Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors
Murphy-Jones, Georgina Timmons, Stephen
Murphy-Jones, Georgina
Timmons, Stephen
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Abstract
Introduction For a patient nearing the end of his or
her life, transfer from a nursing home to the ED can be
inappropriate, with potentially negative consequences,
but transfer in these circumstances is, regrettably, all too
common. There is a lack of published literature exploring
how paramedics make decisions in end-of-life care
situations. This study aims to explore how paramedics
make decisions when asked to transport nursing home
residents nearing the end of their lives.
Methods Phenomenological influenced design with a
pragmatic approach. Semi-structured face-to-face
interviews were conducted with six paramedics in an
English NHS Ambulance Trust and subsequent data
collected by text message. Audio-recorded interviews
were transcribed verbatim and analysed using a thematic
approach.
Results Three themes emerged in relation to the
decision to transport patients from nursing homes to EDs
in end-of-life care situations. Paramedics identified
difficulties in understanding nursing home residents’
wishes. When a patient no longer had the capacity for
decision making, paramedics’ reasoning processes were
aligned to best interest decision making, weighing the
risks and benefits of hospitalisation. Paramedics found it
challenging to balance patients’ best interests with
pressure from others: nursing staff, patients’ relatives
and colleagues.
Conclusions A range of factors influence paramedics’
decisions to transport nursing home residents to EDs in
end-of-life care situations. Decision making became a
process of negotiation when the patient’s perceived best
interests conflicted with that of others, resulting in
contrasting approaches by paramedics. This paper
considers how paramedics might be better trained and
supported in dealing with these situations, with the aim
of providing dignified and appropriate care to patients as
they reach the end of their lives.
https://emj.bmj.com/content/emermed/33/10/722.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2015-205405