Ethical dilemmas and care actions in nurses providing palliative sedation

Abstract

Background Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. Objective To explore the meaning of nurses’ experiences in dealing with ethical dilemmas in relation to palliative sedation. Research design A qualitative research design was employed with a thematic analysis approach. Participants and research context Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. Ethical considerations Ethical approval was obtained from the authors’ institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. Results Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague’s disrespectful attitudes toward patients; dilemmas from patients’ families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. Conclusion Nurses’ ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives

“… 45 , 50 In addition, nurses’ exercise of ethical reasoning could help build their coping strategies to face moral and ethical dilemmas. 18 , 19 , 21…”

“…45,50 In addition, nurses' exercise of ethical reasoning could help build their coping strategies to face moral and ethical dilemmas. 18,19,21 Lastly, end-of-life management during COVID unveiled PC health professionals' moral duty to prepare, educate, and guide their colleagues working in other disciplines, especially in emergency wards. 47,70 The PC model of care could support all health professionals who struggle to understand the end-of-life decisionmaking process.…”

“…Several studies highlighted that such a scenario is generated by issues like treatments considered futile for patients and the criteria applied for admission, 12 , 13 the lack of time to establish effective relationships with relatives and patients, and health professionals’ disagreements on decisions to withdraw treatments too. 14 – 18 …”

“…’ 19 This situation produced major ethical dilemmas like communicating the truth regarding the prognosis to the patient and the emergency end-of-life conditions. 18 , 40 …”

“…Several studies highlighted that such a scenario is generated by issues like treatments considered futile for patients and the criteria applied for admission, 12,13 the lack of time to establish effective relationships with relatives and patients, and health professionals' disagreements on decisions to withdraw treatments too. [14][15][16][17][18] During COVID-19, specifically the first wave, high demand and unexpected end-of-life care management ethically challenged healthcare workers. Intensive care units (ICUs) were overwhelmed by the demand for beds and ventilator support.…”