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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Ethical decision-making in hospice care.

Andreas Walker1, Christof Breitsameter2

  • 1Westfälische Wilhelms-University of Münster, Germany andreas.walker@uni-muenster.de.

Nursing Ethics
|July 2, 2014
PubMed
Summary

Hospice nurses adapt their care to practical realities, especially concerning medication and end-of-life feeding decisions. Ethical decision-making involves adjusting care standards to meet patient needs within workplace constraints.

Keywords:
Aspiration adaptationend-of-life decision-makinghospice carenursing ethicspalliative care

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Area of Science:

  • Palliative Care
  • Bioethics
  • Nursing Practice

Background:

  • Hospices employ a holistic approach, prioritizing patient physical, psychological, social, and spiritual welfare.
  • Hospices operate with distinct mission statements, ethical codes, and standards of care.

Purpose of the Study:

  • To investigate the practical processes and decision-making latitude in ethical situations within hospice care.
  • To understand how ethical considerations are managed in daily hospice nursing practice.

Main Methods:

  • A qualitative research approach was utilized.
  • Grounded theory methods informed data collection and analysis.
  • Ethical approval was obtained, and informed consent secured from participants.

Main Results:

  • Ethical dimensions arise in medication management (pre-final phase) and end-of-life nutrition/hydration.
  • Decisions in these areas are typically made collectively.
  • Nurses' ethical decision-making latitude is primarily confined to their care delivery style, adapting ideal care to practical realities.

Conclusions:

  • Nurses must adapt their approach to integrate the four pillars of hospice care (physical, psychological, social, spiritual) into daily practice.
  • Ethically relevant decisions often involve nurses adjusting their expectations to align with encountered practical conditions.