Developing a survey to measure nursing students' knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

BACKGROUND

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada's legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses' (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students' knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

METHODS

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

RESULTS

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

DISCUSSION

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students' attitudes toward MAiD in a Canadian context.

CONCLUSION

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Nursing Students' Views about Do-Not-Resuscitate Orders: Quasi-Experimental Study

"Do Not Resuscitate" (DNR) order is one of the challenging issues encountered in end of life care. This study aimed to determine the effect of education about DNR on the views of senior nursing students. Students, who selected elective course of palliative care and received education about DNR formed the intervention group (n = 106) while the students who did not select the lesson were in the control group (n = 107). Data were collected using a questionnaire. It revealed that the students who had education about DNR agreed with the positive statements about DNR more than the control group. Also, intervention group students had a high agreement DNR should be a part of vocational training for health professionals. It is important and necessary to focus on the special role of nurses when a DNR order is given, and nursing education raised the awareness and views about DNR according to the data from this study.

"I Should at Least Have the Feeling That It […] Really Comes from Within": Professional Nursing Views on Assisted Suicide

Background

Due to a decision by the German Federal Constitutional Court of February 26, 2020, it is currently possible in Germany to avail of assisted suicide. The ruling has given rise to a controversial debate within the professional community as well as in society in general. Within this debate, little attention has been given to the role of nursing staff in assisted suicide. However, international studies show that nurses play an important role in assisted suicide.

Objective

The aim of this study is to assess the views and attitudes of nurses from different care settings in Germany toward assisted suicide.

Design

A qualitative research design was chosen to capture the subjective experience of nursing staff on suicide assistance. This was analyzed using the grounded theory method.

Methods

With the help of a semi-structured, narrative-generating interview guide, in which five case vignettes are integrated, 20 interviews were conducted with nursing professionals from different care settings throughout Germany.

Results

The analyzed phenomenon shows that nursing professionals need to understand the desire to die for themselves. The individual life situation of the respective patient is decisive. The action strategy based on being able to tolerate the wish to die determines how intensively they want to be involved before, during, and after assisted suicide. For nurses, however, it is undisputed that it is their professional role to accompany the patient in their "existence" and thus also in the context of assisted suicide.

Conclusion

In view of the future development of assisted suicide in Germany, it seems necessary to prepare nursing professionals for activities related to assisted suicide by means of a curricular offer. In addition, nursing professionals should be supported in forming their own attitude to the issue.

The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers’ attitudes towards suicide and suicidal patients: a qualitative study

Background

There has been mixed findings on whether a healthcare workers’ religious beliefs contribute positively or negatively to their attitudes towards suicidal patients.

Aims

This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers’ attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population.

Methods

Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers’ acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient’s religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice.

Results

Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support.

Conclusions

The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.

The Ethics of Dying: Deciphering Pandemic-Resultant Pressures That Influence Elderly Patients' Medical Assistance in Dying (MAiD) Decisions

The objective of medicine is to provide humans with the best possible health outcomes from the beginning to the end of life. If the continuation of life becomes unbearable, some may evaluate procedures to end their lives prematurely. One such procedure is Medical Assistance in Dying (MAiD), and it is hotly contended in many spheres of society. From legal to personal perspectives, there are strong arguments for its implementation and prohibition. This article intends to add to this rich discourse by exploring MAiD in the context of our current pandemic-ridden society as new pressures from social isolation and guilt threaten the autonomy of vulnerable elderly patients. Although autonomy is of chief importance, variables within our current context undermine otherwise independent decisions. Many older individuals are isolated from their social network, resulting in a decline in their mental health. Individuals in such a state are more likely to request a MAiD outcome. Furthermore, overwhelmed healthcare systems may not adequately address this state, which would normally have prompted a mental health intervention. The future of MAiD is far from settled and careful consideration must be given as new contexts come to light, such as those outlined in this paper.

Examining the religiosity of nursing caregivers and their attitudes toward voluntary and involuntary euthanasia

BACKGROUND

Nurses play an important role in taking care of people who have a terminal illness.

AIMS

To examine nursing caregivers' religiosity as the mediator between voluntary and involuntary euthanasia, and to compare nursing caregiver religiosity groups and the voluntary and involuntary euthanasia attitudes of nurses and nursing students.

METHODS

A cross sectional design was applied and 298 nursing caregivers voluntarily participated and completed the questionnaire.

FINDINGS

Religiosity partially contributes as mediator between voluntary and involuntary euthanasia. All nursing caregiver religiosity groups show more support for voluntary euthanasia. Moreover, nursing students and nurses differ with respect to support for euthanasia in extreme situations, such as patients that are clinically brain-dead.

CONCLUSION

Findings may be attributed to the clash of religious values, due to the common injunction against taking a life especially as regards involuntary euthanasia.

Knowledge and Attitudes Towards Abortion and Euthanasia Among Health Students in Papua New Guinea

PURPOSE

The purpose of this study was to explore knowledge and attitudes of health program students towards ethical issues pertaining to the beginning and the end of human life, and associations between these attitudes and demographic variables.

PARTICIPANTS AND METHODS

The study took a mixed-method approach with self-administered survey questionnaires and in-depth interviews. A total of 88 students participated in the survey, and 10 students participated in interviews. The study was conducted among students in the Health Extension Program at a Christian university in Papua New Guinea.

