PADILLO GROUP BSN 3E CHAPTER 1 3 Sir Jes 3

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EMERGENCY DEPARTMENT NURSES’ PERCEPTIONS OF THEIR ROLES

AND CHALLENGES IN PROVIDING END-OF-LIFE CARE
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A Research Proposal Presented to

The Faculty of Nursing Department
St. Alexius College, City of Koronadal
_____________
In Partial Fulfillment
of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING
By
Adrian Miles Z. Duce

Jimmy C. Gregorio Jr.
Erllea Lloren Q. Grijaldo
Kheyh J. Gonzales
Krispearlmae F. Padillo
Sherylyn Joy B. Tamayo
DECEMBER 2023
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ST. ALEXIUS COLLEGE
Gen. San. Drive, City of Koronadal, South Cotabato, Philippines 09506, Tel.: (083) 228-2019, Fax: (083) 228-4015, Email: st.alexiuscollege@yahoo.com
CHAPTER I
INTRODUCTION
Background of the Study
Caring for individuals who die suddenly and unexpectedly in emergency
departments (EDs) may be difficult and complicated. Emergency rooms may not
be entirely equipped to care for terminally ill patients and their families because
they are staffed and designed for quick diagnosis, treatment, referral, and
release (Yancey et al. 2022). Furthermore, Giles et al. 2019 cited in their study
on Nurses’ perceptions and experiences of caring for patients who die in the
emergency department setting that emergency department (ED) nurses tend to
prioritize life-saving interventions over family-centered end-of-life (EOL) care.
As the number of individuals presenting to and dying in emergency
departments rises as our population ages, it is critical to provide safe, effective
end-of-life treatment in this context. Nurses' views must be heard to improve care
for those dying suddenly and unexpectedly in the emergency department (Giles
et al. 2019). In the study of Aquino, et al. 2022, the authors claimed that because
of conceptual differences between end-of-life care and emergency care, nurses
in the emergency department confront difficulties in providing end-of-life care.
When a dying patient has unmanageable symptoms, financial concerns,
or restricted access to community services, the emergency department

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commonly becomes their entryway to such treatment (Tiah et al. 2023). As a
large segment of the US population ages, the number of fatalities in emergency
rooms is anticipated to rise. As a result, when a patient dies, emergency nurses
have several challenges in delivering appropriate end-of-life care. Providing
enough privacy for patients and family members was a key barrier to providing
end-of-life treatment in the emergency department, owing primarily to inadequate
department architecture, particularly in rural emergency rooms with little space
(Beckstrand et al. 2017).
In Japan, 1.5% of patients taken to the emergency room are confirmed
dead on arrival, while 10% of severely sick patients die during treatment. Some
nurses argue that the emergency department is incapable of providing the best
care required to attain these aims and goals. This has been linked to the fact that
there is less time in the emergency department than in the wards to form
relationships among patients, relatives, and healthcare staff (Shida, 2023).
In a retrospective study conducted in Hongkong in 2014 by Tse et al. the
provision of EOL care in the emergency department can enhance patients’ last
moments of life, facilitate the grief and bereavement process of families, and
enhance the professional development of staff in the emergency department.
The emergency department's fast-paced and frequently chaotic environment
makes it difficult to provide treatment for patients nearing the end of their lives
(Tiah et al. 2023). The skills and time required for comprehensive end-of-life care
compete with the priorities of dealing with acute situations. However, according
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to Arya et al. (2020), nurses have been challenged by the COVID-19 pandemic
as it likely strains the healthcare system beyond capacity, and palliative care
services will be needed across many different care settings, including emergency
departments.
According to Omoya et al. (2023), emergency nurses must be able to
provide end-of-life care (EOLC) as part of their duty and obligations. Despite this
mismatch of responsibilities and education, end-of-life care is rapidly becoming a
component of emergency work, and workers will need to have the skills
necessary to deliver care in an environment that is not aligned with end-of-life
care’s goals. A collaborative practice approach is required as the guiding premise
for any excellent end-of-life care. The knowledge of each team member's job is at
the heart of this method. Griffiths (2019) proposed that a mismatch in job
expectations might create impediments to excellent supply. While some studies
have investigated emergency nurses' experiences with giving end-of-life care,
there is a considerable void in the research literature that has particularly
investigated emergency nurses' involvement in the provision of end-of-life care.
(Omoya et al. 2023).
The purpose of this study is to determine emergency department nurses’
perceptions of their respective roles and challenges when providing end-of-life
care.
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Theoretical Framework
This study is anchored in a theory that could best support the research.
Orem’s Self-Care Deficit Theory, Neuman’s Systems Mode, and Peplau’s
Interpersonal Relation Theory may contribute to understanding the emergency
nurses’ perceptions of their roles in providing end-of-life care.
Dorothea Orem’s self-care deficit theory focuses on individuals’ ability to
perform self-care. The theory suggests patients are better able to recover when
they maintain some independence over their self-care. The theory helps nurses
determine what aspects of patient care they should focus on in each situation,
and it stresses the importance to patients themselves of maintaining autonomy
over their self-care processes (Regis College, 2021). Orem's theory emphasizes
the importance of self-care and self-care deficits. In the context of end-of-life care
provided by emergency nurses, understanding a patient's self-care abilities and
deficits is crucial. It helps nurses tailor their care to the specific needs of each
patient, especially when patients are no longer able to perform essential self-care
activities due to their condition, these dying patients often face fear, anxiety, and
a sense of loss. According to Mchugh (2021), the goal of Hildegard Peplau's
Interpersonal Relations Theory focuses on the nurse-patient relationship where it
emphasizes the role of the nurse as a therapeutic partner, providing emotional
support, and facilitating communication between patients and other nurses during
emergencies.
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Another theory that will support this study is the theory of Hildegard
Peplau on interpersonal relations. The idea of Peplau has numerous applications
in the field of nursing, such as patient mental health, care for loved ones and
emergency staff nurses, and end-of-life care. Her work has left a legacy that
emphasizes the value of interpersonal interactions and the nurse's role in
assisting patients in achieving improved health and well-being. This theory
guides nurses in establishing trust, promoting patient engagement, and
enhancing the overall ER experience for patients (Mchugh,2021). The
development of a therapeutic connection offers emotional support, easing
suffering and assisting patients in navigating these difficult feelings. Improved
Communication An open and productive communication environment is fostered
by a good nurse-patient relationship. Patients who are nearing death can voice
their worries, preferences, and wishes, assisting Emergency Department Nurses
in modifying care to match their specific requirements. This can be seen as an
important aspect of care within the Neuman System Model as it relates to the
patient’s emotional and psychological well-being. Effective communication and
interaction can help nurses assess and address the patients’ stressors and
emotional responses (Bsn, 2023).
In the context of man as an open system, Betty Neuman considered the
client as an open system that responds to environmental stresses. According to
the Betty Neuman Systems Model, the physiological, psychological, social,
developmental, and spiritual factors of the client are all present (Gonzalo, 2023).
The Neuman model incorporates stress and coping techniques. It begins the
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assessment of stressors, both internal and external, and their impact on the
patient. In the context of end-of-life care (EOLC) in the Emergency Department
(ED), nurses can assess the stressors specific to the patient’s condition, the
family’s emotional state, and the environment itself. This includes evaluating the
patient’s physical symptoms, emotional distress, and spiritual or existential
concerns. Neuman’s model emphasizes holistic care, which is crucial in End-of-
Life situations. Providing support for emotional distress, anxiety, and grief is
essential. Through Effective communication, which is a cornerstone of Neuman’s
model nurses can use this framework to encourage open and honest
communication with the patient and their family about the patient’s condition and
prognosis (Bsn, 2023).
Conceptual Framework
In Figure 1, the conceptual framework describes the relationship between the
independent variable which is the Roles and Challenges, and the dependent
variable is the Quality of End-of-Life Care.
INDEPENDENT VARIABLE DEPENDENT VARIABLE
ROLES AND CHALLENGES QUALITY OF END-OF-LIFE

