title: Ethical dilemmas around the dying patient with stroke: a qualitative interview study with team members on stroke units in Sweden.
abstract: In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on "nondecisions" about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had "problems holding to the decision." The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was "communication barriers," a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
authors.affiliation: Questions or comments about this article may be directed to Helene Eriksson, MSc SRN, at helene.m.eriksson@liu.se. She is a Lecturer at the Department of Social and Welfare Studies, Linkoping University, Norrköping, Sweden. Gisela Andersson, MSc SRN, is an Infection Control Nurse at Vrinnevi Hospital, Norrköping, Sweden. Louise Olsson, Lic MedSci SRN, is a Lecturer at the Department of Social and Welfare Studies, Linkoping University, Norrköping, Sweden. Anna Milberg, MD PhD, is an Assistant Professor at the Department of Social and Welfare Studies, Linkoping University, Norrköping, LAH/Unit of Palliative Care, University Hospital, Linkoping, and Palliative Education and Research Centre in the County of Ostergotland, Sweden. Maria Friedrichsen, RN PhD, is an Associate Professor at the Department of Social and Welfare Studies, Linkoping University, Norrköping, and Palliative Education and Research Centre in the County of Ostergotland, Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Eriksson
authors.forename: Gisela
authors.initials: G
authors.lastname: Andersson
authors.forename: Louise
authors.initials: L
authors.lastname: Olsson
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.forename: Maria
authors.initials: M
authors.lastname: Friedrichsen
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003144:Communication Barriers; D005260:Female; D064946:Hospice and Palliative Care Nursing / Q000941:ethics*; D006801:Humans; D008297:Male; D065816:Neuroscience Nursing / Q000941:ethics*; D009728:Nursing Assistants / Q000941:ethics / Q000523:psychology; D009741:Nursing Staff, Hospital / Q000941:ethics / Q000523:psychology; D009746:Nursing, Team / Q000941:ethics; D010166:Palliative Care / Q000941:ethics*; D059825:Physical Therapists / Q000941:ethics / Q000523:psychology; D036301:Qualitative Research; D012297:Right to Die / Q000941:ethics*; D020521:Stroke / Q000451:nursing*; D000071939:Stroke Rehabilitation; D013548:Sweden; D013727:Terminal Care / Q000941:ethics*