Nurses’ experience with palliative sedation procedures in line with the 2005 Swiss guidelines: an exploratory study

Martyna Tomczyk, Bernard J. Schumacher

Abstract


Many international studies have shown that the process of palliative sedation in an end-of-life context can be an adverse, even emotionally distressing experience for nurses. However, to the best of our knowledge, the experience of nurses working in palliative care in Switzerland has never been explored. The purpose of our study was, therefore, to understand and describe nurses’ experience with the process of palliative sedation in line with the Swiss guidelines developed in 2005. We opted for an exploratory qualitative monocentric study using comprehensive individual interviews to achieve this objective. A total of 10 nurses were approached, and nine agreed to take part. After the interviews were transcribed, eight were ultimately included in the analysis. This analysis shows that nurses’ attitudes toward the process of palliative sedation tended to be hesitant, resistant, or confident and that this was linked to the length of time they had worked in palliative care. These findings suggest that the 2005 Swiss guidelines do not protect nurses against the uncertainty related to process of palliative sedation. A national comprehensive multicentric study therefore needs to be developed to consolidate these results.


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Abarshi, E. A., Papavasiliou, E. S., Preston, N., Brown, J., & Payne, S. (2014). The complexity of nurses’ attitudes and practice of sedation at the end of life: a systematic literature review. Journal of Pain and Symptom Management, 47(5), 915–25.e11. https://doi.org/10.1016/j.jpainsymman.2013.06.011.

Abarshi, E., Rietjens, J., Robijn, L. et al. (2017). International variations in clinical practice guidelines for palliative sedation: A systematic review. BMJ Supportive & Palliative Care, 7(3), 223–9. https://doi.org/10.1136/bmjspcare-2016-001159.

Alami, S., Desjeux, D., & Garabuau-Moussaoui, I. (2009). Les méthodes qualitatives. PUF.

Aubry, R. (2011). Réflexions sur les pratiques et le quotidien des médecins, sur le soin palliatif et le rapport à la mort dans une maladie incurable et douloureuse. Dans : Ferry, J.M, directeur, Fin(s) de vie : le débat. PUF, p. 217–241.

Beauverd, M., Bernard, M., Currat, T. et al. (2014). French Swiss physicians’ attitude toward palliative sedation: Influence of prognosis and type of suffering. Palliative & Supportive Care, 12(5), 345–50. https://doi.org/10.1017/S1478951513000278.

Blanchet, A., & Gotman, A. (2010). L’enquête et ses méthodes : l’entretien. Armand Colin.

Brinkkemper, T., van Norel, A. M., Szadek, K. M. et al. (2013). The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: A systematic review. Palliative Medicine, 27(1), 54–67. https://doi.org/10.1177/0269216311425421.

Brugidou, M., Le Roux, D., & Salomon, A. C. (2005). Colloque « L’analyse secondaire en recherche qualitative », Grenoble. https://reanalyse.hypotheses.org/files/2014/09/Pr%C3%A9sentation.pdf (Accès le 04 avril 2020).

Centre National de Ressources Textuelles et Lexicales. Consulté sur : http://www.cnrtl.fr/definition/conceptualisation/substantif. (Accès le 04 avril 2020).

Cherny, N. I., Radbruch, L., & The Board of the European Association for Palliative Care. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581–93. https://doi.org/10.1177/0269216309107024.

Cherny, N. I., & ESMO Guidelines Working Group. (2014). ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Annals of Oncology, (Suppl. 3), iii143–52. https://doi.org/10.1093/annonc/mdu238.

Davis, M. (2009a). Palliative sedation: Four questions. Progress in Palliative Care, 17, 203–4.

Davis, M. (2009b). Does palliative sedation always relieve symptoms? Journal of Palliative Medicine, 12(10), 875–7. https://doi.org/10.1089/jpm.2009.0148.

Demertzi, A., Schnakers, C., Ledoux, D. et al. (2009). Different beliefs about pain perception in the vegetative and minimally conscious states: A European survey of medical and paramedical professionals. Progress in Brain Research, 177, 329–38. https://doi.org/10.1016/S0079-6123(09)17722-1.