CARE
Figure 1. Conceptual Framework

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Statement of the Problem
This study aims to know the nurses’ perceptions of their respective roles
and challenges encountered when providing end-of-life care. Specifically, it
seeks to answer the following questions:
1. What is the socio-demographic characteristic of emergency department
nurses in terms of:
a. Gender;
b. Age;
c. Tribe;
d. Religion;
e. Level of Education; and
f. Years of experience?
2. What are the roles that emergency department nurses perceive when it
comes to providing end-of-life care in terms of:
a. Emotional Support for Patients;
b. Ethical Decision- making;
c. Grief Support; and
d. Communication and Emotional Support?
3. What is the extent of challenges encountered by emergency department
nurses when fulfilling their roles related to end-of-life care in terms of:
a. Emotional Support for Patients;

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b. Ethical Decision- making;
c. Grief Support; and
d. Communication and Emotional Support?
4. Is there a significant relationship between emergency department nurses’
roles and challenges when providing end-of-life care?
Significance of the Study
This study is significant to the Nursing Department in general because it
will provide information to the Nurses.
Specifically, the study is beneficial to the following:
Hospital Administrators: This will enhance the end-of-life care provided by
Emergency Department Nurses, improve staff training and resources, and
address ethical and communication challenges that may arise in emergency
department settings during these critical moments.
Student nurses: This will provide insights into the challenges, ethical
considerations, and emotional aspects of providing end-of-life care in the
emergency department. It can contribute to their education, clinical training, and
the development of important skills and attributes required for nursing practice.
Nurses: This can contribute to their professional development, enhance their
ability to provide compassionate and effective end-of-life care, improve
communication and ethical decision-making skills, and ultimately lead to better
care outcomes for patients and their families in emergency department settings.
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St. Alexius College Administrators: This study will serve as a valuable
educational resource, a catalyst for research and curriculum development, and a
tool for promoting ethical, patient-centered care, particularly within healthcare
and nursing programs.
Future Researchers: This study serves as a stepping stone for future researchers
in the field of healthcare, offering a starting point, methodological insights, and
potential areas for further exploration. It contributes to the ongoing conversation
and research related to end-of-life care in emergency departments.
Scope and Limitation of the Study
The study is about emergency department nurses' perception of their roles
and challenges in providing end-of-life care. The study will be conducted using
an actual face-to-face survey of the 83 selected respondents of the study who
are the nurses in the emergency department at South Cotabato Provincial
Hospital (SCPH), Dr. Arturo P. Pingoy Medical Center (DAPPMC), South
Cotabato Medical Cooperative Medical Center (SOCOMEDICS), and Allah Valley
Medical Specialists’ Center, Inc. in 2023. This study will be conducted to
determine the different perceptions of their roles and challenges in providing end-
of-life life. The data will be gathered using printed questionnaires.

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Definition of Terms
The terms included in this section were operationally defined:
Emergency Room (ER): The Emergency Room, often referred to as the ER, is a
specialized medical facility within a hospital where patients with acute, life-
threatening, or severe medical conditions receive immediate care and treatment.
Medical Emergency: A sudden and serious medical condition that requires
immediate medical intervention to prevent further harm or death.
Nurse: Registered Nurses (RN) and Nurse Practitioners (NP) play a crucial role
in the ER, providing initial assessments, administering medications, and
coordinating patient care. Their practice is characterized by a unique blend of
clinical expertise, compassionate care, and patient advocacy.
End-of-life-care: Involves the comprehensive and compassionate approach to
providing medical, emotional, and spiritual support to individuals nearing the end
of their lives. It focuses on enhancing the quality of life for both the individual and
their loved ones by managing symptoms, addressing emotional and
psychological needs, fostering open communication, facilitating shared decision-
making, and ensuring a dignified and comfortable transition into the final stages
of life.
Roles: Involves specific and delineated responsibilities assigned to healthcare
professionals, support staff, and teams to ensure efficient and effective
management of patients during critical and urgent situations.

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Challenges: This refers to the specific and varied difficulties, obstacles, and
stressors encountered in the course of their daily duties and responsibilities
within the emergency department setting, including but not limited to, managing
high patient volumes, providing critical and time-sensitive care, coping with
emotional distress, maintaining patient safety, handling complex medical cases,
ensuring efficient resource allocation, and adhering to stringent protocols and
guidelines.
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CHAPTER II
REVIEW OF RELATED LITERATURE
The researchers provide a review of related material pertinent to the
comprehension and clarity of the topic under consideration. These are based on
the findings of several studies relating to this research.
What is End of Life Care (EOLC)?
End-of-life care (EOLC) is defined as the care of terminally ill patients who
are nearing death and have stopped treatment to cure their disease. Patients
who are nearing death require care in important areas such as mental,
emotional, and physical needs, spiritual needs, and maintaining functionality as
long as possible. The goal of EOL care is to control pain, anxiety, and other
symptoms so the patient can be comfortable (Gupta et al. 2023). The importance
of end-of-life care for patients and their families is well documented; however, the
skills and knowledge of emergency nurses in delivering end-of-life care are not
widely understood; however, it is clear from the existing literature that we fall
short of consistently providing good end-of-life care, despite a recognition of the
need to improve (Dawood, 2019).

