Nurses’ perceptions and experiences of caring for patients who die in the emergency department setting

•Nurses want to provide quality end of life care in the emergency department.•End of life care in the emergency department is hampered by multiple barriers.•Enhancing communication is central to improving EOL care in the ED.•Cultural change is needed to prioritise care of the dying patient in the ED. The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians’ perceptions and experiences of providing such care when the death is sudden and unexpected. This study explored nurses’ perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED. Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically. 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected. ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.