Nurses’ attitudes towards the practice of palliative sedation

Ebun Abarshi, an experienced researcher formerly on the EUROIMPACT Project, shares some findings from a systematic review of literature on the complexity of nurses’ attitudes and practice of sedation at the end of life.

Dr Ebun Abarshi

Dr Ebun Abarshi

When caring for patients with advanced and terminal illnesses, nurses, like other practitioners, sometimes have to manage symptoms that do not respond to optimal treatment and care within a given space of time. Even for the most experienced nurses, the demands of caring for such patients can be very challenging indeed. There is the need to address gaps and overlaps in communication following the breaking of bad news, to be part of the decision-making process, as well as to administer the sedative and monitor the patient and family until the very end.

Within the EUROIMPACT project, I aimed to describe the practice of palliative sedation in Europe. According to the EAPC, palliative sedation is “the monitored use of medication to induce decreased or absent awareness in order to relieve the burden of otherwise intractable suffering…”. For a small population of palliative care patients, the use of palliative sedation is an acceptable, ethical practice, when used in appropriate proportions. However, it is not without pros and cons.

Although systematic reviews had been undertaken amongst physicians and practitioners in the past, I considered it important to explore separately the attitudes of nurses because of the unique role they play in the management of patients at the end of life. A key finding from the review was that regardless of patient age, diagnoses, or care setting, the overall goal and intention of care remained to relieve suffering and ensure the patient was comfortable. Several of the nurses were in a dilemma as to whether to give the sedatives, when to give, and how much to give. Understandably, their level of education, expertise, and the roles they played per setting influenced their perception of the practice. However, many maintained a cautious attitude towards the practice, emphasising its benefit only as a ‘last resort’ measure.

The review suggested that nurses felt supported when the decision to sedate was discussed, when they were trained as to what to expect during and after sedation (eg failed sedation), and when operational guidelines were in place.

Further reading
Abarshi E, Papavasiliou E, Preston N, Brown J and Payne S. ‘The Complexity of Nurses’ Attitudes and Practice of Sedation at the End of Life: A Systematic Literature Review’, (on behalf of EUROIMPACT), J Pain Symptom Manage, 2014 May; 47(5): 915-925.e11. doi: 10.1016/j. jpainsymman.2013.06.011. Epub 2013 Sep 24.

Abarshi E and Payne S. ‘Awareness of the EAPC’s recommended framework for the use of sedation in palliative care: an internet-based survey’ European Journal of Palliative Care, 2014 (vol. 21.2). This article is available to download free of charge from the EAPC website.

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