Home care nurses' ethical compass in palliative decision-making processes

Area of Science:

• Nursing
• Palliative Care
• Healthcare Ethics

Background:

• Home care nurses play a crucial role in supporting home-dwelling patients during the palliative phase.
• Shared decision-making (SDM) is vital in palliative care but presents unique challenges for nurses.
• Understanding nurses' perceptions of their role in SDM is essential for improving care quality.

Purpose of the Study:

• To explore home care nurses' experiences and perceptions of their role in shared decision-making for palliative care patients.
• To identify the ethical challenges faced by home care nurses during SDM in end-of-life care.
• To provide insights into supporting nurses in navigating complex decision-making processes.

Main Methods:

• Exploratory qualitative design utilizing four focus group interviews.
• Involved 24 home care nurses from four municipalities.
• Analysis guided by Gadamer's hermeneutics.

Main Results:

• Nurses experience being "captured between guidelines and personal values," necessitating "covering one's back" and managing patient ambivalence in life-and-death decisions.
• Nurses navigate a "network of blurry boundaries" and practice "sitting tight," withholding actions or views despite evident courses of action.
• Identified significant ethical challenges in SDM within the home care palliative setting.

Conclusions:

• Home care nurses encounter substantial ethical challenges in shared decision-making during palliative care.
• The study underscores the need for enhanced support structures for home care nurses.
• Applying core healthcare ethics principles can help clarify nurses' roles and strengthen SDM in palliative care.