Hospice Nurses' Views About the Necessity for Palliative Sedation in Existential Suffering

Area of Science:

• Palliative Care
• Medical Ethics
• Nursing Research

Background:

• Disagreements between nurses and physicians on managing existential suffering in terminally ill patients pose challenges in adult hospice care.
• Existential suffering requires careful assessment and management, often involving complex ethical considerations.

Purpose of the Study:

• To explore nurses' decision-making processes for palliative sedation in cases of existential suffering within an inpatient adult hospice.
• To compare nurses' approaches to palliative sedation decision-making with those of physicians.

Main Methods:

• Utilized Charmaz's constructivist grounded theory methodology.
• Conducted case-based guided interviews with nurses in a German inpatient adult hospice, using a case vignette.
• Analyzed interview data using MAXQDA software, adhering to grounded theory principles.

Main Results:

• Identified five key categories: enabling quality of life, perceiving existential suffering, decision-making, performing palliative sedation, and palliative sedation as a solution.
• Focused analysis on the decision-making process for palliative sedation in response to existential suffering.
• Highlighted nurses' limited involvement in the decision-making process despite their insights into patient suffering.

Conclusions:

• Nurses' perspectives are crucial for holistic and ethical care in palliative sedation for existential suffering.
• Strengthening nurses' role in decision-making can foster ethical practice and mitigate moral distress.
• Interdisciplinary collaboration is essential to integrate nurses' insights into palliative care for terminally ill patients.