Ethical issues in palliative care: nursing and quality of life

Ibrahim et al. BMC Nursing (2024) 23:854 https://doi.org/10.1186/s12912-024-02530-7 BMC Nursing Open Access RESEARCH Ethical issues in palliative care: nursing and quality of life Ateya Megahed Ibrahim1,10*, Donia Elsaid Fathi Zaghamir2,10, Hassanat Ramadan Abdel-Aziz3,10, Omaima Mohamed Elalem1,4, Taliaa Mohsen Al-yafeai5, Hosny Maher Sultan Sultan6, Amina Mohamed Abdelfatah Sliman7, Reham AbdElhamed AbdElmawla Elsaid8, Taghreed Hussien Aboelola9 and Fathia Ahmed Mersal9 Abstract Background Nurses occupy a pivotal role in the provision of palliative care, acting as frontline providers who address the physical, emotional, social, and spiritual needs of patients. The complexities inherent in palliative care frequently give rise to ethical dilemmas that significantly impact nurses’ decision-making and patient interactions. It is therefore essential to gain an understanding of nurses’ perceptions of ethical issues, quality of life, and adherence to patient rights in order to enhance the care delivered in these settings. Aim This study aims to assess the ethical issues encountered by nurses in palliative care, evaluate their quality of life, and measure their understanding and adherence to patient rights. Methods A quantitative cross-sectional survey was conducted among a sample of 85 nurses working in palliative care settings, specifically within the Oncology Department and Pain Clinic at a Specialized Hospital in Egypt. A stratified random sampling technique was employed. The data were collected using standardised questionnaires, including the Ethical Issues Scale (EIS), the Nursing Quality of Life Scale (NQOLS), and the Patient Rights Questionnaire (PRQ). The validity and reliability of these instruments were established prior to the commencement of the study. The collected data were subjected to mean and standard deviation (SD) calculations. Statistical analyses, including the calculation of Pearson correlation coefficients, were conducted. Results The study sample comprised a diverse cohort of nurses, with a mean age of 40 years. The ethical issues were evaluated, yielding a mean score of 4.03 (SD = 0.74) on the EIS, with the highest score for “Patient Care” (M = 4.2, SD = 0.7). The overall quality of life mean score was 6.75, with the working dimension exhibiting the highest mean score at 7.1. The PRQ results indicated a high level of awareness regarding patient rights, with a total mean score of 49.5 (SD = 6.8). The results of the correlation analysis indicated a moderate positive correlation between ethical issues and patient rights (r = 0.52, p < 0.01), and ethical issues and quality of life (r = 0.45, p < 0.01). Conversely, a weaker correlation was found between quality of life and patient rights (r = 0.40, p < 0.05). Conclusions The findings elucidate the ethical challenges confronted by nurses in palliative care and their ramifications for the quality of life and adherence to patient rights. It is imperative that nurses engaged in palliative *Correspondence: Ateya Megahed Ibrahim Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Ibrahim et al. BMC Nursing (2024) 23:854 Page 2 of 12 care undergo continuous education and training in order to enhance their ethical decision-making abilities and thereby improve the quality of care they provide. Recommendations It is imperative that strategies be developed to support nurses in addressing ethical dilemmas, to promote awareness of patient rights, and to enhance their overall quality of life through targeted interventions and resources. Clinical trial No clinical Trial. Keywords Palliative care, Nursing ethics, Quality of life, Patient rights, Ethical dilemmas Introduction Palliative care, which aims to enhance the quality of life for patients with severe, life-limiting illnesses, constitutes an indispensable component of contemporary healthcare. In addition to addressing patients’ and their families’ medical concerns, this field also addresses their emotional, social, and spiritual needs [1–3]. The importance of palliative care and its ethical aspects is increasing in line with the rising prevalence of chronic illnesses and terminal disorders, which are the result of demographic changes and advances in medical technology [4–6]. In their role as primary caretakers in these environments, nurses are confronted with a unique set of ethical challenges that demand careful reflection and nuanced decision-making [7–10]. Palliative care presents a complex ethical landscape, comprising a number of significant challenges. These include the management of informed consent, the upholding of patient autonomy, and the making of difficult end-of-life decisions [11–13]. It is the responsibility of nurses to navigate these issues while striking a balance between moral precepts, including fairness (ensuring equitable treatment), non-maleficence (preventing injury), and beneficence (acting in the patient’s best interest). The imperative to persist with a compassionate approach that respects the views and preferences of patients and their families intensifies these concerns [14–16]. Palliative care is a holistic approach that prioritises the quality of life (QoL) of the patient. This encompasses not only the alleviation of physical symptoms but also the management of psychological distress, social isolation and spiritual needs. Given their ability to tailor care to the specific requirements of each patient, nurses play a pivotal role in assessing and enhancing the quality of life of those in their care. This necessitates an awareness of the values and preferences of the patients and a commitment to upholding their autonomy and dignity throughout their illness [17–19]. Palliative care was never intended to be exclusively for patients with terminal tumors; rather, it has a long history of focusing on symptom reduction and improving the quality of life for individuals with life-limiting illnesses. While it was initially implemented primarily for patients with terminal cancer, palliative care has evolved to encompass the management of complex chronic ill (...truncated)