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J Pain Symptom Manage. 2014 May;47(5):915-925.e11. doi: 10.1016/j.jpainsymman.2013.06.011. Epub 2013 Sep 24.

The complexity of nurses' attitudes and practice of sedation at the end of life: a systematic literature review.

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International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom. Electronic address:
International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom.
Centre for the Promotion of Excellence in Palliative Care, De Montfort University, Leicester, United Kingdom.



Sedation is administered to some palliative care patients at the end of their life. Nurses play an important role in this practice.


To systematically review the evidence on nurses' attitudes and practice of end-of-life sedation.


We searched eight electronic databases, four key palliative care journals, and reference lists for empirical studies published in English, between 1990 and 2012, on nurses and their attitudes toward and practice of sedation until a patient's death. A total of 10 studies met the inclusion criteria.


Data were generated from 7515 nurses in four main settings (specialized palliative care unit, home, nursing home, and acute hospital) from seven countries (Belgium, Canada, Japan, The Netherlands, Norway, U.K., and U.S.). On average, the quality of the evidence was good; hence, we analyzed all selected studies. Based on the findings from a previous review, we categorized the emerging themes into: 1) important factors leading to the patient receiving palliative sedation (PS), 2) nurses' attitudes toward PS, and 3) nurses' experience of PS at the end of a patient's life. In general, nurses had a positive but cautious attitude toward the practice of PS. Most saw it as a last resort treatment for relieving suffering and refractory symptoms, and its practice was often influenced by their level of education, expertise, and the roles they played per setting.


Most nurses administered sedation until death only within the given circumstances because of the anticipatory benefits in controlling refractory symptoms and suffering. Some of them experienced burdens during PS delivery; these could be supported by operational guidelines and task-related training.


Nurses; attitudes; continuous sedation; deep sedation; palliative sedation; practice; review

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