Nursing practices in palliative sedation across respiratory medicine wards and palliative care units in Japan: A cross-sectional study

Objective: This study aimed to quantitatively assess nursing practices related to palliative sedation (PS) among nurses in respiratory medicine wards (RMWs) and palliative care units (PCUs) and to identify factors influencing these practices. Methods: A nationwide cross-sectional survey was conducted among nurses in 25 RMWs and 35 PCUs in Japan. A total of 430 nurses (171 from RMWs and 259 from PCUs) completed self-administered questionnaires. Exploratory factor analysis identified key components of PS-related nursing practices, and multiple regression analysis examined influencing factors. Results: Five key components of PS-related nursing practices were identified: collaboration with experts, assessment and alleviation of suffering, decision-making support, psychological support for families, and evaluation of PS appropriateness and effectiveness. The total PS nursing practice score was significantly lower in RMW nurses (60.6 +/- 11.2) than in PCU nurses (68.3 +/- 10.6, P < 0.0001). Multiple regression analysis showed that opportunities to discuss bioethics (beta = -0.22, P < 0.001), attitudes toward caring for dying patients (FATCOD-B-J, beta = 0.22, P < 0.05), collaborative practice with physicians (CPS, beta = 0.39, P < 0.001), and opportunities for joint conferences with palliative care teams (beta = -0.23, P < 0.001) were significant influencing factors. Conclusions: To enhance PS-related nursing practices in RMWs, efforts should focus on improving nurses'ethical decision-making abilities, fostering interdisciplinary collaboration, and reducing the psychological burden associated with end-of-life care.