Dying in the emergency unit: a study on the caregivers' practices

Résumé En

Introduction: The goals of emergency ward hospitalization units (EWHU) are to take care of severely-ill patients before their admission into a hospital department and to provide immediate intensive care. The number of deaths (1 /2 per week) is one of the highest in comparison to other hospital units. However, death remains a relatively ''surprising'' event in such units. Our hypothesis is that the gap between the objectives of acute care and the frequent confrontation with death may induce breaks along the care practices leading to psychological suffering of the caregivers. Methods: Both the approaches and the methodological aspects of our research, performed in two different EWHU, are clearly multidisciplinary. Approaches, Objectives, Methods: 1-Epidemiology. To characterize the clinical care and the trajectories of the deceased patients. Restropective analysis of 300 patient files. 2-Sociology. To formalize the various aspects of care. Direct observation. 3-Psychology of work. To unveil the subjective relations to the work and analyse the representations of palliative care. Group discussions. Results: The results obtained are both corrobatory and complementary. They show that, although there is no explicit palliative approach, informed palliative care giving does however exist, the goal of which being to improve the quality of the patient's life and the accompanying of the family. They also highlight some specific representations of palliative care : one is related to the care of very terminally-ill patients whereas another is linked to its non-professional content. Finally, our results lead to an increased knowledge of the causes of work-induced suffering. Conclusion: The investigation of death in EWHU, still poorly developed, may however reveal changes in the dominant medical paradigm and raise the issue of the incorporation of palliative care in EWHU.