“Caught in the middle”- emergency doctors and nurses’ experiences of ethical dilemmas in end of life care: A qualitative study

• Published in: International emergency nursing 2024-12, Vol.77, p.101535, Article 101535
• Main Authors: (Tomi) Omoya, Oluwatomilayo, De Bellis, Anita, Breaden, Katrina
• Format: Article
• Language: English
• Subjects: Advance directives; Doctors; Emergency; End of life care; Ethical dilemmas; Nurses
• ISSN: 1755-599X
• DOI: 10.1016/j.ienj.2024.101535

•Doctors faced moral distress from decision-making responsibilities, while nurses felt it from enacting care against moral beliefs.•End of life treatment decisions can pose dilemmas for emergency clinicians, but ethical principles offer guidance.•Participants suggested collaborative decision making with nurses in treatment plans to improve ethical dilemma experiences. The integration of end of life care into emergency work is gaining momentum, especially in Australia. Emergency doctors and nurses are increasingly required to make decisions regarding the provision of end of life care. The importance of end of life care for patients and their families in the emergency department is well documented, but ethical dilemmas that arise in end of life care provision are not widely researched. A qualitative interpretative design and phenomenological approach were used to create an understanding and meaning about ethical dilemmas faced by emergency nurses and doctors in end of life care. Sixteen doctors and nurses were purposively recruited through professional organisations. Data were collected using semi-structured in-depth interviews. Interviews were audio-taped, transcribed verbatim, and thematically analysed using a qualitative seven stage thematic analysis. The overarching constitutive pattern ‘decision making processes’ was conceptualised within the two identified major themes including: 1) Short-term (ST) versus Long-term (LT) ethical dilemmas and; 2) Individual versus community ethical dilemmas. These themes were uncovered using the phenomenological hermeneutic concepts of epoche (openness) to construct meaning and understanding for participants. In this study, the frequent experiences of ethical dilemmas by emergency doctors and nurses demonstrated that end of life care in the emergency department was challenging. The stated experiences were related to barriers that contributed to the complexities reported in making ethical decisions at the end of life. Therefore, an understanding of ethical principles is needed to navigate care for patients and their families for the best possible outcomes.