Date of Award

2018

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN, Dean; Ruth A. Bush, PhD, MPH

Keywords

palliative care, emergency department

Abstract

Background:

Purpose: This study explored barriers and perceptions of providing palliative care services while patients are in the emergency department (ED) in order to increase the>likelihood of caregivers to elicit palliative care methodologies for patients with chronic illness, who are not necessarily at the end of life, but rather who are identified through repeated visits to the ED.

Design and Methods: A mixed methods approach was used to explore the barriers and perceptions of providing palliative care services in the ED. By using a qualitative approach, evidenced by grounded theory, this study explored the barriers and perceptions of providing palliative care services in the ED. Structured cultural interviews were the preferred mode of data collection for this selected population. Concomitantly, the researcher conducted a survey, distributed via email further comparing relationships between the identified themes. This comparative analysis lends itself to a mixed methodological approach to explore the barriers and perceptions of providing palliative care services in the ED. Through data collection by interviews and internet survey, the researcher broadens the scope of information gathering to improve insight into this study.

Eight participants working in a district hospital in southern California participated in the qualitative portion of the study. The interviews were audio-recorded during a one-on-on confidential session, transcribed verbatim, and analyzed per the extensive research conducted by Glaser and Strauss (1967). The survey questions were sent via email to the American Association of Emergency Nurses (AAENP) and respondents anonymously selected answers. Thirty-five emergency nurse practitioners, all members of a national organization, responded to the on-line survey.

Results: Themes for the one-on-one interviews included defining palliative and hospice services, perceptions of family and patients about palliative care in the emergency department, barriers to utilizing palliative care in the emergency department, personal philosophy and palliative care services, effects of palliative care services on emergency department efficiency and hospital throughput, and vision of palliative care in the future.

The conceptual model depicts the barriers and perceptions to utilizing palliative care in the emergency department, supported by Murray’s (2007) transition model of care.

Conclusion: Exploration of the barriers and perceptions of caregivers illustrated initiating the conversation about palliative care services is not only a difficult discussion to broach, but also a matter of timing and sensitivity for patients and families during an acute episode of a chronic illness. Caregivers agree on the efficacy and need for palliative care in the emergency department. Further research is needed to explore concepts consistent with a successful palliative care program in the emergency departments as it relates to decreased admissions for patients with chronic illnesses, access to outpatient resources and enhanced education and knowledge for caregivers about palliative care.

Document Type

Dissertation: Open Access

Department

Nursing

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