Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer.
Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients.



Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data.



Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened.



Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.
School of Health Sciences,University of Brighton,Brighton,England,United Kingdom.
Kay
K
De Vries
St. George's Healthcare National Health Service Trust,St. George's Hospital,Tooting,London,England,United Kingdom.
Marek
M
Plaskota
D000328:Adult; D003657:Decision Making / Q000941:ethics; D004739:England; D005260:Female; D064946:Hospice and Palliative Care Nursing / Q000941:ethics* / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009726:Nurses / Q000523:psychology*; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods*; D000078329:Workforce
D006993:Hypnotics and Sedatives
Ethical dilemmas; Hospice nurses; Palliative sedation; Peaceful death; Terminal restlessness