medwireNews: Dutch researchers recommend that nurses should be more involved in decision making concerning patients who receive continuous palliative sedation at the end of life.
Their study results show that in the vast majority of cases, nurses feel involved in the decision to use sedation, but that this figure drops to two-thirds in the home care setting.
Indeed, more "procedural obstacles" were identified in the home care setting by nurses participating in the study, including limited access to medicines and equipment, compared with a nursing homes/hospice or hospitals setting.
The findings also reveal that nurses are present at the start of sedation in the majority of cases, which may put them in a "potentially undesirable position" as events may arise in which the physician must be able to intervene, write the authors in the International Journal of Nursing Studies.
"This study highlights that nurses are key participants in palliative sedation," say Jimmy Arevalo (VU University Medical Center, Amsterdam, the Netherlands) and colleagues.
A total of 277 nurses responded to their 2008 questionnaire, which assessed whether they had ever been involved in the use of continuous palliative care and information about their last patient.
More nurses working in home care settings reported use of sedation compared with those working in nursing homes/hospices or hospitals, at 86% versus 81% and 63%. Overall, 85% of nurses felt involved in the decision to use sedation; however, this figure was lower in the home setting, at 69%, report Arevalo et al.
While the respondents reported medications and medical equipment being available most of the time, at 95% and 94%, respectively, the corresponding percentages were lower for those who gave care in the home setting, at 84% and 88%.
Nurses were present at the start of the sedation far more frequently, at 81% of the time, than were relatives, at 53%, or physicians, at 45%.
They also reported being responsible for arrangements to monitor the sedation process, how caregivers could be contacted, who was responsible for adjusting medication, and who coordinated healthcare, re-enforcing the importance of their participation in the different phases of implementation of palliative sedation, note Arevalo and co-workers.
"Nurses could also develop the practice of palliative sedation by anticipating procedural obstacles," they conclude.
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