The Complexity of Nurses' Attitudes and Practice of Sedation at the End of Life: A Systematic Literature Review

Abarshi, Ebun; Papavasiliou, Evie; Preston, Nancy; Brown, Jayne; Payne, Sheila; Impact, Euro

doi:10.1016/j.jpainsymman.2013.06.011

Cited by 36 publications

(60 citation statements)

References 41 publications

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“…Our study confirmed previous studies showing that nurses, who play an important role in sedation, appear to be the group most vulnerable to doubt during sedation [22]. Following the discussion and the medical decision to sedate, they are the ones involved in its “ultimate” implementation: preparation and injection of the medication.…”

Section: Discussionsupporting

confidence: 88%

“…Teamwork helps reduce individual distress by clarifying the course of action, providing an opportunity for dialogue and organisation and offering professional recognition and support [48]. In addition to extending psychological support to health care providers [22], teamwork enables providers to build cooperation and devise ways to arrive at agreed rules governing their work. Teamwork thereby makes it possible for providers to reconfigure their approach to their professional competence in the sedation situations that constitute a burden for them [49].…”

Section: Discussionmentioning

confidence: 99%

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Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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BackgroundDespite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation.MethodsData were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives.ResultsHealth care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients.ConclusionsThe uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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“…As noted in the findings, the challenge of providing pain relief without unwanted side-effects remains a dilemma, 69 especially if patient dignity is to be preserved.…”

Section: Symptom Controlmentioning

confidence: 97%

Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: A systematic review

2015

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“…The authors identified inconsistencies and a lack of clarity on what constituted "intolerable" or "refractory" suffering and proposed that the patient's ability to consent should be explicitly recorded, that the team have a shared and explicit understanding of the terminology and definitions of sedation, and that formal mechanisms for support (such as clinical supervision) are offered to staff. The development of guidelines has become a focus and priority due to concerns and uncertainty surrounding decisionmaking dilemmas and the connotations and inferences related to euthanasia and palliative sedation (Abarshi et al, 2014;Schildmann & Schildmann, 2014;Cherny & Radbruch, 2009;Hauser & Walsh, 2009;Legemaate et al, 2007;Verkerk et al, 2007;de Graeff & Dean, 2007;Engström et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Vries

Plaskota

2016

Pall Supp Care

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Objective: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients.Method: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data.Results: Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened.Significance of results: Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.

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The Complexity of Nurses' Attitudes and Practice of Sedation at the End of Life: A Systematic Literature Review

Cited by 36 publications

References 41 publications

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: A systematic review

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

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