health care for dying patients and their families : lessons

from end - of - life care

end-of-life (EOL) care for dying patients and their families is understudied, says Christine Bell. She

says the emergency nurse can be the driver of care and advocacy for these patients. Bell says the

fast-paced, resource-challenged ED setting can compromise the EOL experience.Other

recommendations included integration of deathand dying exercises into nursing curricula, respect

for spiritualand cultural differences, and supportive strategies (eg,debrieufb01ngs after EOL events)

to help staff develop copingand stress management skills.ConclusionsThis mixed-methods study

indicates that emergency nursesare comfortable with providing care, have positive attitudestoward

the dying, and believe patients and families deserveto have a digniufb01ed EOL

experience..However, theyrecognized that this was not always achievableu2014or evenappropriate

to their deufb01ned roleu2014within the constraints ofthe emergency care setting..They described a

mismatchbetween the life-saving nature of emergency care and themore emotionally demanding

nature of EOL careu2014onethat often resulted in arbitrary decisions to prioritize onepatientu2019s

needs over anotheru2019s..Signiufb01cant challenges toproviding EOL emergency care included

limited time andspace; gaps in resources and services; inadequate staffeducation and preparation;

and the heavy emotional burdenon nurses, patients, and families..More research is needed tobetter

understand the relationship among emergencynursesu2019positive attitudes toward caring for the

dying andbereaved, their exposure to EOL education, and the actualpractice competencies that
could improve the EOLexperience for nurses, patients, and families in theemergency

department.AcknowledgmentWe acknowledge Leslie Gates for her assistance with this study.