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Open Access Nurses' Moral Experience of Administering PRN Anti-seizure Medications in Pediatric Palliative Care Le dilemme moral des infirmières concernant l'administration d'anticonvulsivants au besoin dans le cadre des soins palliatifs pédiatriques

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Abstract:

This article explores nurses' decision-making related to the administration of PRN anti-seizure medications to children with long-term seizure disorders in palliative care. Hermeneutic phenomenological inquiry guided by van Manen's approach was the method used. Six nurses participated in interviews. Data analysis revealed that was the overarching theme in which nurses engaged in bearing witness, being attentive, creating connectedness, and finding the right thing to do. Four themes emerged: being in the know — what to know and ways of knowing; marking time — waiting and timekeeping; seeking a sense of personal comfort — developing a sense of comfort, experiencing distress, and responding to distress; and making the decision — recognizing a seizure, identifying options, weighing the options, and rethinking the decision. This study reveals the moral dilemmas and resulting moral distress that may be experienced in making this type of decision and advances our thinking about the corresponding tensions and rewards.

French
Le présent article étudie le processus de décision des infirmières concernant l'administration d'anticonvulsivants au besoin à des enfants souffrant de troubles convulsifs de longue durée dans le cadre des soins palliatifs. À cet effet, on a utilisé l'étude phénoménologique herméneutique suivant la démarche méthodologique de van Manen. Six infirmières ont participé aux entretiens. L'analyse des données a révélé que la réaction globale des infirmières étaient qu'elles ne veulent pas que cela se produise quand elles sont de garde, puisqu'elles sont les témoins de ce qui se passe, elles sont à l'écoute des patients, créent des liens avec eux et savent ce qu'il faut faire. Quatre thèmes sont ressortis de l'étude : savoir ce qui se passe — ce qu'il faut savoir et les façons de savoir; prendre en note ce qui se passe au bon moment — attendre et minuter; trouver un certain réconfort personnel — développer un sentiment de réconfort, être confronté à la détresse et y répondre; et prendre la décision — reconnaître une crise convulsive, déterminer les options, peser le pour et le contre et repenser la décision. Cette étude révèle qu'en prenant ce genre de décisions, les infirmières peuvent se retrouver face à des cas de conscience engendrant une détresse morale. Elle nous permet aussi de mieux comprendre les tensions et les récompenses qui s'y rattachent.

Keywords: CHRONIC ILLNESS; DECISION-MAKING; ETHICS; PALLIATIVE CARE; PEDIATRIC NURSING

Document Type: Research Article

Publication date: 2011-09-01

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