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Ethical Decision Making in Hospice Care

The article that was reviewed in this paper addresses issues that fall in Topic 1, “Patient Care Issues related to Assigned Clinical Experiences.” The review involves a critical analysis of a research article by Walker and Breitsameter (2015) titled “Ethical Decision-Making in Hospice Care.” In the paper, the authors analyzed related ethical issues during decision making by nurses providing hospice care. Hospice care mainly involves providing care and support to patients in their end-of-life stages (Patel, Gorawara-Bhat, Levine, & Shega, 2012). The care services are mainly provided by a team of volunteers and healthcare professionals who offer both psychological, medical, and spiritual support to the patients (McCarthy, 2010). The main objective of providing this type of care is to ensure the patient maintains their dignity, comfort and peace, even as they die (Holland, 2010).

Study Objectives and Justification

The study was grounded on the fact that hospice care addresses the spiritual, physical, social, and psychological needs of the patients. As such, the care providers are faced with a lot of ethical-related concerns (de Veer, Francke, Struijs, & Willems, 2013). This narration made the article ideal for analysis within the selected topic of study. The major objective of this study was to address how nurses provide due consideration for the four main pillars involved in hospice care during the daily activities of the nurses. The authors also analyzed the type, nature, and degree of problems that result from the process. The authors determined the degree of importance that is accorded to the established mission statements, as well as the established standards in decision-making processes.

Study Design

This was a qualitative study whose data was collected mainly through structured questionnaires and observations. The study received ethical approval from the relevant ethical body. All the participants provided informed consent before being allowed to participate in the study. The study population included 14 trained nurses, three geriatric nurses and one social worker. One of the authors followed and observed the activities of nurses during different activities such as case conferences, meetings, and handing over. Semi-structured interviews were also administered during the study period and hospice staffs working full time, such as nurses, hospice, and patient directors were included. Efforts were made to include men to avoid gender bias, given that in most cases nurses are women.

Thematic guidelines were used to set the nature of the interviews. During the interviews, the staffs’ training and their source of motivation were inquired first. This was followed by questions that centered on the nature of care the staff provided, resulting ethical and conflicting situations, and the degree of latitude they faced during decision-making. Digital recording devices were used to record the interviews. Verbatim transcription followed the process of recording. The collected data was rendered anonymous during the entire process. Notes were handwritten down as the observation process took place. The notes were then processed before being rendered anonymous.


It was established that decision-making process is guided by an established framework of codes of ethics, as well as the mission and vision statements of the particular hospice. However, it was demonstrated that nurses, sometimes, adjusted their activities to practically attainable conditions, based on particular circumstances. The nurses observed showed the ability to deviate from the set standards to a certain degree without contravening them per se.

It was also observed that during routine activities, the social aspect was given priority over hygienic issues because nurses believed that social aspects in some situations met the patient expectations better than routine care. Several nurses interviewed did not consider their daily duties as routine, even though they had been doing the same work repeatedly throughout their service at the hospice. Death was not considered to be a matter of course, despite the general knowledge that hospices are places where people come to experience their death. This was highly evident, despite the availability of both external and internal programs of the institution. It was also established that the manner in which every patient succumbed to death was highly individualized, mainly being determined by the negotiations between the nurse in charge and the patient.

Relevance of the Study to Nursing

Nurses are the main care providers in hospices. Understanding the technicalities involved in this setting is, therefore, vital in ensuring effective and sufficient service delivery. Nurses are expected to be better positioned to provide holistic care that will take care of both the spiritual, physical, psychological, and social needs of the patient (Goethals, Dierckx de Casterle´, & Gastmans, 2013). The reviewed article provides vital information needed by nurses to help them achieve the dream of providing a holistic care. Also, human rights activism has taken center stage in today’s world, and any nursing engagement should be done within the provisions of the law and the established set of ethics. This article provides an insight into how nurses can effectively work within the set standards and vary on how they perform their duties without contravening the set standards.

Effect on Students’ Nursing Practice

It is the desire of the nursing profession that any student graduating from a nursing school is properly equipped to perform all the duties expected of them (McCarthy, 2010). This article will, therefore, help the student be fully informed of what is expected of them if they choose to serve in a hospice environment. It also helps the student to understand fully the holistic care that is required in most of the nursing duties. The student will also understand the need for a code of ethics being observed at the workplace, and the need to follow the established standards and mission statements of given institutions for the betterment of the patient. This article will, therefore, help the student to sharpen their nursing skills, venture into the nursing field well prepared, and administer their duties satisfactorily.


de Veer, A. J., Francke, A. L., Struijs, A., & Willems, D. L. (2013). Determinants of moral distress in daily nursing practice: a cross sectional correlational questionnaire survey. International Journal of Nursing Studies, 50(1), 100-108. Web.

Goethals, S., Dierckx de Casterle´, B., & Gastmans, C. (2013). Nurses’ decision-making process in cases of physical restraint in acute elderly care: a qualitative study. International Journal of Nursing Studies, 50(5), 603–612. Web.

Holland, S. (2010). Scepticism about the virtue ethics approach to nursing ethics. Nursing Philosophy, 11(3), 151–158. Web.

McCarthy, J. (2010). Moral instability: the upsides for nursing practice. Nursing Philosophy, 11(2), 127–135. Web.

Patel, B., Gorawara-Bhat, R., Levine, S., & Shega, J. W. (2012). Nurses’ attitudes and experiences surrounding palliative sedation: components for developing policy for nursing professionals, Journal of Palliative Medicine, 15(4), 432–437. Web.

Walker, A., & Breitsameter, C. (2015). Ethical decision-making in hospicecare. Nursing Ethics, 22(3), 321–330. Web.