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This signifies a change in focus away from curative therapies and toward
treatments focused on boosting comfort and maintaining dignity. The overall
purpose of end-of-life care is to facilitate a "good death". A decent death is
congruent with patients' and families' preferences, as well as clinical, cultural,
and ethical norms. The goal to improve end-of-life grief for patients and their
families in the face of societal and professional denial of death provides
emergency care professionals with unique end-of-life care issues (De Aquino et
al. 2022).
According to Lee et al. (2023), end-of-life care is stressed to the point
where the World Health Organization (WHO) advocates considering it as an
ethical duty. This, however, is still in its early stages and is only available in a few
places and for a few subjects. EOLC was described as nursing care delivered to
patients and their families in partnership with the medical team, including nurses'
behaviors and thoughts following the patient's death (Satake & Arao, 2019).
Family carers described good end-of-life care as providing residents basic
care and spiritual support; recognizing and treating symptoms; assuring
continuity in care; respecting resident’s end-of-life wishes; offering
environmental, emotional and psychosocial support; keeping family informed;
promoting family understanding; and establishing a partnership with family carers
by involving and guiding them in shared decision-making. These elements
improved the quality of end-of-life of both residents and their families, thus
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suggesting a common ground between good end-of-life care and palliative care
(Basso et al.,2019).
According to Anderson et al. (2021) high rates of burnout among
healthcare professionals in general and Emergency Department (ED) workers
have been noted in a significant body of literature. Reduced patient safety and
quality of treatment, as well as multiple negative health consequences for the
affected personnel, are all linked to poor workplace well-being. Supporting
emergency department nurses is more crucial than ever as they deal with
increasing everyday demands brought on by heavy workloads, complicated
patient presentations, and mass casualty incidents.
In their final month of life, half of older persons visit the emergency
department. In addition, a 2015 Institutes of Medicine assessment found that
more than 50% of people are unable to engage in decision-making as they
approach the end of their life. In 1995, as cited by Abbott (2018) Oregon became
the first state to make use of a form that would convert patient requests into
directives that could be carried out in a variety of healthcare settings. According
to Abbott (2018), they respect patients' demands on how they will be handled
with their informed consent. Forms that include instructions for current care act
as a supplement to written advance directives. The form is intended for several
distinct populations, including those who are very elderly and frail, those who
have already lost decisional capacity or who are likely to do so as their condition
worsens, and those who are close enough to the end of their lives that the
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trajectory of their death is known (typically in the last 6 to 12 months of a severe
chronic disease that will be life-ending). People who are reaching the end of their
lives can now turn their wishes into directives. This can help some people avoid
unneeded hospitalization, mechanical breathing, or resuscitation. Others see it
as confirmation of their desire for extensive involvement.
Prolonging the end-of-life process increases the duration of health care
work and delegated death management to health care professionals by patients'
relatives. As a result, it is critical to investigate strategies to improve the quality of
end-of-life care by identifying predictors. End-of-life care should be person-
centered, to alleviate severe health-related suffering, whether physical,
psychological, social, or spiritual. End-of-life nurses typically spend the most time
with dying patients, providing care to patients who want to die with dignity; hence,
end-of-life nursing care is extremely important (Kim & Choi, 2022).
It is regarded as one of the most challenging elements of medical
treatment in all contexts and clinical specialties. Guidelines advise nurses on how
to deliver the most effective end-of-life care, and end-of-life care training is now
included in all undergraduate medical and nursing programs. These professional
body guidelines and stipulations within curricula reinforce the idea that good care
at the end of life is the responsibility of all healthcare professionals and that
prognostic disclosure should aim to be comprehensive, timely, and included in
conversations with the patient regularly to ensure high-quality care. It has been
demonstrated that following these suggestions improves both patients and

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healthcare staff's experiences with end-of-life processes and treatment. It aids in
the establishment of clear expectations, emphasizes the need of planning and
preparing oneself and family, reduces travel and treatment expenses for patients
and medical professionals/services, and allows for a more successful grieving
and bereavement process for both family and medical teams. Realistic
prognostic conversations, along with early palliative care, have been proven to
reduce the misuse of unneeded therapies while, perhaps counterintuitively,
prolonging patient survival. Improving end-of-life care (EOLC) is a significant
topic, considering the projected rise in deaths over the next decade and beyond
(Latham et al. 2023).
Challenges of Emergency Department Nurses when Providing End-of-Life
Care
In this review, the challenges in providing quality EOLC, from nurses’
viewpoints, people who are diagnosed with non-malignant progressive diseases
in ED settings. End-of-life-care education and training, emergency department
design, lack of family support, workload, emergency department nurses’
communication and decision making, end-of-life care quality in the emergency
department, resource availability (time, space, appropriate interdisciplinary
personal and integrating in the emergency department. Nine studies emphasized
the importance of education and training for emergency department nurses in
order to provide end-of-life care. A number of studies suggested that insufficient
education in regard to end-of-life care is considered a major barrier to providing

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quality care for patients. Providing sufficient education and training is thought to
be the biggest obstacle to offering care in emergency departments. In the
majority of the studies, emergency department nurses also emphasized design
as a critical obstacle to providing quality end-of-life care. It is startling to learn
that nurses still view emergency department design as a barrier to providing care
for patients who are dying, even in the presence of recommendations for the
design. In contrast, other hospital settings, such as cancer and palliative care
departments, have not seen any obstacles to offering end-of-life care due to
departmental architecture. This might be a reflection of the emergency
department’s nature, which frequently produces loud noises that can impair the
delivery of care. Additionally, patient privacy is a concern for the emergency
department nurses which is difficult to maintain (Alqahtani, A. 2019).
According to the statistics that have been studied by Pranita, D. et al.
(2019) barriers are limited PPEs equipment (45.9%), equipment that irritates the
skin when used for hand hygiene (37.8%), an increase in the number of patients
in need of environmental disinfection (32.4%), a lack of support and oversight in
the implementation of standard precautions for safe injection (16.2%), and
equipment limitations on respiratory hygiene practices/ethics of coughing and
sneezing (10.8%) are the barriers that people perceive as most preventing them
from completing their tasks. The hospital should pay attention to the study of the
ratio of nurses and patients to safe working practices and strengthen the function
properly and regularly to overcome some equipment. The hospital should also
look for hand hygiene equipment containing emollient/moisturizers and alcohol-

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type hand rub n-propanol to overcome skin irritation. To increase standard
precautions, the hospital should also develop a practice program and publicize
prizes or punishments.
Emergency Department Design
Emergency nurses are aware of the need to have family members there
during resuscitation, have safe places to store bodies, and have extra
resuscitation rooms available so that families can process their loss before being
taken away to attend to another trauma patient’s urgent requirements. Nurses
can assess current facilities to find areas that should be remodeled or changed to
enhance patient privacy, enhance treatment, or make better use of available
space. It is essential to comprehend how emergency department design affects
end-of-life care. While redesigning or constructing new emergency departments,
improvements to space, layout, and privacy must be taken into account, even if
changing the architecture and design of an emergency department might be
difficult. To ascertain the effect of emergency department design on EOL care,
more investigation is necessary. A challenging part of emergency nursing is
providing care for people who are dying. It is essential to comprehend how the
design affects end-of-life care. An emergency department’s layout may have an
impact on a nurse’s capacity to offer care. Restructuring emergency rooms is
necessary in order to give patients and their families more room. While designing
new emergency departments or remodeling existing ones, improvements to

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space, layout, and privacy must be taken into account, even if changing the
layout and design of an emergency department might be difficult (Beckstran, R.
2019).
Emergency Department Nurses’ Communication and Decision-Making
They constantly have to make important admission decisions, and in
certain growing systems, their decisions are called into doubt (Özakın et al.
2020). The lack of a decision support structure can result in low productivity,
delayed patient treatment, longer wait times for medical care than recommended
by medical guidelines, prolonged stays in the ED, and overworked nurses. In the
healthcare industry, Multiple Criteria Decision Making (MCDM) methods are
becoming more and more popular as a means of facilitating and improving the
quality of decision-making (Pegoraro et al. 2020).
It can be difficult to tell patients about their care and status, especially in
hectic, time-sensitive settings like the emergency department. A crucial and
practical element of a good patient experience is meaningful and educational
exchanges between patients and nurses. Improving patient-nurse communication
and having an impact on local, national, and worldwide practice can be achieved
by establishing communicative procedures that are realistic, useful, and
representative of the service. For patient-centered treatment and a positive
patient experience, communication between nurses and patients is essential.

