Nurses' opinions on euthanasia in Spain: an evaluation using a new version of the EAS

BACKGROUND

Bioethical dilemmas at the end of life have led to regularization processes for the provision of medical assistance in dying patients in different countries. Since the regulation of euthanasia in Spain in 2021, the euthanasia act has been included as one of the benefits of the health system, which has undergone uneven development and implementation in different autonomous communities. The aim of this study was to review the Spanish version of the Euthanasia Attitude Scale following the partial modification of four items.

METHODS

A cross-sectional study was conducted with a non-probabilistic sample of Spanish health workers from Islas Baleares. A self-reported sociodemographic questionnaire and the Euthanasia Attitude Scale were used for data collection. The psychometric properties of the scale were assessed, including reliability and validity, using a confirmatory factor analysis and a parallel analysis.

RESULTS

The Cronbach's alpha of the EAS was α = 0.892, which implies good internal consistency. According to the confirmatory factor analysis, a Kaiser-Meyer-Olkin-value of 0.938 was obtained, and the result of Bartlett's test of sphericity was < 0.001. The questionnaire included four loading factors, which explained up to 56.99% of the variance. The parallel analysis revealed three significant factors and a fourth, less interpretative factor.

CONCLUSIONS

The EAS-ES-R is a valid instrument for assessing the attitudes toward euthanasia of both trainees and practicing health professionals. It may also be of vital importance in detecting training, support and implementation needs for laws regulating euthanasia in Spain.

Educational content and strategies to support nurses from culturally and linguistically diverse backgrounds caring for patients considering voluntary assisted dying: The Australian experience

OBJECTIVES

Drawing on findings from a qualitative study that aimed to explore the knowledge and attitudes of nurses from culturally and linguistically diverse (CALD) backgrounds about voluntary assisted dying (VAD). The study also aimed to identify the strategies that assist nurses in their readiness and preparation for exposure to VAD. This paper reports on the educational content and strategies that could assist nurses from CALD backgrounds to be better prepared when they encounter VAD requests.

BACKGROUND

Around the world, healthcare professionals have roles to play in caring for patients requesting voluntary assisted dying. Nurses, particularly those from diverse geographic and clinical settings, have voiced inadequate knowledge and understanding about voluntary assisted dying.

DESIGN

A qualitative descriptive approach was undertaken.

METHODS

Data collection involved one focus group and 16 in-depth interviews. A total of 21 nurses from CALD backgrounds were recruited from one Australian state. Thematic analysis was conducted to interpret the data.

FINDINGS

Nurses identified their knowledge gaps and specified the need for education and workplace training on VAD, its legal and ethical aspects, clarity on their role, communication techniques and how VAD intersects with their practice. They suggested various teaching strategies that could prepare nurses to work safely and confidently in a clinical environment where voluntary assisted dying is an option for patients.

CONCLUSION

Given the high number of nurses from diverse backgrounds working in the Australian health sector, these nurses need to be fully prepared to care for patients requesting VAD.

Nursing students' view on their future role and skills regarding euthanasia due to unbearable mental suffering: A mixed-method Study

AIM

To explore final-year bachelor nursing students' view on their future role and skills regarding euthanasia due to unbearable mental suffering (UMS-euthanasia) and to discover possible education needs.

BACKGROUND

Since UMS-euthanasia is legal in Belgium, nursing students will be confronted with this issue during their future internship, or professional career. Graduated nurses believe to have an important role in the process of euthanasia where good communication skills and sufficient legal knowledge are essential.

DESIGN

Mixed-methods sequential explanatory design.

METHODS

First, a questionnaire was administered to all final-year bachelor nursing students at eight university colleges in Flanders (October 2020 and March 2021). Second, qualitative information was collected by organising focus groups with these students to gain more insights into the quantitative results (October 2021).

RESULTS

The final-year nursing students from the survey (n = 249) and from the three focus groups (n = 21) see a clear future role for themselves in the decision-making process, as well as in supporting the patient and family before, during and after UMS-euthanasia, but not in assisting in administering UMS-euthanasia. However, they also indicate they lack knowledge and skills in dealing adequately with UMS-euthanasia. Psychiatric internship alumni perceive a diminished role for themselves in the preparatory acts (p < 0.05). Ever involved in euthanasia shows a statistically significant difference in the demand for simulation.

