It's all about the individual's right to choose: A qualitative study of Australian culturally and linguistically diverse nurses’ knowledge of and attitudes to voluntary assisted dying

Gendered and racial experiences of moral distress: A scoping review

AIM

To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.

DESIGN

Scoping review.

METHODS

The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted.

DATA SOURCES

Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.

RESULTS

After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.

IMPACT

This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.

CONCLUSION

There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A meta-synthesis exploring nurses' experiences of assisted dying and participation decision-making

AIMS AND OBJECTIVES

To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making.

BACKGROUND

Assisted dying is a complex and contentious issue with the potential to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions.

DESIGN

Systematic review. A meta-synthesis using thematic analysis.

METHODS

Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA.

RESULTS

The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders.

CONCLUSIONS

The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research.

RELEVANCE TO CLINICAL PRACTICE

It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.

Mindful self-care and mental well-being of university health educators and professionals in Hail Region, Saudi Arabia

BACKGROUND

Psychological stress is a familiar occurrence as it is linked with a sense of lack of control when up fronted with uncertainty. The study examines the mindful self-care practices of health educators and professionals in various domains and determines their relationship to the self-perceived level of mental well-being.

MATERIALS AND METHODS

The study employs the quantitative descriptive approach. It was conducted in the Hail region in the academic year 2020-2021 and was participated by 91 respondents from various colleges. Self-care practices and mental well-being of health educators and professionals were determined using the Mindful Self-Care Scale and the Warwick Edinburgh Mental Well-being Scale. Pearson correlation (2-tailed) was performed to assess the significant relationship between self-care behavior and mental well-being. Post-hoc test for correlation was conducted between the mean rating for each variable for self-care behavior and the mean rating for mental well-being. This was tested at an appropriate probability value of 0.01 and 0.05.

RESULTS

The overall mean for self-care behaviors of the respondents was 3.96 (SD 0.81) while the overall mental well-being score was 51.90 (SD 8.0). This was considered as average mental well-being, not indicative of possible/clinical depression. A significant relationship exists between the overall rating for self-care behavior and the overall rating for mental well-being (r = 0.661, P value < 0.001). Furthermore, with a correlation score of 0.661, the two variables have a moderately strong and significant positive relationship.

CONCLUSIONS

The study affirmed the relationship between mindful self-care behaviors and mental well-being. Engaging in self-care practices regularly and frequently can develop one's well-being.

Religiosidade/Espiritualidade na Prática em Enfermagem: Revisão Integrativa

Introdução: Embora a dimensão religiosa/espiritual seja um dos vértices do cuidado em saúde, tem despertado dúvidas quanto à sua operacionalização na prática profissional. Objetivo: Compreender de que modo a religiosidade/espiritualidade (R/E) está presente na atuação profissional em Enfermagem. Método: Revisão integrativa da literatura científica realizada em seis bases de dados/bibliotecas do campo da saúde, incluindo artigos publicados entre janeiro de 2008 e dezembro de 2021. Resultados e Discussões: O corpus foi composto por 21 estudos, em sua maioria qualitativos (85,72%), com primeiro autor brasileiro (57,15%). A R/E se faz presente na prática em Enfermagem, de maneira que algumas atitudes, disposições e comportamentos parecem indispensáveis para o cuidado religioso/espiritual e alguns contextos parecem mais propícios para tal integração. Conclusão: O lugar que a R/E ocupa dentro da Enfermagem ainda não está consolidado, existindo diversos questionamentos e dilemas éticos em aberto. Recomenda-se a realização de estudos que possam oferecer evidências para a prática em termos da incorporação dessa dimensão no cuidado em saúde.

Australian Health Professionals’ Attitudes toward Voluntary Assisted Dying: A Cross-Sectional Survey

Voluntary assisted dying (VAD) is when a terminally ill person with decision-making capacity consensually ends their life with assistance from an authorised professional. Many countries have legalised VAD, and health professionals’ roles within VAD frameworks are varied. Health professionals must be well informed of their legal obligations to ensure they practice within the legal boundaries, and those professionals with objections toward VAD should ensure that their eligible patients have equitable access. Given the current landscape of VAD, it is important to understand different health professionals’ attitudes toward VAD and what may underpin these attitudes. We explored (a) Australian health professionals’ attitudes toward VAD; (b) the psychological components that underpin those attitudes; (c) health professionals’ level of knowledge about VAD; (d) health professionals’ most common beliefs, emotions, and experiences related to VAD. A cross-sectional correlational survey design was used. A total of 182 Australian health professionals participated in the online survey based on a tripartite model of attitudes. We conducted a binomial logistic regression through a Generalised Linear Mixed Model and found polarised attitudes toward VAD between health professionals. Attitudes were accounted for by beliefs, emotions, education, and strength of religious beliefs. Knowledge of VAD was low, but not associated with overall attitude in our model. We highlight the importance of reflexive practice to help health professionals identify their values and feelings related to VAD, and to understand how these may affect their clinical practice. Low knowledge of VAD suggests that legislative and procedural training should be mandatory.