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This communication gap is a significant national and worldwide healthcare
concern. A crucial part of the patient pathway, the patient-nurse connection, and
nursing practice is patient-specific information, especially in the emergency
department (Blackburn et al. 2019).
In order to discuss patient information and make timely choices, nurses
work in collaboration with a variety of other healthcare experts and maintain
constant communication with team members. Additionally, emergency care is
given by nurses in accordance with priorities established by experts, methodical
evaluations and analyses. When unanticipated resource shortages or the
admission of new patients occur in the emergency department, nurses frequently
stop working on their primary jobs. When a task is stopped, nurses prioritize the
remaining duties based on urgency and priority. However, this takes time and
attention, and they are unable to complete the tasks right away as their workload
grows. Surveying the extent of disruptions faced by emergency department
nurses and associated variables is therefore crucial (Kwon et al. 2021).
The ability to communicate effectively is a critical competency for nurses
since it is essential to building trust and ensuring patient safety and quality of
care (Agea et al. 2022). Overall satisfaction is influenced by contact with nurses
but there isn't much data to help them make sure that communication in the
emergency room is efficient. Patient satisfaction scores improved when
emergency nurses adopted practices like informing patients about delays in their
care in the main emergency department and waiting for area (Hermann et al.
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2019). Given the social and medical upheaval that is now occurring, it is
becoming increasingly important for nurses to improve their interpersonal
communication skills. When performing their professional tasks, they need to be
able to communicate effectively in order to provide patients with the finest
treatment possible (Daheshi et al. 2023).
End of Life Care Quality in the Emergency Department
Providing quality end-of-life care in the emergency department was raised
as a challenge in two studies, and this theme includes two different ways of
improving patient dignity and measuring care. First, Granero-Molina et al. (2023)
conducted a study in Spain and confirmed that improving the dignity of dying
patients in emergency departments is a challenge in providing end-of-life care.
The authors of this study reported that dignity could reflect many attributes,
including patients' preferences, values, lifestyle, respect, autonomy,
empowerment, and feeling comfortable with oneself. Additionally, this study
suggested that the loss of dignity in the emergency department can be attributed
to the lack of standard protocols focused on giving care and the fact that
emergency departments are designed to save lives, not. to provide end-of-life
care. Second, Alqahtani, Mitchell et al. 2019 reported that measuring the quality
of care is critical, as it allows for confirmation that the best has been done for
dying patients in emergency department. Resource Availability (Time, Space,
Appropriate Interdisciplinary personnel).

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Two studies mentioned that the restricted availability of resources,
including time, space, and the lack of an appropriate mix of skilled personnel, is
considered an obstacle to providing quality end-of-life care in the emergency
department. (Aquino et al. 2022) reported that the chaos and noise are often
caused mainly by a lack of resources that are usually available in other hospital
departments. The authors of this study also suggest that limited time, space, and
resources affected the nurses' abilities to provide the care required; as a result,
that can increase feelings of frustration among nurses. Another study found that
specific resource allocation for end-of-life care services is required. The authors
felt that the restriction. The provision of competent end-of-life care has been
recognized to improve the quality of death. (Patrick, 2001 as cited in Tiah et al.
2023) Its importance cannot be overstated in ensuring minimal suffering to the
patient and improving medical, psychological, and relational Tiah et al. (2023) to
next-of-kin and healthcare professionals. Ito, Tsubaki et al. (2021) However,
despite encountering death daily, the emergency department has not been
associated with implementing effective end-of-life care.
Related Studies
Roles of Emergency Department Nurses when Doing End-of-Life Care
The nurses' actions indicated their end-of-life care included love, defined
as a desire to create calm, grounded by the virtue of natural goodness,

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responsibility, and dedication, with a willingness to focus on the individual and
their family, making the most of whatever time they have left. To continue
providing end-of-life care the nurses successfully protected their authentic self by
using a ‘professional identity’ and employing ‘defense of self’. The nurses found
the unpredictable nature of hospital end-of-life care difficult but used collaborative
power to manage situations (Stuart 2022).
According to Savioli et al. (2022) the role of the emergency department is
to provide treatment for people following a traumatic or acute injury or illness.
Such an environment creates a unique set of challenges that impact emergency
nurses’ ability to provide quality end-of-life care. With advances in medical
technologies, people are growing older and living longer with their chronic
illnesses and co-morbidities. Consequently, emergency departments are
increasingly caring for patients in need of palliative and end-of-life care.
However, little is known about how people die, and the care provided to patients
at the emergency departments in Australia. The area was described as an
inappropriate place for death to occur. The participants’ believed that a dying
patient and their family were unlikely to experience a good death in the
emergency department because the environment could not support the
necessary elements to ensure quality care. The first major finding of this study
was the identification that the emergency department was not the ideal place for
death to occur based on environmental and attitudinal obstacles. The second
major finding was that dying patients were moved out of the emergency
department as soon as practicable because it was believed to be in the best

