Creating comfort: nurses' perspectives on pressure care management in the last 48 hours of life.

The aim of this paper is to report the results of a study exploring the pressure care management of patients during their last 48 hours of life, from the perspective of registered nurses caring for such patients in an acute care hospital setting. A qualitative approach of interpretative description was used. Semi-structured interviews were conducted with twelve registered nurses working in palliative care/haematology/oncology wards in a metropolitan hospital in Melbourne, Australia. Analysis of the experiences of nurses in pressure care management of the patient in the last hours of life offered understandings into the nurse's role as a moral agent in the clinical setting. As moral agents, nurses were motivated by a desire to 'do the best for the patient'; in this instance to provide comfort and a peaceful death. They made decisions based on their past experience, knowledge and beliefs. However, their actions could be constrained by the beliefs of their colleagues, the culture of the organisation, and respect for the wishes of both patients and family members, which contributed to moral dilemmas that could give rise to clinician distress. Nurses need to strive for consensus in clinical practice as to what is the best care for the patient and where possible include the patient and family in these discussions. The development of policies such as advance directives and processes that highlight quality communication and conflict management may assist nurses in clinical decision making in this area.