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Burnitt E, Grealish LA, Crilly J, May K, Ranse J. Providing end of life care in the emergency department: A hermeneutic phenomenological study. Australas Emerg Care 2024:S2588-994X(24)00002-2. [PMID: 38310030 DOI: 10.1016/j.auec.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department. METHODS A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken. FINDINGS Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department. CONCLUSIONS Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.
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Affiliation(s)
- Ellie Burnitt
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
| | - Laurie A Grealish
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Gold Coast Health, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Mental Health, Griffith University, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia
| | - Katya May
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Queensland, Australia
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Matthews T, LaScala A, Tomkin T, Gaeta L, Fitzgerald K, Solomita M, Ragione B, Jahan TP, Pepic S, Apurillo L, Siegel V, Frederick A, Arrillaga A, Klein LR, Cuellar J, Raio C, Penta K, Rothburd L, Eckardt SA, Eckardt P. Resource Deployment in Response to Trauma Patients. Cureus 2023; 15:e49979. [PMID: 38058531 PMCID: PMC10697664 DOI: 10.7759/cureus.49979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background Variance in the deployment of the trauma team to the emergency department (ED) can result in patient treatment delays and excess burden on ED personnel. Characteristics of trauma patients, including mechanism of injury, injury type, and age, have been associated with differences in trauma resource deployment. Therefore, this retrospective, single-site study aimed to examine the deployment patterns of trauma resources, the characteristics of the trauma patients associated with levels of trauma resource deployment, and the deployment impact on ED workforce utilization and non-trauma ED patients. Methodology This was an investigator-initiated, single-institution, retrospective cohort study of all patients designated as a trauma response and admitted to a community hospital's ED from July 01, 2019, through July 01, 2022. Results Resource deployment for trauma patients varied by mechanism of injury (p < 0.001), injury type (p < 0.001), and patient age groups (p < 0.001). Specifically, there was a lower average trauma activation for geriatric trauma patients with a fall as a mechanism of injury compared to all younger patient groups with any mechanism of injury (F(5) = 234.49, p < 0.001). In the subsample, there was an average of 3.35 ED registered nurses (RNs) allocated to each trauma patient. Additionally, the ED RNs were temporarily reallocated from an average of 4.09 non-trauma patients to respond to trauma patients, despite over a third of the trauma patients in the subsample being the trauma patients being discharged home from the ED. Conclusions Trauma activation responses need to be standardized with a specific plan for geriatric fall patients to ensure efficient use of trauma and ED personnel resources.
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Affiliation(s)
- Thomas Matthews
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Alexa LaScala
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Theresa Tomkin
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Lisa Gaeta
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Karen Fitzgerald
- Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | - Michele Solomita
- Nursing Administration, Good Samaritan University Hospital, West Islip, USA
| | - Barbara Ragione
- Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | - Saliha Pepic
- Research, City University of New York, New York, USA
| | | | | | - Amy Frederick
- Trauma, Good Samaritan University Hospital, West Islip, USA
| | - Abenamar Arrillaga
- Surgical Critical Care, Good Samaritan University Hospital, West Islip, USA
| | - Lauren R Klein
- Emergency Medicine, Good Samaritan University Hospital, West Islip, USA
| | - John Cuellar
- Orthopedic Surgery, Good Samaritan University Hospital, West Islip, USA
| | - Christopher Raio
- Emergency Medicine, Good Samaritan University Hospital, West Islip, USA
| | - Keri Penta
- Nursing/Performance Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | - Sarah A Eckardt
- Data Scientist, Eckardt & Eckardt Consulting, LLC, St. James, USA
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