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interests of the patient. These findings are important because they explain that
the emergency nurses believed that if death occurred in the emergency
department the patient would experience poor end-of-life care.
Nurses carry most of the emotional role in EOLC and would therefore
benefit from having an environment in which they have the emotional support
they need. The delivery of quality end-of-life care was believed to be paramount
and required staff to work together to achieve the best outcome for the dying
patient and their families. Regardless of the similarities and differences that were
perceived within their roles, the nurses and doctors believed that their main
objective was to ensure that comfort care was provided to dying patients (Omoya
et al. 2023).
Due to philosophical tensions between end-of-life care and emergency
care, nurses in the emergency department face challenges in the provision of
end-of-life care. For patients who die in the emergency department, care can be
considered provided in the period beginning at presentation, or the end of active
treatment in the emergency department, to the patient’s death in the same
setting. The desire to enhance the bereavement of patients and their families
amidst a social and professional denial of death presents emergency care nurses
with unique challenges. Contextually ill-fitting end-of-life care models and the
philosophical tensions between EOLC and emergency care mean that staff in the
emergency department are often unable to provide optimal care for individuals
during their last moments of life. Consequently, some bereaved families have felt
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unsatisfied with the care they and their dying relatives have received in the
emergency department. With the emergency department being a common place
where people die, it is important to understand the emergency care nurse’s end-
of-life care practices, and factors that influence these practices to inform the
novel, contextually appropriate models and educational interventions that
facilitate end-of-life care in the emergency department (De Aquino et al. 2022).
In the study of De Aquino et al. (2022), findings suggest that younger
nurses undertake Patient and family-centered decision-making and Spiritual
support practices less frequently than older nurses. The heightened death
anxiety among younger nurses may minimize their involvement in end-of-life
care. Development of strategies that provide emotional support for emergency
nurses, facilitating the involvement of families, and providing nurses with
immediate resources during the provision of end-of-life care in the Emergency
department. It also appears beneficial to develop education strategies that can
enhance the knowledge and preparation of emergency care nurses in addressing
issues. The care of patients is complex and often difficult in the emergency
setting. The study investigated both the most and least frequently reported end of
life care practices of emergency care nurses. Frequent engagement pertained to
practices of Environmental modification, while results indicate practices of
Emotional support are undertaken the least.
Perceptions on End-of-Life-Care
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The high mortality rate in the Emergency Department is consistent with
the high demand for end-of-life care. In hospitals, care for patients who are dying
is common. Nevertheless, little is known about the critical components of and
obstacles to the best care from the standpoint of key service providers, which is
essential for providing high-quality care in hospital settings. However, the
emergency department work system needs to save lives precisely and swiftly. It
has an impact on care quality. This study set out to ascertain the emergency
department nurses perspectives of supportive behaviors and the difficulties
involved in giving dying patients end of life care (Ariyanti et al. 2019).
The empathy of families and family access to loved ones, a quiet setting,
appropriate pain management and a shift away from taxing treatments are all
essential components of care for patients who are dying, according to nurses.
But sometimes nurses were unable to give their patients this kind of care. It was
common knowledge that the ED was not the right place for end-of-life care or for
caring for families after a patient had passed away, and that staff-to-staff and
staff-to-family communication was difficult.
The perceptions about how to interpret End-of-Life Care differed as well
as when this should be offered and decided, which might have practical
consequences (Wallerstedt et al. 2019) There are differences in opinions
regarding when and how best to offer and interpret end-of-life care, which could
have real-world ramifications. When it comes to end-of-life care, the patient's
remaining time on earth plays a crucial role in decision-making, providing care,

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and planning. Using interprofessional communication to foster collaboration and
understanding across a range of care levels is a challenge.
The study highlights the importance of respecting patients' wishes in their
final stages of life, avoiding therapeutic obstinacy, and providing empathetic,
individualized care. It emphasizes the need to respect their autonomy, and
decision-making, and facilitate swift referral to palliative care. The study suggests
that Emergency department Nurses should focus on preserving dignity and
promoting acceptance, rather than focusing solely on saving lives (Marti‐Garcia
et al. 2023).
Synthesis
This study aims to know the nurses’ perceptions and roles and challenges
when providing end-of-life care. Different classification and meaning coming from
different sources and authors that helps to give ideas on the situation. The study
sources categorize from the definition of end-of-life care, roles of emergency
department nurses when doing end-of-life care, challenges of emergency
department nurses when providing end-of-life care, emergency department
design, and emergency department nurses’ communication and decision making.
The ideas that have been gathered from various sources help the researchers
find out for the possible things to happen and give ideas on the information that
they need related to end-of-life care. Their capacity to explain their research
helps to determine to specific information and gives an idea of the possible

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outcome of the study. Death and dying are inevitable and important aspects of
nursing, and staff should receive relevant and sufficient education (Fassier et al.
2016). It is essential to alter attitudes toward end-of-life care and to create
systematic, standardized education programs with lessons on how to assess a
dying patient (Reul et al. 2023). The nurses found the unpredictable nature of
hospital end-of-life care difficult but used collaborative power to manage
situations (Stuart, 2022). The nurses and doctors believed that their main
objective was to ensure that comfort care was provided to dying patients (Omoya
et al. 2023).
The related studies which are roles of emergency department nurses
when doing End-of-Life Care and Perceptions on End-of-Life Care that has been
gathered by its related studies that support this research. It is definitely given by
the researchers mentioned in the related reviews of the literature their negative
and positive perceptions of their studies. According to Chang et al. (2022) nurses'
stress is exacerbated by emergency department environmental conditions.
According to Baqeas et al. (2021), it is considered to be a crucial component that
might lower compassion satisfaction and cause compassion fatigue. Palliative
care or end-of-life care is a method that helps patients (adults and children) and
their families' quality of life while they are dealing with issues brought on by a life-
threatening disease (WHO, 2020). It is supported by other studies and combines
the idea of the outcomes of the study.

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CHAPTER III
METHODOLOGY
Research Design
The research study will utilize a quantitative research design specifically
the descriptive approach in analyzing quantifiable measures, according to
Bhandari (2021). Quantitative research is used for the process of collecting and
analyzing numerical data. It can be used to find patterns and averages, make
predictions, test causal relationships, and generalize results to the study. By
examining their experiences as they are subjectively lived, new meanings and
appreciations were developed to inform, or even redirect, how individuals,
understand the experience. (Neubauer et al. 2019). End-of-life care is provided in
a variety of healthcare settings, it is very important to assess end-of-life care and
to provide safe and quality services to patients (Blaževičienė et al. 2020b). This
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could help to know the nurses’ perceptions and roles when providing end-of-life
care in their characteristics, roles, faced challenges, and significant relationships
between emergency department staff nurses.
The research design will highlight the research flow and the underlying
elements that would influence the research planning and implementation that
could be a guide for the study. With the help of the quantitative research method
approach, it entails gathering and quantifying numerical data. The acquired data
will be evaluated using a variety of mathematical and statistical methodologies to
arrive at conclusions and findings (Fleetwood, 2023).
Research Locale
The study will be conducted in different hospitals with emergency rooms
around the City of Koronadal, South Cotabato. Doctor Arturo P. Pingoy Medical
Center (DAPPMC). A level II hospital, Gensan Drive Koronadal City, 9506 South
Cotabato. Allah Valley Medical Specialists Center, Inc., a level II hospital,
Gensan Drive, City of Koronadal, 9506 South Cotabato. South Cotabato Medical
Cooperative Medical Center (SOCOMEDICS), a level II hospital, Judge Alba St,
Poblacion, City of Koronadal, 9506 South Cotabato and South Cotabato
Provincial Hospital (SCPH), a level II hospital, 640 Osmena, Poblacion, City of
Koronadal, South Cotabato.

