Written by Dr Oluwatomilayo (Tomi) Omoya, Associate Lecturer, College of Nursing and Health Sciences
Emergency departments (ED) are traditionally known for saving lives. But when patients who require end-of-life care presents to ED, which is a setting that does not align with the goals of end-of-life care, ED clinicians will have to take on the role of providing care that represents the wishes of the patient. Over the past few decades, a lot more patients are now coming into ED across Australia seeking care at the end of life. Therefore, the roles of ED doctors and nurses is moving beyond the traditional lifesaving role and now they must have the skills to provide care at the end of life.
ED doctors and nurses across Australia often describe end-of-life care as “core business” of ED and acknowledge that regardless of personal opinions and thoughts regarding what the roles of an ED clinician should entail, end-of-life care is going to increasingly become a core part of ED work.[1] It is important to note that for any quality end-of-life care, it requires a collaborative practice approach and at the core of this approach is the understanding of the roles of each team member. But when there are mismatches or differences in the expectations regarding roles for each member of the team, it can be a barrier to providing end-of-life care. Hence, research to clearly identify the understanding and expectations that surrounds the role of each team member was undertaken.
Results of our research exploring the perception of what the roles of ED nurses and doctors entailed when providing end-of-life care showed that ED nurses believed that effective communication of goals of care was the most crucial role of the doctors.[1] The reason for this was that when end-of-life care conversations were poorly performed, there was a negative outcome for the patient and their families. ED doctors on the other hand believed that their major role was working out the goals of care for the dying patient.
Knowledge of these assumptions and differences in expectations placed on each other’s roles will allow ED doctors and nurses to improve on areas that would create a better collaborative approach to end-of-life care for patients and families. Both ED doctors and nurses agreed that the nursing role was intensive due to the numerous responsibilities (comfort, spiritual and emotional care, extra mindfulness, and sensitivity) required and as a result, a significant level of emotional burden was often experienced. Nurses carried most of the emotional role and doctors often felt a sense of responsibility for care outcome and with that came a sense of guilt when the care outcome was believed to be a negative one.
ED clinicians stated that end-of-life care has a place within the ED despite the conflicts between the objectives of ED work and end-of-life care. Many of the participants agreed that palliative care should be integrated into emergency work even though the lay public might not perceive this to be so. Therefore, increase in collaboration between palliative care and emergency departments would be beneficial.
For more information:
Oluwatomilayo (Tomi) Omoya, Anita De Bellis, Katrina Breaden. Emergency department staff perceptions of their roles in providing end of life care.
Australasian Emergency Care, 2022.
Omoya OT, De Bellis A, Breaden K. Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department: A Phenomenological Study (220kb pdf).
References
- Omoya OT, Bellis A, Breaden K. Emergency department staff perceptions of their roles in providing end of life care. Australas Emerg Care. 2022 Sep 7:S2588-994X(22)00070-7. doi: 10.1016/j.auec.2022.09.001. Epub ahead of print. PMID: 36088253.
Dr Oluwatomilayo (Tomi) Omoya
Associate Lecturer, College of Nursing and Health Sciences