Research Article| Volume 26, ISSUE 2, P126-131, June 2023

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Emergency department staff perceptions of their roles in providing end of life care

Published:September 07, 2022DOI:



      End of life care in the emergency department is environmentally and culturally challenging. The aim of this study was to determine Australian emergency department doctors and nurses’ perceptions of their roles in providing end of life care in this environment.


      Perceptions of end-of-life care roles were identified through semi-structured interviews with doctors and nurses using Dieklemann’s seven interpretative stages of analysis guided by phenomenological interpretive underpinnings (hermeneutics). Nine nurses and seven doctors were recruited using purposive sampling. Organisations for emergency doctors (Australasian College for Emergency Medicine: ACEM) and emergency nurses (College of Emergency Nursing Australasia: CENA) were approached to advertise the study and recruit participants across Australia via email.


      Results were categorised into four themes namely: role perception; the intensive nature of the role; emotional burden; and role integration. The participants stated that end of life care was provided according to their professional roles and responsibilities. Doctors and nurses had distinct tasks, some of which overlapped. The accounts of the participants in relation to their understanding of each other’s roles highlighted differences in how nurses perceived the role of doctors, and vice versa. The participants spoke about aspects that had an impact on their role of practicing end of life care in the emergency department setting.


      In this study, all participants expressed concern for dying patients in the emergency department. 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.


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        • Keene E.
        • Hutton N.
        • Hall B.
        • Rushton C.
        Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient continuing nursing education.
        Paediatr Nurs. 2010; 36: 185-189
        • Lowery D.S.
        • Quest T.E.
        Emergency medicine and palliative care.
        Clin Geriatr Med. 2015; 31: 295-303
      1. Australian Institute of Health and Welfare. ED Care 2017-18: Australian hospital statistics’, in Health Services Series no. 89. Cat. no. HSE 216.Canberra: AIHW. 2018 [Available from:–18/summary.

        • Solberg L.M.
        • Hincapie-Echeverri J.
        Palliative care in the emergency department.
        Crit Care Nurs. 2015; 27: 355-368
        • Smith A.K.
        • Fisher J.
        • Schonberg M.A.
        • Pallin D.J.
        • Block S.D.
        • Forrow L.
        • et al.
        Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department.
        Ann Emerg Med. 2009; 54: 86-93
        • DeVader T.E.
        • Albrecht R.
        • Reiter M.
        Initiating palliative care in the emergency department.
        J Emerg Med. 2012; 43: 803-810
        • Bos‐van den Hoek D.W.
        • Thodé M.
        • Jongerden I.P.
        • Van Laarhoven H.W.
        • Smets E.M.
        • Tange D.
        • et al.
        The role of hospital nurses in shared decision‐making about life‐prolonging treatment: a qualitative interview study.
        J Adv Nurs. 2021; 77 (296-30)
      2. Word Health Organisation. Palliative Care: Key facts. 2020 [Available from:

      3. National Health and Medical Research Council. An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions, NHMRC Commonw Aust. 2011 [Available from:

        • Griffiths I.
        What are the challenges for nurses when providing end-of-life care in intensive care units?.
        Br J Nurs. 2019; 28: 1047-1052
        • Heaston S.
        • Beckstrand R.L.
        • Bond A.E.
        • Palmer S.P.
        Emergency nurses' perceptions of obstacles and supportive behaviors in end-of-life care.
        J Emerg Nurs. 2006; 32: 477-485
        • Beckstrand R.L.
        • Smith M.D.
        • Heaston S.
        • Bond A.E.
        Emergency nurses’ perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care.
        J Emerg Nurs. 2008; 34: 290-300
        • Grudzen C.R.
        • Richardson L.D.
        • Hopper S.S.
        • Ortiz J.M.
        • Whang C.
        • Morrison R.S.
        Does palliative care have a future in the emergency department? Discussions with attending emergency physicians.
        J Pain Symptom Manag. 2012; 43: 1-9
        • Bradley V.
        • Burney C.
        • Hughes G.
        Do patients die well in your emergency department?.
        Emerg Med Austral. 2013; 25: 334-339
        • Decker K.
        • Lee S.
        • Morphet J.
        The experiences of emergency nurses in providing end-of-life care to patients in the emergency department.
        Austral Emerg Nurs J. 2015; 18: 68-74
        • Polit D.
        • Beck C.
        Nursing research: generating and assessing evidence for nursing practice. 8th ed. Lippincott Williams & Wilkins, Sydney2008
      4. Gadamer H. Truth and method, 2nd Revised ed. Weinsheimer J, Marshall D. Trans. London, New York: Continuum (first published in Germany in 1960); 2004.

