Dataset Information

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

ABSTRACT:

Background

Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.

Methods

This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.

Results

The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.

Conclusion

Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.

SUBMITTER: Raus K

PROVIDER: S-EPMC3942295 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Publications

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

Raus Kasper K Brown Jayne J Seale Clive C Rietjens Judith A C JA Janssens Rien R Bruinsma Sophie S Mortier Freddy F Payne Sheila S Sterckx Sigrid S

BMC medical ethics 20140220

<h4>Background</h4>Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.<h4>Methods</h4>This study is an international qualitative interview study involving interviews with physicians, nurses, and rela ...[more]

PMID: 24555871

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Project description:BackgroundEthical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity.MethodsIn this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals.ResultsAdjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009).ConclusionsThe results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students.RegistrationThis randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.

Project description:Background and objectivesHuman morality has been investigated using a variety of tasks ranging from judgments of hypothetical dilemmas to viewing morally salient stimuli. These experiments have provided insight into neural correlates of moral judgments and emotions, yet these approaches reveal important differences in moral cognition. Moral reasoning tasks require active deliberation while moral emotion tasks involve the perception of stimuli with moral implications. We examined convergent and divergent brain activity associated with these experimental paradigms taking a quantitative meta-analytic approach.Data sourceA systematic search of the literature yielded 40 studies. Studies involving explicit decisions in a moral situation were categorized as active (n = 22); studies evoking moral emotions were categorized as passive (n = 18). We conducted a coordinate-based meta-analysis using the Activation Likelihood Estimation to determine reliable patterns of brain activity.Results & conclusionsResults revealed a convergent pattern of reliable brain activity for both task categories in regions of the default network, consistent with the social and contextual information processes supported by this brain network. Active tasks revealed more reliable activity in the temporoparietal junction, angular gyrus and temporal pole. Active tasks demand deliberative reasoning and may disproportionately involve the retrieval of social knowledge from memory, mental state attribution, and construction of the context through associative processes. In contrast, passive tasks reliably engaged regions associated with visual and emotional information processing, including lingual gyrus and the amygdala. A laterality effect was observed in dorsomedial prefrontal cortex, with active tasks engaging the left, and passive tasks engaging the right. While overlapping activity patterns suggest a shared neural network for both tasks, differential activity suggests that processing of moral input is affected by task demands. The results provide novel insight into distinct features of moral cognition, including the generation of moral context through associative processes and the perceptual detection of moral salience.

Dataset Information

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

Background

Methods

Results

Conclusion

Publications

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

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