Emergency Room Nurses Transitioning from Curative to End-of-Life Care: The Rural Influence

Emergency Room (ER) nurses in rural communities face unique obstacles and barriers while caring for patients and families at end-of-life. Standard guidelines, programs, and resources may be more difficult to implement in smaller rural hospitals with a limited budget and staff.  For this reason, it is important to explore the needs of rural ER nurses to develop education, resources, and support unique to end-of-life care in rural communities.

            A secondary content analysis was performed to examine rural influences on ER nurses transitioning care from curative to end-of-life care. The preliminary study using grounded theory explored the personal transitioning of ER nurses (N = 10) when the focus of care changes from curative to end of life. Participants included both rural (n = 6) and urban (n = 4) registered nurses working in ER settings. Urban nurses served as a contrasting group to enhance the likelihood of identifying rural components and influences.  

            Rural concepts and characteristics as outlined in Lee and McDonagh (2006) were used as a guide for examining the content of the categories and sub-processes of the preliminary study.  The categories were preparing caring, immersion, making sense, changing gears, and reflecting with a core category, caring driven. The sub-processes involved focus, feelings, and conflict. Both rural and urban ER nurses moved through the categories in a forward sequence.

            The secondary analysis revealed several rural components within various sub-processes. Rural concepts including lack of anonymity, distance, and informal networks were evident among rural nurses. Differences found among rural and urban nurses involved the sub-process, conflict. Staff resources and connectedness had a greater effect on the transitioning of ER nurses. In addition to support for patients and families, rural nurses expressed a need for personal and emotional support. Knowledge and experience influenced both groups. Education was essential among rural nurses since they commonly found themselves in charge of critical situations. Such rural concepts as time and distance were compensated in some aspects with technology however, barriers remain.

Implications for nursing include strategies to improve staff resources, end-of-life education, and personal support. Educational strategies may involve traditional methods and more innovative methods using simulation with end-of-life care. Staff resources were essential elements to support nurses caring for dying patients and their families. Mentoring programs designed to create a culture of support may influence preparedness, decision making, and coping, and consequently, enhance end-of-life care.