Understanding healthcare professionals’ lived experiences of death in the Emergency Department and the influence of personal values and norms

Abstract

Background: The Emergency Department (ED) is traditionally viewed as a place, where staff are trained to save lives and improve the patient’s medical condition. Death in the ED is rarely planned, but often a sudden and unexpected event, carrying the potential for emotional and psychological impact on healthcare professionals (HCP). While ED is not considered by HCPs an ideal place for end-of-life care, the culture of emergency medicine is shifting to a more patient goal-centred culture. Despite these efforts, death occurring in the ED still presents a unique challenge for the staff. The purpose of this research study is to explore healthcare professionals’ lived experiences of death in the ED, their meaning and the influence of their personal values and norms on this experience, using a phenomenological and interpretative methodology.

Methodology and methods: Interpretative phenomenological analysis (IPA) was applied to explore the lived experiences of seventeen healthcare professionals working in the ED, in different roles and levels of seniority, including doctors, nurses and healthcare assistants, about their experiences with death. Data was collected via semi-structured interviews, using an online video platform and audio recordings, and analysis was guided by the phenomenological, ideographic, and hermeneutic principles of IPA.

Findings: The analytic process resulted in three higher order concepts and nine super-ordinate themes. The higher order concept Experiencing death in the ED was underpinned by the superordinate themes of ‘ED deaths to remember’ and ‘Objectifying and humanising death’; the higher order concept Making sense of death in the ED, was constructed by ‘Meaning of death’, ‘Values and norms’ and ‘Faith and spiritual beliefs’ as super-ordinate themes; and the final higher
order concept, Influenced by death in the ED, had its foundation on ‘Changed by death’, ‘Emotional labour of death’, ‘Coping with death’ and ‘Learning from death’.

Conclusion: This study concludes that factors, such as a patient’s age, traumatic circumstances, or the unexpected nature of death, are responsible for making HCP’s death experiences in the ED memorable. Personal, cultural, social, spiritual, and moral values held by healthcare professionals, influence their attitudes towards death, their coping and grieving mechanisms, their relationship
with the dying or deceased patient’s family members, how they provide care to other patients and their decision-making processes in their personal and professional life. Provision of training and improvement of support services, are seen by staff as practical tools in better managing the death experience in the ED.

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Identifiers

ORCID for Laszlo Penzes: orcid.org/0000-0002-0840-4419

ORCID for Michelle Myall: orcid.org/0000-0001-8733-7412

ORCID for Joanne Turnbull: orcid.org/0000-0002-5006-4438

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