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Views and experiences of nurses in providing end-of-life care to patients in an ED context: a qualitative systematic review
  1. Amber Mughal,
  2. Catrin Evans
  1. School of Health Sciences, University of Nottingham, Nottingham, UK
  1. Correspondence to Amber Mughal, School of Nursing and Midwifery, The Aga Khan University School of Nursing and Midwifery, Karachi 74800, Pakistan; amber.mughal07{at}


Introduction With an increase in the population living with terminal illness, many patients are accessing EDs during the last days of their life. Yet EDs are often not well prepared to provide end-of-life (EOL) care. The aim of this review was to identify and synthesise studies that describe the views and experiences of emergency nurses in providing EOL care so as to understand the barriers and challenges that they face while caring for these patients and to identify factors that can support appropriate care delivery.

Method A qualitative meta-synthesis was undertaken using a thematic approach. Study quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument tool. Five databases were searched in June 2016.

Results Eleven qualitative studies met the inclusion criteria and were assessed as having high quality. Sixty-nine findings were identified, combined into 11 descriptive themes and then synthesised into 3 analytical themes: (1) Incongruent ED environment and EOL care. (2) Lack of resources, systems and capacity. (3) EOL care as a rewarding act or an emotional burden.

Conclusion The review identified a need for: (1) Additional training for nurses. (2) The development of clear guidelines in the form of pathways and protocols. (3) Having a separate space for the dying. (4) Providing a supportive environment for staff dealing with high emotional burden and challenging workloads. In order to improve EOL care, organisations must work on the barriers that hinder care provision.

  • death/mortality
  • emergency department
  • nursing, emergency departments

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  • Contributors AM planned the study. AM conducted search and CE reviewed it. The quality of each paper was assessed independently by AM and CE. Data extraction was initially done by AM and it was discussed with CE, through regular meetings. Thematic analysis was done by AM and then was discussed with CE and confirmed. Confidence in the review findings was evaluated by both AM and CE. The study was reported by AM and reviewed by CE. AM submitted the study. Both the contributors are responsible for overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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