RESULTS

Students showed a higher acceptance of abortion than euthanasia. More year-4 students presented significantly deeper knowledge of euthanasia and abortion compared to year-1 students. There were no gender differences regarding knowledge and attitude towards these two bioethical issues. The majority of students opposed the idea of women's right to abortion, which is attributed mainly to socio-cultural reasons. The qualitative analysis indicated a very strong perception that having children 'defines' womanhood and also revealed general disapproval of any form of euthanasia. A low level of acceptance of various forms of euthanasia is associated with a respect for older people in Melanesian society and beliefs that ancestors' support is required for achieving prosperity in life.

CONCLUSION

The study offered a comprehensive description and analysis of students' knowledge and attitudes towards ethical issues pertaining to the beginning and the end of human life. Presented a low level of knowledge towards bioethical issues, together with a small proportion of the knowledge gained from lectures and tutorials, indicated inadequate teaching of bioethics and calls for further improvement. In the perspective of rapid social and cultural changes in the Papua New Guinea society, further studies on changing attitudes towards bioethics issues would be valuable.

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.

The Islamic perspective on physician-assisted suicide and euthanasia

Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one's life to be forbidden. Islam sanctifies life and depicts it as a gift from God (Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.

Relationship Between the Needs of Turkish Relatives of Patients Admitted to an Intensive Care Unit and Their Coping Styles

Admission to an intensive care unit is a traumatic event for many patients' relatives. Also, the relatives may be subject to many requirements to during this process. Therefore, it is very important to determine their requirements and coping styles. This study used a descriptive, relational design. The sample of the research consisted of 247 relatives of patients staying in six intensive care units. It was found that, 65.2% of the patients' relatives were women, and their mean age was 37.25 ± 12.7 years. What they mostly needed was support, proximity, information, assurance and comfort. In that order; among the coping styles it was found that they usually used the following approaches: self-confident approach, an problem-focused coping method; was found to be used by relatives most frequently, followed by helpless approach, an emotion-focused coping style. Requirements: Assurance, information, support and comfort sub-dimension scores and problem-focused coping style; self-confident approach and social support search approach sub-dimension scores between statistically positive, significant relationship was found. Information, proximity, support and comfort sub-dimension scores and emotion-focused coping style; helpless approach and submissive sub-dimension scores between statistically positive, significant relationship was found (p<0.05). It was found that patients' relatives used the helpless approach and submissive approach to cope with stres: during this process their information needs increased and upon fulfillment of requirements, they started using self-confident approach and the social support approach, which are problem-focused coping styles.

Attitudes toward euthanasia-dual view: Nursing students and nurses

Caregivers such as nurses and nursing students have different religiosity backgrounds and have important roles as to terminally ill patients and euthanasia; however, they have different levels of knowledge and experience. Accordingly, the study identify differences between caregivers' religiosity level and euthanasia attitudes, examine differences between caregivers regarding attitude to euthanasia and identify differences between nurses by incidence of terminal patient caring and their relationship to euthanasia. Caregivers (210) volunteered fulfill survey. Main result suggests differences mostly between secular and traditional groups as to euthanasia. Accordingly, our suggestion is that the caregivers should improve communication via simulation of discussing euthanasia.

Factors Affecting California College Students’ Attitudes Toward Assisted Dying

This study focuses on college students’ experiences and beliefs, which affect attitudes toward assisted dying. Of 324 students, 35% wanted the option of assisted dying for a family member with a life-threatening illness. Results of multiple logistic regression indicate students who favored assisted dying were significantly influenced by having a family member die, experiencing hospitalization, thinking about end-of-life issues, and being comfortable with palliative care. Belief in an afterlife and being a caregiver were negatively associated with assisted dying. Students need to receive training in end-of-life care issues, as increasingly professionals will face such requests.

Euthanasia: A Controversial Entity Among Students of Karachi

Background A serene death may be achieved through skilled and compassionate care, as well as by the dying person's own sense of having lived a righteous life. The purpose of this study is to acquire information about students' knowledge and understanding of euthanasia. Materials and Methods Four hundred and fifty-six students from four classes of two institutions with similar demographic characteristics were included in this cross-sectional study. A questionnaire adapted from a study of 'Gruber, et al.' was distributed among the respondents after obtaining a verbal informed consent. The questionnaire had two parts, first dealing with demographics of respondents, and in the second part students were given different situations and asked about their decision in that particular setting to understand their opinion about euthanasia. Results There were 31.7% medical students and 12.9% non-medical students in favor to provide complete medical information (p < 0.001) while 59.2% non-medical students thought that complete information should be given to a patient if any iatrogenic incident occurred. Same favored by 33.7% of medical students (p < 0.001). The majority of medical students (84.5%) felt that cardiopulmonary resuscitation (CPR) must always be provided (p < 0.001) and this was acceptable more among females (p = 0.001). Furthermore, medical students (57.6%) were more in favor of continuing maximum medical treatment including CPR than non-medical students (42.9%, p = 0.003). A total of 83% non-medical students and 46% medical students found euthanasia an acceptable practice. Conclusion Results show a significant difference in perception of medical and non-medical students regarding euthanasia. Non-medical students are more in favor of euthanasia than medical students. Also, it is observed that males seem to be more inclined towards euthanasia while females are more in favor to provide maximum medical treatment.