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Respondents of the Study
The 83 respondents of the study are randomly selected emergency
department nurses in public and private hospitals situated in Koronadal City. The
inclusion criteria of the study included male and female Registered Nurses, who
were stationed in the Emergency Department with two (2) or more years of
experience in the emergency area.
Sampling Technique
The type of sampling technique to be used in the study is probability
sampling, specifically simple random sampling which is most effective in the
study chosen by the researcher with characteristics depending on the study’s
goal. The purest and the most straightforward probability sampling strategy and it
is considered to be the most unbiased representation of the population (Noor et
al., 2022). This Simple sampling method may help the researcher in selecting the
respondents for the study in a fair and equal manner.
Research Instrument
A researcher-made questionnaire will be used in obtaining, measuring,
and analyzing the data. The instrument will be validated for reliability. The
researchers will use printed materials in surveying to generate data in three (3)
parts namely: Part I, the sociodemographic characteristics of emergency
department nurses. Part II roles that emergency department staff perceive

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themselves to have when it comes to providing end-of-life care and Part III will be
about the extent of challenges encountered by Emergency Department staff
Nurses when fulfilling their roles related to end-of-life care.
Data Gathering Procedure
The researchers will be guided by the following guidelines in conducting
the procedure.
A permit for conducting the study will be secured and approved by the
dean of the College of Nursing. A letter would be given to each Hospital in the
City of Koronadal. A consent letter will be provided for the identified respondents
of the study. Data will be gathered via survey questionnaires. The necessary
profiles will be included in the survey sheets, to be answered by the respondents.
Questions in the instrument will be based on the research topic and the
statement of the problem. They will explain to the respondents the importance of
their response to the study. The researcher clarifies some terms to the
respondents so that the respondents can answer the questionnaire with full
knowledge of their responsibility as the subject of the study. In addition, they
would request the respondents to answer with honesty. Researchers use a
Random Sampling Technique. In this study, since the researcher’s goal is to

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determine the importance of Emergency Department Staff Perceptions of their
Roles in Providing End of Life Care, they believe that this method is the most
appropriate in choosing the sample for the research. As well, they will pick all
emergency nurses in the different hospitals found in the City of Koronadal both
the private and public hospitals. Next, the researchers will distribute the survey
questionnaires to the selected respondents. Lastly, the survey questionnaires
would probably be collected after the respondent’s finish answering. After the
respondents answer the questionnaire, the researcher will collect and tally the
data for interpretation. The researcher will use their learning in statistics to help in
determining the appropriate statistical tools to be used and in interpreting the
data. Based on the data the researcher will come up with conclusions and
recommendations for this study.
Statistical Treatment
The researchers will use descriptive statistics that measure the distribution
in frequency and central tendency by using mean, median, and mode as
statistical tool in the study. Descriptive statistics will be used to summarize data
in an organized manner by describing the relationship between variables in a
sample or population. Calculating descriptive statistics represents a vital first step
when conducting research and should always occur before making inferential
statistical comparisons. Descriptive statistics include types of variables (nominal,
ordinal, interval, and ratio) as well as measures of frequency, central tendency,

ST. ALEXIUS COLLEGE
dispersion/variation, and position. Since descriptive statistics condense data into
simpler summary, they enable healthcare decision-makers to assess specific
populations in a more manageable form (Kaur et al. 2018).
Ethical Considerations
In order to gather information for this study, St. Alexius College provided
guidance on a number of things, including survey protocol and human participant
perception and challenges of end-of-life care.
The protection of the integrity of research respondents will be a
particularly essential ethical norm in the conduct of this study, including in studies
of special needs education. These will be the risks and rewards that the
respondents will experience upon participating in the study. The protection of
anonymity and thus privacy is a crucial issue in protecting integrity. This norm will
focus on protection against various forms of risk involved in participation in
research and the protection of participant identities, including concerns for
preventing stigmatization of populations or groups. The practical execution of this
standard, however, can collide with a desire to employ a certain design. The
study's objectives and data collection procedures will be explained to each
respondent personally. There will be enough time for them to ask questions and
voice any concerns.
Voluntary participation ought to be thoroughly knowledgeable about the
processes and dangers in studies and provide their consent to participate. Then,
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one of the most moral concerns is the confidentiality of the records supplied with
the aid of the participants and any information belonging to the participants
should be private and protected. Getting informed consent from respondents is to
let them know what they are working on. Once they know the purpose of the
study, the participants can decide whether or not to participate in it.
However, if the risk to the respondents outweighs the resulting benefits,
then the study should be discontinued. The researchers must ensure that all
gathered data is accurate and without manipulating research materials,
equipment, processes, or changing data or results such that the research is not
accurately represented in the research record.

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lithuania, 59(3), 456. https://doi.org/10.3390/medicina59030456
Tiah L, Chua MT, Kuan WS, Tan A, Tay E, Yash Pal R, Dong C. Perspectives
towards End-of-Life Care in the Emergency Department of Tertiary Public
Hospitals-A Qualitative Analysis. Medicina (Kaunas). 2023 Feb
24;59(3):456. doi: 10.3390/medicina59030456. PMID: 36984457; PMCID:
PMC10053832.
Tse JW, Hung MS, Pang SM. Emergency nurses’ perceptions of providing end-of
life care in a Hong Kong emergency department: a qualitative
study. J Emerg Nurs. 2016;42(3):224–232.
Wallerstedt, B., Benzein, E., Schildmeijer, K., & Sandgren, A. (2019). What is
palliative care? Perceptions of healthcare professionals. Scandinavian
ST. ALEXIUS COLLEGE
journal of caring sciences, 33(1), 77-84.

https://onlinelibrary.wiley.com/doi/full/10.1111/scs.12603
WHO, (1 December 2017) WHO Definition of Palliative Care.; Available online:
http://www.who.int/cancer/palliative/definition/en/
Yancey, C. C. (2022, August 31). Emergency department triage. StatPearls -
NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557583/
APPENDIX A
ST. ALEXIUS COLLEGE
LETTER OF PERMISSION TO THE MEDICAL DIRECTOR OF DR. ARTURO P.

PINGOY
ST. ALEXIUS COLLEGE
APPENDIX B
LETTER OF PERMISSION TO THE CHIEF OF HOSPITAL OF SOUTH

COTABATO PROVINCIAL HOSPITAL
ST. ALEXIUS COLLEGE
APPENDIX C
LETTER OF PERMISSION TO THE HOSPITAL DIRECTOR OF ALLAH VALLEY

MEDICAL SPECIALISTS CENTER, INC.
ST. ALEXIUS COLLEGE
APPENDIX D
LETTER OF PERMISSION TO THE MEDICAL DIRECTOR OF SOUTH

COTABATO MEDICAL COOPERATIVE MEDICAL CENTER
ST. ALEXIUS COLLEGE
APPENDIX E
LETTER TO THE RESPONDENTS
Date
Dear Respondents:
We, the Bachelor or Science in Nursing Level III students at St. Alexius College
presently conducting research entitled “Emergency Department Nurses'
Perceptions of their Roles and Challenges in Providing End of Life Care”. The
Purpose of this study is to determine emergency department nurses’ perceptions
of their respective roles and challenges when providing end-of-life-care in
different Hospitals in Koronadal City.
In line with this, may we ask you to be one of the respondents or our study. Rest
assured that we will consider ethical issues necessary for the purpose of
ensuring the confidentiality of your answers.
Thank you very much in anticipation for your positive response to this request.
Respectfully yours,
KRISPEARLMAE F. PADILLO
Group Leader
Noted by:
JESSIE T. ORANO, RN, RM, MN, MMHA, MAN GIEN CARLO RANIN, RN,
MAN
Research Adviser Co-adviser
ST. ALEXIUS COLLEGE
Approved by:
DR. ARIES M. BALDONADO, RN, RM, LPT

