Palliative Care in the Emergency Department: Exploring Nurses’ Educational Needs Through an Italian Convergent Mixed-Methods Approach

Abstract

Introduction. The progressive increase in population frailty and vulnerability has led to a growing need for palliative care (PC) across healthcare settings, including the emergency department (ED). ED nurses play a key role in caring for patients with palliative care needs in acute and complex situations, making the identification of their educational needs essential to improving care quality. The aim of this study was to explore the educational needs of ED nurses regarding palliative and end-of-life care.

Methods. A convergent mixed-methods study was conducted in October 2024. Quantitative data were collected using two validated self-report questionnaires comprising 42 items and exploring knowledge, attitudes, and practices regarding palliative care. One questionnaire was specifically developed for ED nurses, while the other targeted non-ED nurses. Qualitative data were collected through two online focus groups and analyzed using thematic analysis. Quantitative and qualitative findings were subsequently integrated through convergent analysis. The study received approval from the Local Ethics Committee.

Results. Forty-two of 68 nurses participated in the quantitative phase (response rate 61.8%). The mean knowledge score was 159.3 (SD = 33.9; range 84–238), corresponding to 66.3% of the maximum score and indicating a moderate level of knowledge. Lower self-confidence emerged in discussing death and mortality (mean = 3.3/10; SD = 2.0), while difficulties were identified in the use of non-pharmacological strategies for pain management (mean = 4.0/10; SD = 3.0). Qualitative findings from nine participants highlighted logistical barriers and insufficient perceived training as major obstacles to providing PC in the ED. Integrated analysis also identified insufficient preparation concerning ethical and moral dimensions of palliative care and organizational constraints.

Discussion. The study highlights specific educational and organizational needs among ED nurses involved in palliative care. The findings identify key areas for targeted interventions aimed at improving clinical practice and supporting continuing professional development in emergency palliative care.