CONCLUSIONS

Nursing students see an important role for nurses in UMS-euthanasia but feel inadequately prepared to take on this role. A combination of theoretical knowledge, clinical experience, open discussions, reflection and simulation is an opportunity to prepare nurses for their future role.

An international expansion in voluntary euthanasia/assisted dying: The implications for nursing

AIM

To provide an update on the international position of assisted dying legislation and its implications for nursing policy.

BACKGROUND

Assisted dying legislation has been introduced in health systems in Europe, North America and Australasia (Australia and New Zealand). Despite contributions in research literature, this remains focussed on medical practitioners, with limited acknowledgement of the need for policy development in nursing.

DISCUSSION

There is a need for critical evaluation of this contemporary issue and the significance for nursing practice of the lack of unified nursing perspective and robust policy guidance is identified. An overview of the existing role of voluntary euthanasia/assisted dying with recent developments is provided and the resulting concerns for nurses regarding the scope of practice, role confusion and conflicting professional values is considered.

CONCLUSION

Despite a long history of assisted dying and the continued expansion of these practices, limited and highly variable nursing policy highlights the lack of clear guidance available to nurses. The growing inclusion of nurse practitioners and recognition of registered nurse involvement in the care of individuals on an assisted dying pathway merits clearer support from regulatory authorities and professional organisations.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are the most likely health professionals to be approached with questions regarding assisted dying; they are intimately involved in patient experiences and need to understand what is possible, expected and legal in terms of their scope of practice regarding assisted dying.

IMPLICATIONS FOR NURSING POLICY

Nursing regulators and professional representatives need to provide clear policy statements and guidance identifying the nursing role and recognising where protections and support are necessary.

Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis

AIM

Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life.

DESIGN

A qualitative meta-synthesis.

DATA SOURCES

Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations. Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses.

REVIEW METHODS

Qualitative studies meeting the selection criteria were critically appraised, then an open card-sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD.

RESULTS

Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD.

CONCLUSION

Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family.

IMPACT

VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.

Opinions of nurses regarding Euthanasia and Medically Assisted Suicide

BACKGROUND

Safeguarding the right to die according to the principles of autonomy and freedom of each person has become more important in the last decade, therefore increasing regulation of Euthanasia and Medically Assisted Suicide (MAS).

AIMS

To learn the opinions that the nurses of the autonomous region of Madrid have regarding Euthanasia and Medically Assisted Suicide.

RESEARCH DESIGN

Cross-sectional descriptive study.

PARTICIPANTS AND RESEARCH CONTEXT

All registered nurses in Madrid. The study was done by means of a self-completed anonymous questionnaire. The variables studied were social-demographic, giving opinions about Euthanasia and MAS.

ETHICAL CONSIDERATIONS

Each participant was assured maximum confidentiality and anonymity, ensuring the ethical principles set out in the Declaration of Helsinki, as well as in the Organic Law 3/2018, on Personal Data Protection and guarantee of digital rights.

FINDINGS

A total of 489 nurses answered the questionnaire. In total, 75.7% of the nurses confirmed that Euthanasia should be regulated in Spain. 66.3% indicated that information on Euthanasia should be provided jointly by doctors and nurses, and 42.3% considered that it could be applied by both medical and nursing professionals. A total of 87.2% advocated the participation of nurses in health policy, influencing the drafting of the law. In the face of possible regulation, 35% would request Conscientious Objection, being closely related to their religious beliefs.

DISCUSSION

Different authors point out that nurses' perceptions and attitudes towards Euthanasia are conditioned by different factors, such as religion, gender, poor palliative care, legality and the patient's right to die.

CONCLUSION

Nurses are positioned in favour of the regulation and practice of Euthanasia and MAS, depending on their age, years of experience, training, model of care and especially religious beliefs.

