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Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

BACKGROUND: Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (car...

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Autores principales: Leboul, Danièle, Aubry, Régis, Peter, Jean-Michel, Royer, Victor, Richard, Jean-François, Guirimand, Frédéric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387333/
https://www.ncbi.nlm.nih.gov/pubmed/28399846
http://dx.doi.org/10.1186/s12904-017-0198-8
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author Leboul, Danièle
Aubry, Régis
Peter, Jean-Michel
Royer, Victor
Richard, Jean-François
Guirimand, Frédéric
author_facet Leboul, Danièle
Aubry, Régis
Peter, Jean-Michel
Royer, Victor
Richard, Jean-François
Guirimand, Frédéric
author_sort Leboul, Danièle
collection PubMed
description BACKGROUND: Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation. METHODS: Data were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives. RESULTS: Health care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients. CONCLUSIONS: The uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.
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spelling pubmed-53873332017-04-14 Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study Leboul, Danièle Aubry, Régis Peter, Jean-Michel Royer, Victor Richard, Jean-François Guirimand, Frédéric BMC Palliat Care Research Article BACKGROUND: Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation. METHODS: Data were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives. RESULTS: Health care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients. CONCLUSIONS: The uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it. BioMed Central 2017-04-11 /pmc/articles/PMC5387333/ /pubmed/28399846 http://dx.doi.org/10.1186/s12904-017-0198-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Leboul, Danièle
Aubry, Régis
Peter, Jean-Michel
Royer, Victor
Richard, Jean-François
Guirimand, Frédéric
Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title_full Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title_fullStr Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title_full_unstemmed Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title_short Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
title_sort palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387333/
https://www.ncbi.nlm.nih.gov/pubmed/28399846
http://dx.doi.org/10.1186/s12904-017-0198-8
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