Abstract Background: Patients in the terminal phase in the end-of-life often suffer of infractable symtoms such as pain, delirium and dyspnéa. In cases where no other symtomatic revelaing therapy is aduqate for revealing the suffering of the patient palliative sedation can be administrated. Palliative sedation means is to relieve unbearable symptoms by lowering the patient's level of consciousness by adminstration of sedatives. Objective: The aim of the study was to describe nurses experiences of paliative sedation and review the selected articles data collection method. Method: The Descriptive literature review based on 10 articles. Results: Based on nurses experiences, palliative sedation therapy is an aduqate method in revealing suffering caused by refractory symptoms in the terminal stage of life. The treatment can contribiute to a good quality of death. Palliative sedation implyes adverse effects on the patients social life as well as nutrition and hydration status. There is disagreement about whether physical or mental suffering is the correct indication for palliative sedation. The patient aswell as relatives i plays a major role in decision-making regarding palliative sedation. The nurse carries responsabilitys of grand massure and has a widespread role in decision-making and administration of palliative sedation. The treatment raises ethical issues and contribute to emotional stress for nurses, this is linked to the possibly life-shortening properties of the treatment. Questionaires, personal interviews and focus group interwievs where used as data collection methods in the included articles. Conclusion: Nurses carries a extensive role in decision-making and administration of palliative sedation. Palliativ sedering contributes to emotional stress as well as ethical issues. / Sammanfattning Bakgrund: Det är inte ovanligt att patienter i det terminala skedet upplever outhärdligt lidande relaterat till symptom som smärta, deleirium och dyspné. När ingen annan lindrande behandling ger adekvat symptomlindring kan palliativ sedering administreras.  Palliativ sedering innebär är genom administrering av sedativa läkemedel sänka patientens medvetandegrad i syftet att lindra outhärdliga symptom. Syfte: Studiens syfte var att beskriva sjuksköterskors erfarenheter av palliativ sedering samt granska de valda artiklarnas datainsamlingmetod. Metod: Beskrivande litteraturstudie baserad på 10 vetenskapliga artiklar. Resultat: Palliativ sedering ger adekvat lindring av outhärdliga symtom i det terminala skedet och kan bidra till en ökad livskvalité i livets slutskede. Behandlingen har negativa konsekvenser för nutrition- och vätsketillförsel samt patientens sociala liv. Det råder meningsskiljaktigheter om huruvida fysiskt eller psykiskt lidande är den korrekta indikationen för palliativ sedering. Patienten och anhöriga spelar en betydande roll för beslutsfatande och administrering. Sjuksköterskor är i hög grad delaktiga i behandlingen och bär ett stort ansvar över faktorer som beslutsfattande och administrering. Behandlingen väcker etiska frågeställningar och bidrar till emotionell belastning för sjuksköterskor, detta kopplat till behandlingens eventuellt livsförkortande egenskaper. De inkluderade artiklarna har använt sig av enkät, personliga intervjuer samt fokusgruppsintervjuer som datainsamlingsmetod. Slutsats: Sjuksköterskan har en utbredd roll i beslutsfattande och administrering av palliativ sedering. Palliativ sedering bidrar till emotionell belastning samt etiska frågeställningar.

Introduktion/Bakgrund: Patienter i livets slutskede som upplever outhärdliga symtom kan få palliativ sedering. Sjuksköterskor har en viktig roll när palliativ sedering tillämpas. De har ansvar för att stötta och företräda både patient och närstående. Det finns en brist på forskning om närståendes upplevelser av palliativ sedering. Syfte: Syftet med litteraturstudien var att belysa hur det upplevs att vara närstående till en patient som får palliativ sedering. Metod: Litteraturstudien genomfördes enligt Polit och Becks (2016) nio steg. Databassökningen gjordes i tre databaser; PubMed, Cinahl samt PsycINFO där åtta artiklar identifierades till resultatet. Resultat: Närståendes upplevelser sammanställdes i fem teman: önskan om en god död, behov av information och kunskap, tankegångar, möjlighet till avsked och känsla av ansvar. Slutsats: Närstående hade en positiv upplevelse av palliativ sedering. De tveksamheter som närstående generellt hade var om patientens välmående, eventuell förkortning av livet samt ifall sederingen gav en god död. Resultatet visade ett stort behov av information och kunskap från vårdgivare för att närstående skulle ha en bättre upplevelse.

