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Relational ethics of delirium care: Findings from a hospice ethnography
Author(s) -
Wright David Kenneth,
Brajtman Susan,
Macdonald Mary Ellen
Publication year - 2018
Publication title -
nursing inquiry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.66
H-Index - 49
eISSN - 1440-1800
pISSN - 1320-7881
DOI - 10.1111/nin.12234
Subject(s) - delirium , dignity , palliative care , nursing , context (archaeology) , ethnography , medicine , hospice care , end of life care , psychology , psychiatry , sociology , anthropology , law , biology , paleontology , political science
Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. This overarching commitment to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care.