Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care

Eur J Cardiovasc Nurs. 2019 Oct;18(7):577-583. doi: 10.1177/1474515119851621. Epub 2019 May 15.


Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.

Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.

Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.

Results: The CES was found to offer possibilities for meeting in an ethical 'free-zone' where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.

Conclusion: Participating in CES was experienced as meeting in an ethical 'free-zone' and seemed to be a means of facilitating integration of palliative and heart-failure care.

Keywords: Clinical ethical support; PREFER study; RiFECC; heart failure; implementation; palliative care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Heart Failure / nursing*
  • Home Care Services / ethics*
  • Home Care Services / standards*
  • Hospice and Palliative Care Nursing / ethics*
  • Hospice and Palliative Care Nursing / standards*
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Qualitative Research
  • Sweden