Unbearable Suffering: A Concept Analysis

To understand and analyze the concept of "unbearable suffering" using a concept analysis method and to propose a new nursing diagnosis, the Walker and Avant method of concept analysis was used. Following the concept analysis method in 8 steps, a literature search was carried out in the MEDLINE, Dialnet, WOS, and PsycINFO databases between 2016 and 2020. Articles of theoretical or empirical nature, written in English, with the abstract available were included. As a result, 11 articles (4 theoretical and 7 empirical) were included. In addition, 2 cases were developed. The proposed new diagnosis, "unbearable suffering," refers to the situation of an individual who, because of a variety of factors, regardless of the cause, feels that he/she is unable to bear the suffering he/she is experiencing. The diagnosis is proposed for inclusion in "Domain 9: Coping/Stress Tolerance" and "Class 2: Coping Responses" of the North American Nursing Diagnosis Association taxonomy. Recognition of a nursing diagnosis for unbearable suffering could be key in identifying this type of suffering and facilitating interventions to reduce or mitigate it. Nurses play a fundamental role in situations of high levels of end-of-life suffering.

Odnos medicinskih sester do evtanazije

Uvod: Evtanazija je pojem, o katerem se mora razpravljati z vidika medicinskih, zdravstvenih in družboslovnih strok. Medicinske sestre so sestavni del zdravstvenih timov, zato je potrebno njihovo vključevanje v etične razprave o evtanaziji. Namen pregleda literature je predstaviti vidik evtanazije v povezavi z zdravstveno nego.Metode: Uporabljen je bil pregled literature, izveden v podatkovnih bazah COBIB.SI, CIHAHL in PubMed od 1. 11. 2020 do 1. 12. 2020. Iskanje je potekalo z uporabo ključnih besed: »evtanazija«, »zdravstvena nega«, v angleškem jeziku s kombinacijo ključnih besed: »attitudes«, »euthanasia« in »nursing«. Potek pregleda literature je prikazan z diagramom PRISMA. Kakovost virov, vključenih v končno analizo, je bila ocenjena s pomočjo hierarhije dokazov. Rezultati so bili sintetizirani z uporabo tematske analize.Rezultati: Izmed 138 virov je bilo v končno analizo vključenih enaindvajsetih člankov. Medicinske sestre so navajale naklonjen, kot tudi nenaklonjen odnos ter prisotnost etičnih dilem v povezavi z evtanazijo. Naklonjen odnos medicinskih sester do evtanazije se kaže v primerih neobvladljivih bolečin, neznosnega trpljenja in neozdravljivih bolezni, nenaklonjen pa v povezavi z nekaterimi demografskimi in kulturnimi značilnostmi medicinskih sester, upoštevanjem načel sočutne oskrbe in spoštovanjem vrednosti človekovega življenja.Diskusija in zaključek: Ugotovitve raziskave prispevajo prepoznati odnos medicinskih sester do evtanazije ter nekatere etične dileme v povezavi z evtanazijo. Potrebno bi bilo izvesti podrobne preglede etičnih dilem in moralnih stisk, ki se pojavljajo v povezavi z evtanazijo in zdravstveno nego.

The Attitude of Iranian Critical Care Nurses Toward Euthanasia: A Multicenter Cross-sectional Study

Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.

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.

Nurses knowledge and attitudes about euthanasia at national and international level: A review of the literature

AIM

To review the available evidence on nurses' attitudes to and knowledge about euthanasia.

METHODS

A literature review was carried out in the databases: PubMed (including Medline), CINAHL, Scopus, PsycINFO, Web of Science and CUIDEN, with inclusive terms of nurses' attitudes and knowledge regarding euthanasia both nationally and internationally. The selection criteria were articles in Spanish, English, Catalan or French published from January 2012 to September 2019 and studies that analysed the nurses' attitudes and knowledge regarding euthanasia and articles that were full available for analysis.

RESULTS

Initially a total of 566 articles were found, and finally 8 met the inclusion criteria of the research question in the review. The total number of nurses participating in the studies was 3,571. Most of the nurses, both at international and national level, have a positive attitude towards the legalization of euthanasia; however, all studies report a lack in nurses' knowledge on the specific theme of euthanasia.

