Emergency Nurses’ Perceived Barriers and Solutions to Engaging Patients With Life-Limiting Illnesses in Serious Illness Conversations: A United States Multicenter Mixed-Method Analysis

• Published in: Journal of emergency nursing Vol. 50; no. 2; pp. 225 - 242
• Main Authors: Adeyemi, Oluwaseun, Walker, Laura, Bermudez, Elizabeth Sherrill, Cuthel, Allison M., Zhao, Nicole, Siman, Nina, Goldfeld, Keith, Brody, Abraham A., DiMaggio, Charles, Grudzen, Corita R., Johnston, Andrew, Venkat, Arvind, Chuirazzi, David, O'Neill, John, Szabo, Kelly, Urosek, Rachel, Deutsch, Ashley, Schoenfeld, Elizabeth, Shaw, Melissa, Guerino, Tricia, Perko, Alayna, Banish, Michael, Sloan, Pamela, Swor, Robert, Otero, Ronny, Reiner, Kim, Hurd, Nicole, Ballaron, Brittany, Ouchi, Kei, Egorova, Natasha, Dundin, Andrew, Troncoso, Niza, Powell, Robin, Debbage, Barbara J., Johnson, Deborah, Powell, John, Cooper, Julie, Graham-Brekke, Doretha, Zimny, Erin, Tokarski, Glenn, Miller, Joseph, Sadia, Olive, Kroll, Jennifer, Siller, Jennifer, Fleischer-Black, Jessica, Evelyn, Karen, Stark, Laura, Gordon, Lauren, Richardson, Lynne, Lin, Michelle, Genes, Nicholas, Loprinzi-Brauer, Caitlin, Heaton, Heather, Bellolio, M Fernanda, Christenson, Molly, Shelley, Donna, Tan, Audrey, Rosenthal, Barry, Wittman, Ian, Peterson, Kathy, Hageman-Sheehan, Lila, Gulati, Rajneesh, Smeltz, Robert, Stark, Stephen, Datta, Suchismita, Thompson, Tisha, Chodosh, Joshua, Lawrence, Katharine, Brody, Abraham, Horwitz, Leora, Shreves, Ashley, Bolden, Deidre, Hutchinson, Kelly, Gang, Maureen, Goett, Rebecca, Lamba, Sangeeta, Southerland, Lauren T., Gulker, Peg, Isaacs, Eric, Harris, Jennifer, Elie, Marie-Carmelle, Shaw, Matthew, Fernandez, Rosemarie, Bledsoe, Shannon, Wood, Travis, Abella, Benjamin S., Long, Elizabeth, Uspal, Julie, Falk, M. Bradley, Landis, Phillip, Milling, Danielle, Langabeer, Denise, Bourenane, Sorayah, Cridge, Terri, Madsen, Troy, Boutsioulis, Emilia, Nofsinger, Hannah, Jubanyik, Karen, Cohen, Theresa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024; Elsevier Limited
• Subjects: Barriers; Content analysis; Cross-Sectional Studies; Death; Emergency medical care; Emergency nurses; Emergency Service, Hospital; Emergency services; End of life decisions; End-of-Life Nursing Education Consortium; Grief; Human factors; Humans; Illnesses; Medical education; Mixed-methods; Nurses; Nursing; Palliative care; Polls & surveys; Privacy; Professional training; Qualitative research; Quantitative analysis; Serious illness conversation; Surveys and Questionnaires; United States; Work environment; United States; Palliative care; End-of-Life Nursing Education Consortium; Emergency nurses; Serious illness conversation; Mixed-methods
• ISSN: 0099-1767; 1527-2966; 1527-2966
• DOI: 10.1016/j.jen.2023.09.010

This study aimed to assess emergency nurses’ perceived barriers toward engaging patients in serious illness conversations. Using a mixed-method (quant + QUAL) convergent design, we pooled data on the emergency nurses who underwent the End-of-Life Nursing Education Consortium training across 33 emergency departments. Data were extracted from the End-of-Life Nursing Education Consortium post-training questionnaire, comprising a 5-item survey and 1 open-ended question. Our quantitative analysis employed a cross-sectional design to assess the proportion of emergency nurses who report that they will encounter barriers in engaging seriously ill patients in serious illness conversations in the emergency department. Our qualitative analysis used conceptual content analysis to generate themes and meaning units of the perceived barriers and possible solutions toward having serious illness conversations in the emergency department. A total of 2176 emergency nurses responded to the survey. Results from the quantitative analysis showed that 1473 (67.7%) emergency nurses reported that they will encounter barriers while engaging in serious illness conversations. Three thematic barriers—human factors, time constraints, and challenges in the emergency department work environment—emerged from the content analysis. Some of the subthemes included the perceived difficulty of serious illness conversations, delay in daily throughput, and lack of privacy in the emergency department. The potential solutions extracted included the need for continued training, the provision of dedicated emergency nurses to handle serious illness conversations, and the creation of dedicated spaces for serious illness conversations. Emergency nurses may encounter barriers while engaging in serious illness conversations. Institutional-level policies may be required in creating a palliative care-friendly emergency department work environment.