Dumont, S., Blondeau, D., Turcotte, V. et al. (2015). The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland. Palliative & Supportive Care, 13(4), 839–47. https://doi.org/10.1017/S1478951514000364.

Francisco, S., & Cantin, B. (2013). Suivi de la personne recevant une sédation palliative : quelles responsabilités pour l’infirmière? Revue de la Société suisse de médecine et de soins palliatifs « palliative ch », 4 : 47–50. https://www.palliative.ch/fileadmin/user_upload/palliative/magazin/2013_4.pdf

Foley, R. A., Johnson, W. S., Bernard, M. et al. (2015). Attitudes regarding palliative sedation and death hastening among swiss physicians: A contextually sensitive approach. Death Studies, 39(8), 473–82. https://doi.org/10.1080/07481187.2015.1029142.

Ghoneim, M. M. (2007). Incidence of and risk factors for awareness during anaesthesia. Best Practice & Research Clinical Anaesthesiology, 21(3), 327–43. https://doi.org/10.1016/j.bpa.2007.05.002.

Ghoneim, M. M., Block, R. I., Haffarnan, M., & Mathews, M. J. (2009). Awareness during anesthesia: Risk factors, causes and sequelae. A review of reported cases in the literature. Anesthesia & Analgesia, 108(2), 527–35. https://doi.org/10.1213/ane.0b013e318193c634.

Groupe d’experts de la Société suisse de médecine et de soins palliatifs. (2005). Recommandations « Sédation palliative ». Consensus sur la meilleure pratique en soins palliatifs en Suisse. Bigorio. https://www.palliative.ch/fileadmin/user_upload/palliative/fachwelt/E_Standards/E_12_4_bigorio_2005_Sedation_fr._pdf.pdf

Gurschick, L., Mayer, D. K., & Hanson, L. C. (2015). Palliative sedation: an analysis of international guidelines and position statements. American journal of hospice & palliative care, 32(6), 660–71. https://doi.org/10.1177/1049909114533002.

Kaufmann, J. C. (2011). L’enquête et ses méthodes. L’entretien compréhensif. Armand Colin.

Kon, A. (2011). Palliative sedation: It’s not a panacea. American Journal of Bioethics, 11(6), 41–2. https://doi.org/10.1080/15265161.2011.577513.

Leslie, K., Chan, M. T., Myles, P. S., Forbes, A., & McCulloch, T. J. (2010). Posttraumatic stress disorder in aware patients from the B-Aware trial. Anesthesia & Analgesia, 110(3), 823–8. https://doi.org/10.1213/ANE.0b013e3181b8b6ca.

Levinas, E. (1983). Le temps et l’autre. PUF.

Levinas, E. (1995). Difficile liberté. Le Livre de Poche.

Levinas, E. (2009). Éthique et infini. Le Livre de Poche.

Lokker, M. E., Swart, S. J., Rietjens, J. A. C., van Zuylen, L., Perez, R. S. G. M., van der Heide, A. (2018). Palliative sedation and moral distress: A qualitative study of nurses. Applied Nursing Research, 40, 157–61. https://doi.org/10.1016/j.apnr.2018.02.002.

Malherbe, J. F. (1997). Pour une éthique de la médecine. Artel-Érasme.

Mucchieli, A. (2004). Dictionnaire des méthodes qualitatives en sciences humaines. Armand Colin.

Paillé, P., & Mucchielli, A. (2012). L’analyse qualitative en sciences humaines et sociales. Armand Colin.

Papavasiliou, E., Brearley, S. G., Seymour, J. E., Brown, J., Payne, S. A.; EURO IMPACT. (2013). From sedation to continuous sedation until death: How has the conceptual basis of sedation in end-of-life-care changed over time? Journal of Pain and Symptom Management, 46(5), 691–706. https://doi.org/10.1016/j.jpainsymman.2012.11.008.

