Home care nurses’ ethical compass in palliative decision-making processes

This study explored home care nurses' experiences with shared decision-making regarding treatment and care for home-dwelling patients in the palliative phase, focusing on their perceptions of their role. An exploratory qualitative design was used to conduct and interpret four focus group interviews with 24 home care nurses from four municipalities, guided by Gadamer's hermeneutics. Two themes emerged: (1) Being captured between guidelines and personal values, highlighting the importance of covering one's back and the challenges of addressing a patient's ambivalence in decisions about life and death, and (2) Navigating the home care nurses' role, involving being caught in a network of blurry boundaries and sitting tight - understood as holding back one's views or actions even when a clear course seems evident - when decisions need to be made. This study highlights home care nurses' ethical challenges in shared decision-making. It suggests the core principles of healthcare ethics as a framework to support home care nurses in clarifying their roles and enhancing shared decision-making in palliative care.