Experiences of palliative care nurses in the utilisation of palliative sedation in a hospice setting

Abstract

Background Palliative sedation, or bringing about a state of decreased or absent awareness (unconsciousness), is one of the therapies used in end-of-life healthcare settings in order to manage refractory symptoms such as pain, dyspnoea and distress. It is intended to relieve the burden of intolerable suffering of patients who are in the process of dying. Nurses are centrally involved in the utilisation of palliative sedation in end-of-life care; however, there is minimal research available in relation to their experiences in this regard. The dearth of research prompted this study. Aim To explore the experiences of palliative care nurses in the utilisation of palliative sedation in end-of-life care. Methodology A descriptive phenomenological methodology was adopted involving unstructured interviews. A purposive sample was used of 10 palliative care nurses with at least 1 year's experience of working in a hospice setting in Ireland. The data were analysed using Colaizzi's seven-stage phenomenological method. Findings Data analysis led to the identification of four core themes: (1) information sharing, (2) timing of palliative sedation, (3) level of sedation and (4) palliative sedation as a last resort. The results indicate that the participants were generally satisfied with the processes that underpinned decisions to introduce palliative sedation. They saw it as a highly complex intervention, in part because it involved individuals with very complex conditions and symptoms. Conclusions Palliative care patients, families and the general public in Ireland need to have greater understanding of the role of palliative sedation in the treatment of refractory symptoms at the end of life.

Ethical dilemmas and care actions in nurses providing palliative sedation

“…According to the previous studies, patients being close to death is an essential element in determining palliative sedation. 15,18 Therefore, providing compassionate care to patients during the prolonged dying period is complicated. In general, healthcare providers have doubts about their abilities, because they do not know whether care is appropriate in a state where communication with palliative sedation patients is impossible.…”

“…14 These dilemmas among palliative care nurses, occur because they administer sedatives to terminally ill patients with refractory symptoms, observe them, and stay with them for greater lengths of time. 15 Such dilemmas are related to the decision to use sedatives, depth of sedative administration, likelihood of shortening the patient's life, and loss of social interactions. 16 They further occur when the patient's family demands an increase of the sedation level for the patient.…”

The practices of nurses about palliative sedation on palliative care wards: A qualitative study

“…According to nurses, it is important to be aware of the necessity to explain the reality of the situation (Zinn & Moriarty, 2012), and the need to do this in a sensitive manner (Dwyer & McCarthy, 2016). The provision of information to the patient and relatives is also emphasized in the recommendations on palliative sedation (e.g., Cherny & Radbruch, 2009) (Cherny & Radbruch, 2009) nurses provide to the patients and relatives before sedation and to relatives during sedation.…”

“…The literature shows that nurses, together with other team members, are involved in informing both the patient and relatives about palliative sedation (e.g., Dwyer & McCarthy, 2016 ; Zinn & Moriarty, 2012 ; Zuleta‐Benjumea et al, 2018 ). Nurses believe that the patient and relatives need to be given this information several times to facilitate understanding (Zuleta‐Benjumea et al, 2018 ).…”

“…Nurses believe that the patient and relatives need to be given this information several times to facilitate understanding (Zuleta‐Benjumea et al, 2018 ). According to nurses, it is important to be aware of the necessity to explain the reality of the situation (Zinn & Moriarty, 2012 ), and the need to do this in a sensitive manner (Dwyer & McCarthy, 2016 ). The provision of information to the patient and relatives is also emphasized in the recommendations on palliative sedation (e.g., Cherny & Radbruch, 2009 ).…”