Bakgrund: Sjuksköterskan är omvårdnadsansvarig och har en central roll inom palliativ vård där målet är att främja välbefinnande och värdighet för patienten. I de fall palliativa patienter upplever outhärdliga symtom trots symtomlindring kan en sista utväg för minskat lidande vara palliativ sedering. Syfte: Syftet var att sammanfatta och beskriva sjuksköterskors erfarenheter av palliativ sedering. Metod: Studiens design är deskriptiv och resultatet är uppbyggt på tio vetenskapliga artiklar som söktes fram via databaserna PubMed och CINAHL. Huvudresultat: Resultatet i litteraturstudien visade att sjuksköterskor som arbetat med palliativ sedering hade flera olika roller. Inom yrkesrollen skulle sjuksköterskan utföra omvårdnad, administrera läkemedel, samarbeta med läkare och bemöta anhöriga. Resultatet visade även att palliativ sedering kunde väcka etiska frågeställningar hos sjuksköterskor vilket kunde leda till emotionell påfrestning. Framträdande i studierna var att trots svårigheter fanns en vilja och tröst i att sjuksköterskans handlingar syftar till att lindra lidande i livets slutskede. Slutsats: Sjuksköterskor kan uppleva etiska svårigheter och en emotionell börda i sin yrkesroll som sjuksköterska vid palliativ sedering. De kan även möta utmaningar då de har flera roller att axla vid palliativ sedering och förutom att lindra patientens lidande ska de också vara ett stöd för anhöriga och informera dem. Sjuksköterskor har en betydelsefull roll i livets slutskede eftersom deras främsta fokus är att främja välbefinnande för patient och anhöriga. / Background: The nurse is responsible for the nursing care and has a central role in palliative care where the aim is to promote well-being and dignity for the patient. In cases where palliative patients experience unbearable symptoms despite symptom relief medications, a last resort for reduced suffering may be palliative sedation. Aim: The aim was to summarize and describe nurses’ experiences of palliative sedation. Method: The study’s design is descriptive and the results are based on ten scientific articles that were gathered through the databases PubMed and CINAHL. Main results: The results of the literature study showed that nurses who had worked with palliative sedation had several different roles. Within the professional role, the nurse would provide nursing care, administer medications, collaborate with doctors and care for patients’ relatives. The results also showed that palliative sedation could raise ethical dilemmas for the nurses, which could lead to emotional distress. However, prominent in the studies was that despite difficulties there was a will and comfort in the fact that the nurses’ actions aim to alleviate suffering in the end of the patients’ lives. Conclusion: Nurses can experience ethical difficulties and an emotional burden related to their professional role in palliative sedation. Nurses can face challenges as they have several roles to play during palliative sedation, and in addition to alleviating the patients’ suffering, the nurses also have to support and give information to the patients’ relatives. Nurses play an important role in patients end of life-care since their main focus is to promote well-being for the patient and relatives.

Introduction: Palliative sedation is the use of sedatives to lower the alertness for symptomcontrol, when suffering is otherwise uncontrollable. Its role in palliative care is frequentlyargued, with both proponents and opponents. End-of-life decisions raise many concerns,including ethical ones, regarding which ethical principle should be valued the most. Someopponents argue that palliative sedation is ethically similar to euthanasia, but there alsoappears to be some confusion concerning concepts and definitions. Aim: To discuss ethical arguments for and against palliative sedation, and relevant ethicaldifferences between palliative sedation and euthanasia. Furthermore, to try to clarify differentconcepts and definitions used in the discussion of the matter. Materials and methods: This work is based on a qualitative literature study, and anargumentative- and concept analysis on hermeneutic ground. Material was gathered through aliterature search, and contains official material, debate articles and scientific articles. Results: Palliative sedation can be argued to protect the ethical values of autonomy,beneficence, dignity and integrity, but simultaneously it is argued to violate those ethicalconcepts. There seems to be disagreements regarding which principle should be highestvalued. Conclusion: The matter of palliative sedation is delicate, and engages a lot of people. Pro- andcontra-arguments vary in strength, partly because of an inconsistency in the use of differentconcepts and definitions. In most of the material studied, it is argued that palliative sedation isethically acceptable, whereas euthanasia is not.