Papavasiliou, E., Payne, S., Brearley, S., Brown, J., & Seymour, J. (2013). Continuous sedation (CS) until death: Mapping the literature by bibliometric analysis. Journal of Pain and Symptom Management, 45(6), 1073–82.e10. https://doi.org/10.1016/j.jpainsymman.2012.05.012.

Perrot, S. (2016). Les bases neurophysiologiques de la douleur. Dans : Perrot, S. Douleur, soins palliatifs et accompagnement. Éditions Med-Line, p. 17–30.

Pierron, J.Ph., Schumacher, B., & Zielinski, A. (2019). Levinas et le soin. Numéro spécial (2019-1, nr. 14) de Ethique, politique, religions. Paris: Classiques Garnier.

Pudas-Tähkä, S. M., Axelin, A., Aantaa, R., Lund, V., & Salanterä, S. (2009). Pain assessment tools for unconscious or sedated intensive care patients: a systematic review. Journal of Advanced Nursing, 65(5), 946–56. https://doi.org/10.1111/j.1365-2648.2008.04947.x.

Ribau, C., Lasry, J. C., Bouchard, L., Moutel, G., Hervé, C., & Marc-Vergnes, J. P. (2005). La phénoménologie : une approche scientifique aux expériences vécues. Recherche en soins infirmiers, 81(2), 21–7. https://doi.org/10.3917/rsi.081.0021.

Ricœur, P. (1990). Soi-même comme un autre. Éditions du Seuil.

Royal Dutch Medical Association (KNMG). (2009). Guideline for Palliative Sedation Royal Dutch Medical Association. https://palliativedrugs.com/download/091110_KNMG_Guideline_for_Palliative_sedation_2009__2_%5B1%5D.pdf.

Sanders, R., Tononi, G., Laureys, S., Sleigh, J., & Stat, D. (2012). Unresponsiveness ≠ Unconsciousness. Anesthesiology, 116(4), 946–59. https://doi.org/10.1097/ALN.0b013e318249d0a7.

Saunders, C. (1993). Some challenges that face us. Second Congress of the European Association for Palliative Care Brussels, 19–22 October, 1992. Palliative Medicine, 7, 77–83.

Schildmann, E., & Schildmann J. (2014). Palliative sedation therapy: A systematic literature review and critical appraisal of available guidance on indication and decision-making. Journal of Palliative Medicine, 17, 601–612.

Società Italiana di Cure Palliative. (2007). Raccomandazioni della SICP sulla sedazione terminale/ sedazione palliative. https://www.fondazioneluvi.org/wp-content/uploads/2017/01/Sedazione-Terminale-Sedazione-Palliativa.pdf

Société québécoise des médecins de soins palliatifs and Collège des médecins du Québec. (2016). La sédation palliative en fin de vie. http://www.cmq.org/publications-pdf/p-1-2016-08-29-fr-sedation-palliative-fin-de-vie.pdf

Tomczyk, M., & Dieudonné-Rahm, N. (2019). La conceptualisation de la sédation palliative par les infirmiers exerçant au sein de l’unité de soins palliatifs de l’Hôpital fribourgeois, en Suisse romande. Une recherche qualitative exploratoire. Recherche en soins infirmiers, 137, 6–17.

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–57. https://doi.org/10.1093/intqhc/mzm042.

Van Campenhoudt, L., & Quivy R. (2011). Manuel de recherche en sciences sociales. Dunod.

Verspieren, P. (1984). Face à celui qui meurt. Desclée de Brouwer.

Ziegler, S., Schmid, M., Bopp, M., Bosshard, G., & Puhan, M. A. (2018). Continuous deep sedation until death in patients admitted to palliative care specialists and internists: A focus group study on conceptual understanding and administration in German-speaking Switzerland. Swiss Medical Weekly, Aug 22; 148:w14657. https://doi.org/smw.2018.14657. eCollection 2018 Aug 13.

Zuleta-Benjumea, A., Muñoz, S. M., Vélez, M. C., & Krikorian, A. (2018). Level of knowledge, emotional impact and perception about the role of nursing professionals concerning palliative sedation. Journal of Clinical Nursing, 27(21–22), 3968–78. https://doi.org/10.1111/jocn.14582.


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