DISCUSSION

The results show that nurses describe their attitude as positive towards the practice of euthanasia. In terms of knowledge, nurses reported the need to have more specific training on this subject is conclusive. In addition, this review provides a global and current vision that can serve as a necessary starting point for further work and progress in nurse training and for future research.

Attitudes of Indian Medical and Nursing Students Towards Euthanasia: A Cross-Sectional Survey

This cross-sectional survey was carried out among medical internees (n = 92) and nursing students (n = 228) to investigate their attitudes towards euthanasia. The data was collected by administering a Euthanasia Attitude questionnaire. The findings revealed that a majority (61%) of the participants were in support of euthanasia. Yet ethical dilemmas prevail among students about active and passive euthanasia and legalization of euthanasia. Further, age, gender, religion, education and exposure to patients who require euthanasia were significantly differed with euthanasia attitudes (p < 0.05). Therefore, it is strongly recommended that health care students should receive ethics education to prepare them in dealing with euthanasia related issues in their professional practice.

Spanish Version of the Attitude Towards Euthanasia Scale

Euthanasia is undoubtedly the protagonist of many of the debates around the end of life both among health staff and in the general population. Considering that nurses provide care for terminally ill patients and support families and patients in their final days, it is essential to know their attitudes towards euthanasia. The aims of the study were to adapt and validate the Attitude Towards Euthanasia scale to a Spanish context, to test the dimensionality and to estimate the reliability of the scale. A cross-sectional study was conducted with a non-probabilistic sample of Spanish health-workers of 201 in a University Hospital in Ciudad Real. A self-reported socio-demographic questionnaire and the Euthanasia Attitude Scale were used for data collection. The psychometric properties of the scale were assessed, including reliability and validity using an exploratory and confirmatory factor analysis. Cronbach's alpha of the Attitude Towards Euthanasia scale was α = 0.827 and McDonald's Omega = 0.903. The range of items of homogeneity was from 0.205 to 0.685. For the different exploratory factor analyses carried out, the Bartlett's test of sphericity was p < 0.001 and the sample index value of Kaiser-Meyer-Olkin was over 0.802. in all cases. We present the factorial weights for three models: The first one assumes a unidimensional solution, the second model was composed by three factors and the third model was composed by four factors. In the confirmatory factor analysis, the three models presented an acceptable fit index. The Attitude Towards Euthanasia scale adaptation to a sample of Spanish health workers has shown, with some limitations, appropriate psychometric properties. There have been several differences between the original factorial solution. It would be necessary to replicate the study to reinforce the findings about the number of factors of the scale.

Australian pharmacists' perspectives on physician-assisted suicide (PAS): thematic analysis of semistructured interviews

OBJECTIVES

This study aimed to investigate Australian pharmacists' views about their role in physician-assisted suicide (PAS), their ethical and legal concerns and overall thoughts about PAS in pharmacy.

DESIGN

Semistructured interviews of pharmacists incorporating a previously validated vignette and thematic analysis.

SETTING

Australia (face to face or phone call).

PARTICIPANTS

40 Australian Health Practitioner Regulation Agency registered pharmacists, majority women (65%) with varied experiences in community, hospital, industry, academia, government and other fields.

RESULTS

Emergent themes from the interviews were: legal and logistical framework, ethical framework, training and guidance and healthcare budget. More than half the participants supported the role of pharmacists in the supply of medicines for PAS, while less than half were either against or unsure of the legislation of PAS in Australia. Shared concerns included transparency of prescribing practices and identification of authorised physicians involved in PAS, which were consistent with existing literature. Religious faith, emotion and professional autonomy were key indicators for the implementation of conscientious objection to the supply of medicines in PAS. Re-evaluation of current guidelines, pharmacist training and government reimbursement was also of significance from participants' perspectives.

CONCLUSION

This study revealed current concerns of practising pharmacists in Australia, including previously undocumented perspectives on the pharmacoeconomic impact of and barriers relating to PAS. The need for training of all healthcare professionals involved, the provision of clear guidelines, including regulation around storage, administration and disposal of medicines dispensed for PAS and the updating of current therapeutic guidelines around end-of-life care were all issues delineated by this study. These findings highlighted the need for current and future policies to account for all stakeholders involved in PAS, not solely prescribers.