Universidade Católica Portuguesa, Portugal.
Hospital de Santa Maria, Portugal; Instituto S. João de Deus, Portugal.
Nurs Ethics. 2019 Sep;26(6):1680-1695. doi: 10.1177/0969733018774610. Epub 2018 May 28.
Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly.
To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices.
Qualitative secondary analysis.
PARTICIPANTS/CONTEXT: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal.
Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described.
All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues.
Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients' preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it.
While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses' involvement and practices in end-of-life decision-making.
护士是医疗保健领域中最大的专业群体，也是做出更多决策的群体。2014 年，欧洲委员会生物伦理委员会发布了《关于生命末期医疗决策过程的指南》（以下简称《指南》），旨在改善决策过程，增强专业人员在生命末期决策中的能力。《指南》没有明确提到护士。
分析从事姑息治疗的护士在做出生命末期决策时最看重的伦理原则，并调查这些原则是否与《指南》的框架和建议一致；确定在这些护士当前的生命末期护理实践中，哪些有争议/有争议的问题更为频繁。
定性二次分析。
参与者/背景：来自葡萄牙姑息治疗护士的三个定性数据集，共 32 次访谈。
获得了 Instituto de Bioética（伦理研究实验室）的伦理研究实验室的伦理批准（伦理研究实验室的参考号为 04.2015）。详细说明了伦理程序。
所有参与的护士都将自主权作为生命末期决策的首要伦理原则。他们普遍参与生命末期决策。姑息镇静和沟通是最常提到的有争议/有争议的问题。
自主性在生命末期护理和决策中受到高度重视。护士在评估患者的偏好、意愿和促进预先护理计划方面表示了极大的关注。葡萄牙姑息治疗护士高度参与生命末期决策。这些过程采用了集体、包容的方法。姑息镇静是最常提到的有争议的问题，这与之前的发现一致。沟通也成为一个敏感的伦理问题；然而，令人惊讶的是，只有三名护士提到了这一点。
虽然《指南》的内容没有明确提到护士，但本研究表明，葡萄牙姑息治疗护士参与了这些过程。需要进一步研究护士在生命末期决策中的参与和实践。
