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Having a difficult time leaving: experiences and attitudes of nurses with palliative sedation

Buehler Center on Aging, Health and Society, Northwestern University's Feinberg School of Medicine and Department of Public Health, Rotterdam, University Medical Center Rotterdam, j.rietjens{at}erasmusmc.nl

Joshua Hauser

Buehler Center on Aging, Health and Society, Northwestern University's Feinberg School of Medicine

Agnes van der Heide

Department of Public Health, University Medical Center Rotterdam, Rotterdam

Linda Emanuel

Buehler Center on Aging, Health and Society, Northwestern University's Feinberg School of Medicine

Background: Palliative sedation is an important topic of medical and ethical debates. Although nurses often participate in its use, little is known about their attitudes and experiences. Methods: In a qualitative study, we explored nurses' attitudes and experiences with palliative sedation. In semi-structured interviews with 16 nurses, we collected data about their most memorable cases of palliative sedation. Interviews were transcribed, coded and analysed using constant comparative analysis. Results: In all of the described cases, palliative sedation was used primarily to address physical suffering in severely ill patients. Concomitant reasons for the use of palliative sedation were nonphysical suffering, the patient's wish and the family's distress about the patient's suffering. The use of palliative sedation for the patient's nonphysical suffering was often difficult for many of the nurses. Nurses had different perspectives on whether palliative sedation may have had a life-shortening effect on the patient. Some thought that it had not accelerated death; others thought that it may have accelerated death but that this was justified when there was no other way of relieving discomfort. A third group thought that palliative sedation was close to the practice of euthanasia and they often found it difficult to be involved in its use. Nevertheless, palliative sedation was considered by all the nurses to positively contribute to the patient's quality of dying in all discussed cases. Conclusions: The struggles that nurses in this study cohort experienced indicate the need for further study and may suggest the need for more nursing education and discussion about ethical aspects of palliative sedation. Palliative Medicine 2007; 21 : 643—649

Key Words: end-of-life • palliative sedation • nurses • attitudes • qualitative study

Palliative Medicine, Vol. 21, No. 7, 643-649 (2007)
DOI: 10.1177/0269216307081186


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