Hospice Nurses' Views About the Necessity for Palliative Sedation in Existential Suffering.

内容摘要

Disagreements between nurses and doctors regarding the assessment and management of existential suffering in terminally ill patients represent a critical challenge in palliative care, particularly in the context of inpatient adult hospices. This study aimed to explore nurses' decision-making processes for palliative sedation in cases of existential suffering in an inpatient adult hospice, providing a comparison with physicians' approaches. The study employed Charmaz's constructing grounded theory methodology. Case-based guided interviews, incorporating a case vignette, were conducted with nurses in a German inpatient adult hospice. Data were analyzed using MAXQDA 22.8.0 following Charmaz's methodology. Five categories were identified: (1) enabling quality of life until death, (2) perceiving existential suffering, (3) making a decision, (4) performing palliative sedation, and (5) palliative sedation as a solution for existential suffering. In this article, we focus on the decision-making process. The study highlights the limited involvement of nurses in decision-making processes regarding palliative sedation despite their critical insights into patients' existential suffering. The findings emphasize the need for interdisciplinary collaboration and the integration of nurses' perspectives to achieve more holistic and ethically sound care in inpatient hospices. The study emphasizes the need to strengthen nurses' role in palliative sedation to foster ethical practice and reduce moral distress. © 2025 by the American Society for Pain Management Nursing.