        • Diekelmann N.
        • Allen D.
        • Tanner C.
        The NLN criteria for appraisal of baccalaureate programs: a critical hermeneutic analysis.
        National League for Nursing, New York1989
        • Zhang Y.
        • Pal R.Y.
        • Tam W.S.
        • Lee A.
        • Ong M.
        • Tiew L.H.
        Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: a mixed-method study.
        Int Emerg Nurs. 2018; 37: 13-22
        • Radwany S.
        • Albanese T.
        • Clough L.
        • Sims L.
        • Mason H.
        • Jahangiri S.
        End-of-life decision making and emotional burden: placing family meetings in context.
        Am J Hosp Palliat Med. 2009; 26: 376-383
        • Cipolletta S.
        • Oprandi N.
        What is a good death? Health care professionals’ narrations on end-of-life care.
        Death Stud. 2014; 38: 20-27
        • Wolf L.A.
        • Delao A.M.
        • Perhats C.
        • Clark P.R.
        • Moon M.D.
        • Baker K.M.
        • Carman M.J.
        • Zavotsky K.E.
        • Lenehan G.
        Exploring the management of death: emergency nurses’ perceptions of challenges and facilitators in the provision of end-of-life care in the emergency department.
        J Emerg Nurs. 2015; 41: e23-e33
        • Karlsson M.
        • Kasén A.
        • Wärnå-Furu C.
        Reflecting on one's own death: the existential questions that nurses face during end-of-life care.
        Palliat Support Care. 2017; 15: 158-167
        • Ranse K.
        • Yates P.
        • Coyer F.
        End-of-life care in the intensive care setting: a descriptive exploratory qualitative study of nurses’ beliefs and practices.
        Aust Crit Care. 2012; 25: 4-12
        • Blaževičienė A.
        • Newland J.A.
        • Čivinskienė V.
        • Beckstrand R.L.
        Oncology nurses’ perceptions of obstacles and role at the end-of-life care: cross sectional survey.
        BMC Palliate Care. 2017; 16: 1-8
        • Karbasi C.
        • Pacheco E.
        • Bull C.
        • Evanson A.
        • Chaboyer W.
        Registered nurses’ ' provision of end-of-life care to hospitalised adults: a mixed studies review.
        Nurse Educ Today. 2018; 71: 60-74
        • Benbenishty J.
        • Ganz F.D.
        • Anstey M.H.
        • Barbosa-Camacho F.J.
        • Bocci M.G.
        • Çizmeci E.A.
        • Dybwik K.
        • Ingels C.
        • Lautrette A.
        • Miranda-Ackerman R.C.
        • Estebanez-Montiel B.
        Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: descriptive comparative study.
        Intensive Crit Care Nurs. 2022; 1103138
        • Johnstone M.J.
        • Hutchinson A.M.
        • Redley B.
        • Rawson H.
        Nursing roles and strategies in end-of-life decision making concerning elderly immigrants admitted to acute care hospitals: an Australian study.
        J Transcult Nurs. 2016; 27: 471-479
        • Nedjat-Haiem F.R.
        • Carrion I.V.
        • Gonzalez K.
        • Ell K.
        • Thompson B.
        • Mishra S.I.
        Exploring health care providers’ views about initiating end-of-life care communication.
        Am J Hosp Palliat Med. 2017; 34: 308-317
        • Kalowes P.
        Improving end-of-life care prognostic discussions: role of advanced practice nurses.
        AACN Adv Crit Care. 2015; 26: 151-166
        • Anselm A.H.
        • Palda V.
        • Guest C.B.
        • McLean R.F.
        • Vachon M.L.
        • Kelner M.
        • Lam-McCulloch J.
        Barriers to communication regarding end-of-life care: perspectives of care providers.
        J Crit Care. 2005; 20: 214-223
        • Utami R.S.
        • Pujianto A.
        • Setyawan D.
        • Naviati E.
        • Rochana N.
        Critical care nurses’ experiences of end-of-life care: a qualitative study.
        J Nurs. 2020; 10: 260-274
        • Flannery L.
        • Peters K.
        • Ramjan L.M.
        The differing perspectives of doctors and nurses in end-of-life decisions in the intensive care unit: a qualitative study.
        Aust Crit Care. 2020; 33: 311-316
        • McAndrew N.S.
        • Leske J.S.
        A balancing act: experiences of nurses and physicians when making end-of-life decisions in intensive care units.
        Clin Nurs Res. 2015; 24: 357-374