Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia.
School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
Palliat Med. 2020 Apr;34(4):524-532. doi: 10.1177/0269216319897550. Epub 2020 Feb 7.
Some patients do not receive adequate pain and symptom relief at the end of life, causing distress to patients, families and healthcare professionals. It is unclear whether undertreatment of symptoms occurs, in part, because of nurses' concerns about legal and/or disciplinary repercussions if the patient dies after medication is administered.
The aim was to explore nurses' experiences and knowledge of the law relating to the provision of end-of-life pain and symptom relief.
Semi-structured interviews with nurses were assessed using a six-stage hybrid thematic analysis technique.
SETTING/PARTICIPANTS: Four face-to-face and 21 telephone interviews were conducted with nurses who routinely prescribed and/or administered pain and symptom relief to patients approaching the end of their lives in Queensland and New South Wales, Australia.
While many nurses had no personal experiences with legal or professional repercussions after a patient had died, the fear of hastening death and being held accountable was frequently discussed and regarded as relevant to the provision of inadequate pain and symptom relief. Concerns included potential civil or criminal liability and losing one's job, registration or reputation. Two-thirds of participants believed that pain relief was sometimes withheld because of these legal concerns. Less than half of the interviewed nurses demonstrated knowledge of the doctrine of double effect, the legal protection for health professionals who provide end-of-life pain and symptom relief.
Education is urgently required to strengthen nurses' knowledge of the legal protections supporting the provision of appropriate palliative medication, thereby improving their clinical practice with end-of-life patients.
有些患者在生命末期并未得到充分的疼痛和症状缓解，这给患者、家属和医护人员带来了困扰。目前尚不清楚是否存在治疗不足的情况，部分原因可能是护士担心在给药后患者死亡，会面临法律和/或纪律方面的后果。
旨在探讨护士在临终疼痛和症状缓解方面提供法律知识的经验。
对常规开具和/或管理临终患者疼痛和症状缓解药物的护士进行半结构式访谈，并采用六阶段混合主题分析技术进行评估。
地点/参与者：在澳大利亚昆士兰州和新南威尔士州，对 4 名面对面和 21 名电话访谈的护士进行了访谈，这些护士在接近生命末期的患者中常规开具和/或管理疼痛和症状缓解药物。
尽管许多护士在患者死亡后没有个人经历过法律或职业方面的后果，但担心加速死亡和被追究责任的情况经常被讨论，并被认为与提供不充分的疼痛和症状缓解有关。这些担忧包括潜在的民事或刑事责任以及失去工作、注册或声誉。三分之二的参与者认为，由于这些法律问题，有时会拒绝提供疼痛缓解。接受采访的护士中不到一半的人对双效原则有了解，这是为提供临终疼痛和症状缓解的卫生专业人员提供法律保护的原则。
迫切需要开展教育，以加强护士对支持提供适当姑息治疗药物的法律保护的了解，从而改善他们对临终患者的临床实践。
