role is devolved from medics to nurses at the end of life, and patients and staff perceive that the Emergency Department is not the preferred place of death CONCLUSION: There are areas of concern about end of life care in the Emergency Department. To improve practice and to ensure that a good death occurs, further research is needed. There is a need to understand more about the experience of caregivers when a relative or friend dies in the Emergency Department.