Emergency Room Nurses Transitioning from Curative to End-of-Life Care: The Rural Influence
Rural nurses typically fill several roles as needed from acute and extended care settings and to the emergency room. 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.
Purpose: With the limited resources in rural hospitals, it was necessary to explore the rural influence on rural ER nurses transitioning from curative to end-of-life care. The goal was to capture areas of need to best support rural nurses caring for dying patients and their families in the rural communities.
Method: A secondary analysis using deductive content analysis incorporated Rural Nursing Theory to identify rural influences with rural ER nurses transitioning from curative to end-of-life care. In a primary study, Grounded Theory was used to explore ER nurses’ personal transitioning when the focus of patient care changes from curative to end-of-life. Registered nurses (N=10; rural n=6, urban n=4) from four hospitals (2 rural and 2 urban) in four different counties in Upstate New York participated in semi-structured interviews. Analysis yielded 29 concepts and producing five categories: preparing caring, immersion, making sense, changing gears, and reflecting. Three sub-processes, focus, feelings, and conflict were identified as common threads with conflict as a moderating factor influencing nurses transitioning from curative to end of life care.
Findings: The concepts of distance, resources, and familiarity had the greatest influence on rural ER nurses transitioning from curative to end-of-life care. The strongest characteristic of rural nurses was self-reliance. For this reason, adequate support and resources are essential to care for dying patients and their families in rural communities.
Conclusions: Implications for rural ER nursing include strategies to improve staff resources, access to education, and mentoring.
Keywords: Rural, End-of-life, Transition, Emergency, Nurse
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