Opinion Piece
A ‘good enough death’ in the emergency department – it is possible
Emily Molan
Lecturer in Nursing, University of Canberra, Disciplines of Nursing & Midwifery
Article Text
As an emergency nurse, my experiences with death have been overwhelmingly messy, sad and at times tragic and untimely. A 'good death' or the more recent concept of a 'good enough death' considers the ideal in terms of the constraints of reality (McNamara 2001). Beliefs about a 'good enough death' evolve according to individual experiences with death and spiritual and personal tenets, however symptom control, promoting personhood and dignity, involving the dying person in decision making and honouring those decisions are considered key elements (Griggs 2010; Hopkinson & Hallett 2002; Kehl 2006). My story of Greta shows that a 'good enough death' is possible in the emergency department (ED) when there is strong teamwork.
Greta, an elderly lady with a recent diagnosis of a life-limiting problem, was receiving palliative care at her Residential Aged Care facility as was her request. On this day, Greta developed back pain with haematemesis and was transported to hospital via ambulance without her prescribed continuous infusion of morphine and midazolam. In the ED, Greta was struggling for breath and vomiting. However, she remained coherent and clear about her desires for the trajectory of her care and illness. While anxious and uncomfortable, Greta referred graciously to the treating team as 'Dear', 'Sister' or 'Doctor', and encouraged us to retrieve her aids from her handbag as she was hearing impaired. Greta stated that she did not want any potentially life extending interventions, such as surgery, desiring relief only. She appeared frustrated, uttering that she thought the process would be "quick"; she wanted to die and for the pain to be over. Greta did not appear frightened, just exhausted within her ailing body which was propped awkwardly on the thin mattress.
References
Australian Palliative Residential Aged Care Project (2006) Guidelines for a Palliative Approach in Residential Aged Care. Canberra, Commonwealth of Australia.
Carper B (1978) Fundamental Patterns of Knowing in Nursing, Advances in Nursing Science, 17, 73-86.
Griggs C (2010) Community nurses' perceptions of a good death: a qualitative exploratory study, International Journal of Palliative Nursing, 16, 139-148.
Hewison A, Badger F and Swani T (2011) Leading end-of-life care: an action learning set approach in nursing homes, International Journal of Palliative Nursing, 17, 135-141.
Hopkinson J and Hallett C (2002) Good death? An exploration of newly qualified nurses' understanding of good death, International Journal of Palliative Nursing, 8, 532-539.
Kehl Ka (2006) Moving toward peace: an analysis of the concept of a good death, American Journal of Hospice & Palliative Medicine, 23, 277-286.
Mcnamara B (2001) Fragile lives: death, dying and care, United Kingdom, Open University Press.
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