Dean – College of Nursing
ST. ALEXIUS COLLEGE
APPENDIX F
ALEXIAN CONSENT FORM
You are invited by Nursing Research Students of St. Alexius College to

participate in scientific research: Emergency Department Nurses' Perceptions
of their Roles and Challenges in Providing End of Life Care
Please read this form carefully and ask any questions you may have before
agreeing to take part in the study.
What the study is about: The Purpose of this study is to determine emergency
department nurses’ perceptions of their respective roles and challenges when
providing end-of-life-care.
What we will ask you to do: If you agree to be in this study, we will conduct a
survey with you. The survey will include questions about your personal data,
roles that you perceive yourself when it comes to providing end-of-life-care and
challenges that you encountered when fulfilling your role related to end-of-life-
care To answer the questionnaire it will take about 15-30 minutes to complete.
Risks and Benefits:
There is the risk that you may find some of the questions about your experience
with trust in your patient. There are benefits gained from this interview as it will
provide our Nursing Department new information about your job performance,
relationship with your patient. With the result which bears policy implication to
facilitate the orientation and knowledge building on how to deal with the
experience with your patient. It will as well benefit the nursing student in the
future as they will be guided by the result of this case study.
Your answers will be confidential. The records of this study will be kept
private. In any sort of report we make public we will not include any information
that will make it possible to identify you. If we tape-record the interview, we will
destroy the tape after it has been transcribed, which we anticipate will be within
two months of its taping.
Taking part is voluntary: Taking part in this study is completely voluntary. You
may skip any questions that you do not want to answer. If you decide not to take
part or to skip some of the questions, it will not affect your current or future
relationship with St. Alexius College. If you decide to take part, you are free to
withdraw at any time.
ST. ALEXIUS COLLEGE
If you have questions: The researchers conducting this study are Adrian Miles
Z. Duce, Jimmy C. Gregorio Jr., Erllea Lloren Q. Grijaldo, Kheyh J. Gonzales,
Krispearlmae F. Padillo, Sherilyn Joy B. Tamayo and Gien Carlo Ranin, RN,
MAN, and Jessie T. Orano, RN, RM, MN, MAN, MMHA as thesis advisers.
Please ask any questions you have now. If you have questions later, you may
contact Gien Carlo Ranin, RN, MAN, and Jessie T. Orano, RN, RM, MN, MAN,
MMHA. If you have any questions or concerns regarding your rights as a
participant in this study, you may contact the Institutional Review Board (IRB) at
(083)2282019 or access their website at http://www.stalexiuscollege.com. You
will be given a copy of this form to keep for your records.
Statement of Consent: I have read the information, and have received answers
to any questions I asked. I consent to take part in the study.
Your Signature ______________________
Date _________________________
Your Name (printed)

_____________________________________________________
This consent form will be kept by the Research and Publication Office of St.
Alexius College for at least three years beyond the end of the study.
ST. ALEXIUS COLLEGE
APPENDIX G
RESEARCH INSTRUMENT
Direction: We will appreciate if you can provide us with the following data about
yourself. Please indicate your answer by putting a check mark (✓) on the space
provided for.
PART I. Sociodemographic Characteristics of the Respondents
Age:
____ 20- 25 ____ 35-40
____ 26-30 ____40-45
____ 30-35 ____ 46 and above
Gender:
_____ Male
____ Female
Religion:
____ Roman Catholic
____ Iglesia ni Cristo
____ Islam
____ Others, please specify.

ST. ALEXIUS COLLEGE
Tribe:
____ B’laan ____ T’Boli
____ Maranao ____ Others, please specify.
____ Ilonggo
Level of Education:
____ Bachelor’s Degree
____ Master’s Degree
____ Doctoral Degree
Others, please specify:___________
Years of Experience
____ 1-3 years
____ 4-6 Years
____ 7-9 years
____ 10-12 years and above
PART II. Roles that emergency department nurses perceive themselves to have
when it comes to providing end-of-life care.
Direction: Please indicate your answer by putting a check mark (✓) on the space
provided for as 5 being the highest and 1 as the lowest.
5 – Strongly Agree
4 – Agree
3 – Neither Agree nor Disagree
2 – Disagree
ST. ALEXIUS COLLEGE
1 – Strongly disagree
5 4 3 2 1
Strongly Agree Neither Disagree Strongly

Agree Agree nor disagree
Disagree
1. I am clear about my role in caring

for patients who is dying in the
Emergency Department.
2. I provide emotional support to

patients and their families,
offering a listening ear, empathy,
and reassurance during this
difficult time. I help families cope
with grief and make informed
decisions about their loved one's
care.
3. I have adequate training to care

for patients who is dying in
4. I have adequate training to care

for family members whose loved
one is dying/has died in the
5. Nurses advocate for patients'

rights and ensure their autonomy
is respected throughout their
care. They educate patients and
families about their options and
ST. ALEXIUS COLLEGE
support them in making informed

decisions about their care
preferences.
6. I communicate effectively with

patients, families, and the
healthcare team, ensuring
everyone is kept informed and
involved in the decision-making
process.
7. I respect and accommodate

patients' spiritual and cultural
beliefs, ensuring their end-of-life
care aligns with their values and
traditions.
8. I am responsible for managing

symptoms and ensuring patients
experience comfort during their
final moments, which involves
administering appropriate
medications and interventions.
9. I play a crucial role in facilitating

communication between
healthcare providers, patients,
and their families to ensure
everyone understands the
prognosis and available options
for end-of-life care.
10. I meticulously document all

aspects of the patient's care,
including symptom management,
medications, and family
interactions, ensuring continuity
of care and adherence to ethical
guidelines.
ST. ALEXIUS COLLEGE
Part III. What is the extent of challenges encountered by emergency department

nurses when fulfilling their roles related to end-of-life care?
Direction: Please indicate your answer by putting a check mark (✓) on the space
provided for as 5 being the highest and 1 as the lowest.
5 – Challenged to the Greatest Extent
4 – Challenged to the Great Extent
3 – Challenged to a Moderate Extent
2 – Challenged to a Little Extent
1 – Challenged to No Extent
5 4 3 2 1
Greates Great Moderat Little No Extent

t Extent Extent e Extent Extent
1. Emergency Department nurse having too high

of a workload to allow for adequate time to
care for dying patients and their families
2. Nurses often face ethical dilemmas and difficult

