Nurses' Attitudes and Experiences Surrounding Palliative Sedation: Components for Developing Policy for Nursing Professionals

Abstract

Background: Nurses play an integral role in providing care for patients with end of life (EOL) symptoms refractory to conventional treatments and that may necessitate palliative sedation (PS). A paucity of research on nurses' attitudes, knowledge, and experience with PS exists, despite nurses being instrumental in evaluating its appropriateness and carrying out the care plan. Objective: The objective of the study was to elicit nurses' perspectives and conceptualizations of knowledge and skills needed to administer PS in order to inform development of a hospital policy that addresses identified concerns. Methods: Four focus groups were conducted with nurses likely to have had exposure to PS (oncology, intensive care, and hospice) at an academic medical center. Focus groups were audiotaped, transcribed verbatim, and coded for salient themes. Grounded theory principles were used for the analysis. Results: Among the four focus groups (n = 31), 87% were female, 58% between the ages of 36 and 55, and more than 40% reported 10-plus years of providing patient care. Five domains emerged as important in developing a PS policy: 1) ability to define PS; 2) criterion for using PS; 3) skill set for administering PS; 4) policy and procedural guidelines; and 5) education on PS and EOL care. Conclusions: Nurses identified knowledge, skills, and guidelines as key considerations for implementing PS. Comprehensive policies along with adequate training are needed to expand the availability of PS in acute care hospitals and hospice programs.

One Last Opportunity

“…This has also been seen in previous studies. 11,14,16 Morita et al 13 reported that inexperienced and younger nurses are more inclined to think about resigning because of palliative sedation. This was not reported in the current study; the nurses saw palliative sedation as an opportunity for the patient, the family, and the staff to have a dignified farewell.…”

“…5,6 Previous studies have shown that nurses believe that palliative sedation is perceived as ethically difficult and that further knowledge is required for nurses to feel secure in their role. 10,[13][14][15] Nurses have an important role in palliative sedation. The nurse is involved in the decision making, implementation, and monitoring during treatment.…”

“…The care of the patient's family is also the nurse's responsibility. 2,3,[14][15][16][17] Palliative sedation raises serious ethical questions and thoughts among nurses on whether the treatment shortens the patient's life. 3,5,7,13,15,18 In the qualitative interview study of Rietjens et al, 10 the nurses thought about whether palliative sedation may have had a life-shortening effect.…”

“…11,14,16 It is important to have guidelines for palliative sedation, to reduce stress for staff. It is also important that nurses receive training on palliative sedation and that they feel supported by the whole team.…”

“…It is also important that nurses receive training on palliative sedation and that they feel supported by the whole team. 2,3,10,[13][14][15][16] Despite efforts to find Swedish studies on the subject, none were found. Only a few studies about nurses' experiences of palliative sedation could be found.…”