Emergency Room Nurses Transitioning From Curative to End-Of-Life-Care Roberta Rolland, PhD, RN, FNP
Acknowledgements This research was supported by Omicron Alpha Chapter, Sigma Theta Tau International. The author wishes to acknowledge the guidance of the dissertation committee and the mentoring of Dr. Melanie Kalman. Sincere gratitude is extended to the registered nurses who shared their experiences, giving a voice to all who care for the ill, injured, and dying in the emergency room setting.
■ Abstract The nurse’s role with aggressive curative efforts involves an intense clinical focus, while end-of-life care entails an intense psychosocial focus. Emergency room (ER) nurses commonly experience these two intense foci of care in succession. Grounded theory was used to explore ER nurses’ personal transitioning when the focus of patient care changed from curative to end-oflife. Registered nurses (N = 10) from four hospitals in four different counties in upstate New York participated in semi-structured interviews. Analysis yielded 29 concepts and produced five categories: preparing caring, immersion, making sense, changing gears, and reflecting. Three sub-processes were identified as common threads with conflict as a moderating factor influencing nurses transitioning from curative to end-of-life care: focus, feelings, and conflict. Theoretical integration generated the core category of caring driven. Implications for nursing include strategies to improve staff resources, end-of-life education, and personal support. Keywords: end-of-life, transition, emergency, nurse, caring
Introduction With the advances in technology and medicine, more aggressive efforts and extreme measures are employed to treat the gravely ill and severely injured (Bailey, Murphy, & Porock, 2011). When curative efforts are exhausted and the focus of care changes to end-of-life, the nurse’s focus must change as well. Aggressive curative efforts may involve an
intense physiologic focus, while end-of-life care may entail an intense psychosocial focus. ER nurses commonly experience these two intense foci of care in succession. Although “fewer than one percent of ER visits result in death,” nearly a quarter of a million deaths occur in ERs annually (Centers for Disease Control and Prevention, 2013, p. 29). The ER nurse must respond
Roberta Rolland is currently an Assistant Professor and Director of Undergraduate Programs at Upstate Medical University, College of Nursing, 750 East Adams Street, Syracuse, New York 13210, rollandr@upstate.edu. Journal of the New York State Nurses Association, Volume 45, Number 1
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