Nurses' decision-making in pressure area management in the last 48 hours of life

To report on an aspect of a study that explored nurses' clinical decision-making in pressure area management of people in the last 48 hours of life.

A qualitative approach of interpretive description was used to collect and analyse 12 semi-structured interviews with registered nurses working in a palliative care unit and two haematology/oncology wards.

In this study nurses described their experiences of providing pressure care management for the patient in the last 48 hours of life. Nurses experienced difficulties with determining the frequency of turning the patient, especially during the last phase of life. Factors such as clinical assessment of the patient, ensuring patient comfort, use of pressure relieving aids, patient and family wishes and the influence of professional colleagues were variously valued and prioritised in importance. The context of care informed clinical practice and complicated decisions, which went beyond the consideration of clinical needs.

Nurses need to strive for consensus in clinical practice on the best care for the patient and, where possible, include the patient and family in the discussions. The development of further evidence on the options available for pressure management practices at the end of life can assist in clinical decision-making.