decisions when caring for patients and their
families. These situations can be emotionally
taxing and may require nurses to navigate
complex moral issues while maintaining patient
autonomy and providing compassionate care.
3. Nurses may face resource limitations, such as

insufficient staffing, lack of equipment, or
limited access to End-of-life care services.
These limitations can hinder their ability to
provide optimal end-of-life care.
4. The Emergency Department is often crowded

and lacks private spaces for families to gather
ST. ALEXIUS COLLEGE
and say goodbye to their loved ones. This can

make it difficult to create a dignified and
comforting environment for end-of-life care.
5. Nurse not knowing the patient’s wishes

regarding continuing with treatments and tests
because of the inability to communicate due to
a depressed neurological status or due to
pharmacologic sedation.
6. Nurses may encounter communication barriers

with patients and families, particularly when
dealing with cultural differences, language
barriers, or cognitive impairments.
7. Patients does not want to receive nurses care

because of cultural differences.
8. Balancing the need for symptom relief with

potential side effects, adapting to patients with
diverse needs, and collaborating with other
healthcare professionals to optimize pain and
symptom management can be challenging in
the emergency room setting.
9. Managing time constraints in the fast-paced

emergency setting, conveying sensitive
information with empathy, and handling
potential emotional reactions from patients and
families pose challenges.
10. Maintaining accurate and complete records in

a fast-paced and demanding Emergency
Department environment.
ST. ALEXIUS COLLEGE
APPENDIX H
VALIDATION QUESTIONNAIRE
I would appreciate if you can provide me with your personal information:
Name:___________________________________________________________
Education:
College: _________________________________________________________
Graduate Degree: _________________________________________________
Post Graduate Degree: _____________________________________________
Work Experience:
Year Position Company/Institution
Direction: Please encircle the number of the rating that corresponds to

your choice using the point of equivalent provided below.
ST. ALEXIUS COLLEGE
Rating Verbal Description
5 Excellent
4 Very Good
3 Good
2 Fair
1 Poor
1. Clarity 5 4 3 2 1
The instructions and questions given are

clear, concise, understandable, and suited
to the level of the respondents.
2. Organization 5 4 3 2 1
The questions/items are presented and

organized in logical manner based on the
objectives or statement of the problem of
study.
3. Appropriateness 5 4 3 2 1
The questions/items are appropriate and

relevant to the research study. The questions
were designed to answer appropriately and
comprehensively the specific questions in the
statement of the problem.
4. Adequacy 5 4 3 2 1
The questionnaires are sufficient to gather

information needed to answer questions
in the statement of the problem. It represents
the coverage of the research adequately.
ST. ALEXIUS COLLEGE
5. Objectivity 5 4 3 2 1
Each questions/items requires only one

specific answer and measures only one
behavior. There are no items in the
questionnaire which suggest bias on the
part of the researcher.
6. Attainment of objectives 5 4 3 2 1
The questionnaire as a whole fulfill the

objectives of the study to which it was
instructed.
7. Evaluation Rating System 5 4 3 2 1
The rating system and the scale adopted

is appropriate and relevant to all items.
Comments and Suggestion
________________________________________________________________
________________________________________________________________
________________________________________________________________
__________
___________________________
Name and Signature of Evaluator

ST. ALEXIUS COLLEGE
LETTER TO VALIDATOR
December 7, 2023
MARIE BELEN TAMAYOR, RN, MAN

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i

EMERGENCY DEPARTMENT NURSES’ PERCEPTIONS OF THEIR ROLES

A Research Proposal Presented to

Adrian Miles Z. Duce

Background of the Study

Caring for individuals who die suddenly and unexpectedly in emergency

emergency department setting that emergency department (ED) nurses tend to

prioritize life-saving interventions over family-centered end-of-life (EOL) care.

As the number of individuals presenting to and dying in emergency

departments rises as our population ages, it is critical to provide safe, effective

of conceptual differences between end-of-life care and emergency care, nurses

in the emergency department confront difficulties in providing end-of-life care.

When a dying patient has unmanageable symptoms, financial concerns,

or restricted access to community services, the emergency department

commonly becomes their entryway to such treatment (Tiah et al. 2023). As a

large segment of the US population ages, the number of fatalities in emergency

rooms is anticipated to rise. As a result, when a patient dies, emergency nurses

have several challenges in delivering appropriate end-of-life care. Providing

end-of-life treatment in the emergency department, owing primarily to inadequate

department architecture, particularly in rural emergency rooms with little space

(Beckstrand et al. 2017).

In Japan, 1.5% of patients taken to the emergency room are confirmed

relationships among patients, relatives, and healthcare staff (Shida, 2023).

In a retrospective study conducted in Hongkong in 2014 by Tse et al. the

enhance the professional development of staff in the emergency department.

The emergency department's fast-paced and frequently chaotic environment

According to Omoya et al. (2023), emergency nurses must be able to

mismatch of responsibilities and education, end-of-life care is rapidly becoming a

necessary to deliver care in an environment that is not aligned with end-of-life

care’s goals. A collaborative practice approach is required as the guiding premise

expectations might create impediments to excellent supply. While some studies

have investigated emergency nurses' experiences with giving end-of-life care,

there is a considerable void in the research literature that has particularly

investigated emergency nurses' involvement in the provision of end-of-life care.

(Omoya et al. 2023).

The purpose of this study is to determine emergency department nurses’

perceptions of their respective roles and challenges when providing end-of-life

Orem’s Self-Care Deficit Theory, Neuman’s Systems Mode, and Peplau’s

Interpersonal Relation Theory may contribute to understanding the emergency

nurses’ perceptions of their roles in providing end-of-life care.

Dorothea Orem’s self-care deficit theory focuses on individuals’ ability to

and it stresses the importance to patients themselves of maintaining autonomy

provided by emergency nurses, understanding a patient's self-care abilities and

a sense of loss. According to Mchugh (2021), the goal of Hildegard Peplau's

Interpersonal Relations Theory focuses on the nurse-patient relationship where it

emphasizes the role of the nurse as a therapeutic partner, providing emotional

Peplau on interpersonal relations. The idea of Peplau has numerous applications

emphasizes the value of interpersonal interactions and the nurse's role in

assisting patients in achieving improved health and well-being. This theory

guides nurses in establishing trust, promoting patient engagement, and

enhancing the overall ER experience for patients (Mchugh,2021). The

development of a therapeutic connection offers emotional support, easing

suffering and assisting patients in navigating these difficult feelings. Improved

Communication An open and productive communication environment is fostered

their worries, preferences, and wishes, assisting Emergency Department Nurses

in modifying care to match their specific requirements. This can be seen as an

patient’s emotional and psychological well-being. Effective communication and

emotional responses (Bsn, 2023).

In the context of man as an open system, Betty Neuman considered the

client as an open system that responds to environmental stresses. According to

the Betty Neuman Systems Model, the physiological, psychological, social,

patient. In the context of end-of-life care (EOLC) in the Emergency Department

patient’s physical symptoms, emotional distress, and spiritual or existential