Norwegian nurses’ thoughts and feelings regarding the ethics of palliative sedation

Abstract

The purpose of this descriptive study was to explore whether or not nurses viewed deep palliative sedation as an ethical problem; and, if so, why they felt it posed a problem for them. An exploratory descriptive design with quantitative and qualitative sections was used. A questionnaire, consisting of open- and closed-ended questions, was answered by a sample of 73 nurses employed in three settings in Norway. The results were analyzed using descriptive statistics and content analysis. The findings indicated that 88% of the respondents had provided care for patients with great suffering; 78% had provided care for patients who received palliative sedation; and 63% felt that deep palliative sedation posed ethical problems. The respondents felt it was ethically difficult when patients were not involved in the decision, when families had continued needs to communicate with their loved ones, and when nurses felt uncertain about the relief of symptoms due to patients' inability to communicate.

Integrative Literature Review Nursing Interventions Aimed at the Family of the Person in End of Life Under Palliative Sedation.

“…Therefore, the level of the action support/comfort, according to Arevalo et al, (2013) and Bruinsma et al, (2013), families need support. According to Venke Gran & Miller (2008) and Bruce & Boston (2011), besides the support, it is important that the nurses intervene at the family distress level. Similarly, Robinson (2011) and Bruce & Boston (2011) refer the support at an emotional level.…”

“…Similarly, Robinson (2011) and Bruce & Boston (2011) refer the support at an emotional level. Subscribing also Venke Gran & Miller (2008).…”

“…However, according to some authors, they aim at the same goals, which are the reduction of stress, suffering and anguish of the family. Thus, for Bruinsma et al, (2013);Venke Gran & Miller (2008);Brinkkemper et al, (2011);Bruce & Boston (2011) and Robinson (2011), the nurse must intervene to report on the state of the terminal patients. The latter adds the need to explain the path physiological process of the disease progression and symptoms that will emerge, as well as to inform them about the changes in the treatment and the symptoms that may arise in the terminal patients.…”

“…Asquint et al, (2013a) mention that the nurse must inform and enlighten the family of the desire of the terminal patients. It should be reminded that Robinson (2011) andVenke Gran &Miller (2008) defend the need of nurses to prepare the family for the process of death.…”

“…Robinson (2011) reports the need to intervene in the promotion of family acceptance for palliative sedation, adding, as referred Ghafoor & Silus (2011);VenkeGran& Miller (2008) and Brinkkemper et al, (2011), the need to promote education in how to take care of the person, as well as the need to promote communication between the sick person and his family. VenkeGran& Miller (2008), add the importance of intervening in the promotion of family comfort; and Bruinsma et al, (2013) also defend the promotion of a comfortable and serene atmosphere.…”