Introduction Community nurses working in primary care and in care homes registered to provide nursing care for older people have a key role in activating prescriptions written in advance of symptoms and distress that patients may have at the end of life (anticipatory prescribing). However, little is known about the decision-making processes employed by nurses or their experiences in this area of practice.

Aims and Methods To determine the roles and experiences of community nurses in end of life medication decisions, using sedation in end of life care as an exemplar. A mixed method case study design involving four community nursing teams and four nursing homes in three Cancer Networks. The study takes place in two phases. Phase one is an ethnography using participant observation of nurses involved in decision making about the use of anticipatory prescriptions for sedation in end of life care. In addition, up to 15 interviews will be conducted at each study site (n=120) with healthcare professionals who have played a part in prescribing, dispensing or administration of sedation medication. In phase two a questionnaire survey, informed by existing literature and findings from the ethnography, will be used to access views from district nurses, specialist palliative care nurses, and nursing home nurses across the three Cancer Networks.

Results Phase one of this study is due to commence in October 2011 and results are expected in May 2013.