This dissertation will support full ethical endorsement of terminal sedation for those most urgently in crisis and need of beneficence, those who are dying and in the final hours or days and suffering. To clarify the practice I first detail ethical differences between euthanasia, physician assisted suicide and terminal sedation. Moreover, I identify new areas where harms and benefits need to be evaluated as affecting not only patients, but also families and caregivers. I evaluate the current practice to allow the development of ethical guidelines and greater consensus on deciding the hard cases. This work may also serve to assist those looking to enlarge the practice in the future with ETS for those with debilitating diseases or disability, but they are not my primary goal. Below is the standard I propose for moral allowability for the use of terminal sedation. I will refer to it often in the pages that follow simply as my standard . Terminal sedation is the appropriate and intentional use of medications (benzodiazepines and/or narcotics) to produce ongoing, deep unconsciousness upon 1) a terminal patient’s (or surrogates) request due to 2) suffering intractable pain or other distressing clinical symptoms intolerable to the patient when 3) death is expected within hours or days (less than two weeks) due to the terminal illness, injury, or disease. I offer two versions of initial guidelines for development of hospital policy. The first version outlines minimal guidelines that ought to be utilized to allow TS for patients who fit my standard. The minimal guideline is based upon the recommendations of the American Medical Association with some modifications. The guideline is admittedly restrictive in hopes of gaining wider societal support for a currently controversial practice. Secondly, I offer more moderate guidelines for policy that could become a standard in the future. It maintains the restrictive focus of the minimal guidelines and offers additional education and support to others which has yet to be broadly provided. The moderate guidelines would mark an important step forward for allowing more choices in dying and offering additional supports to those involved with dying patients.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.

No description available.

Sjuksköterskans roll i den palliativa vården är att främja autonomi, livskvalité och lindra lidande. Palliativ sedering är en behandlingsmetod som syftar till att minska outhärdligt lidande, men som leder till en reducerad medvetandenivå och inskränkning av personlig frihet där sjuksköterskan är högst involverad. Litteraturstudiens syfte var att undersöka sjuksköterskors upplevelser av palliativ sedering. Studien genomfördes som en allmän litteraturstudie med stöd av innehållsanalys utifrån en induktiv ansats. I litteraturstudiens resultat framkommer det att sjuksköterskor upplever en ambivalens vid medverkan i palliativ sedering. Sjuksköterskor erfar etiska dilemman när önskan att göra det bästa för patienten står i relation till att frånta patientens autonomi och rädsla att påskynda döden. Beprövad erfarenhet och evidensbaserade riktlinjer är idag inte tillräckliga för att sjuksköterskor ska känna sig trygga i att bedriva vård avseende palliativ sedering. En etablering av tydlig lagstiftning och nationella riktlinjer är därför av värde för att främja en god vård på lika villkor. / Nurses’ role in the palliative care is to promote autonomy, quality of life and relieve suffering. Palliative sedation is a treatment method that aims to reduce unbearable suffering, but leads to a reduced level of consciousness and limitation of autonomy which the nurse contributes to. The aim of the study was to examine nurses' experiences of palliative sedation. The study was conducted as a general literature study, guided by content analysis based on an inductive approach. The results of the literature study reveals that nurses’ experience an ambivalence in the participation of palliative sedation. Nurses' experience ethical dilemmas when the desire to do what seems best for the patient, is inadequate to depriving patient autonomy and fear of hastening death. Guidelines nor the knowledge of palliative sedation are seen enough to provide nurses’ with comfort in their work with palliative sedation. An establishment of regulations and national guidelines are therefor of value to promote good care on equal terms.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.