• Tracey M Giles, Karen Hammad, Katrina Breaden, Christine Drummond, Sandra L Bradley, Adam Gerace, and Eimear Muir-Cochrane.
• College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
• Int Emerg Nurs. 2019 Nov 1; 47: 100789.

IntroductionThe 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.AimThis study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED.MethodsOpen-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically.Results211 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.ConclusionsED 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.Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

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