Definition and validation of the nursing diagnosis label "wish to die": a research protocol

BACKGROUND

Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care. This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis.

METHODS

A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring's diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases.

DISCUSSION

The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

The defining characteristics of newly graduated nurses - A Delphi study

Despite processes designed to ensure that graduates of accredited nursing programs possess the necessary skills and knowledge to enter the workforce, a gap remains between graduate capabilities and industry expectations of work-readiness. This study aims to identify the defining characteristics of work-ready graduate nurses from the perspective of a purposive sample of new graduates, employers and academics utilising a three-round Delphi design and to compare the findings. In Round One participants provided free-text descriptors of graduate attributes, core knowledge and skills. In Rounds Two and Three participants prioritised categorised results from Round One and added free-text responses. Data from these rounds were not aggregated. In Round One, 14 academics, 20 clinicians and 12 graduates provided responses. In Round Two we received 10, 12 and 5 responses respectively and in Round Three 9, 8 and 4 responses respectively. The final round identified 19 characteristics and attributes, 10 knowledge areas and 11 skills for work-ready graduate nurses. This study identified that graduates should be safe practitioners, with professional behaviours, an understanding of anatomy and physiology, pathophysiology of disease, and medication safety, with good patient assessment and communication skills. Time management and prioritisation skills that graduates expect of themselves, develop with consolidation of practice.

Integrative Review of Related Factors and Defining Characteristics of Lack of Family Integrity

PURPOSE

To identify the related factors that compromise family integrity and the defining characteristics of poor family integrity.

METHODS

Integrative review in databases: Pubmed, Scopus, Cinahl, PsycInfo, and Web of Science. The inclusion and exclusion criteria led to the selection of 12 articles.

FINDINGS

Family conflicts, lack of communication, and detachment from family as risk factors that have a negative impact on family integrity. A decrease in the physical and psychological quality of life as defining characteristics of poor family integrity.

CONCLUSIONS

Lack of family integrity has a significant impact on the physical, mental, and social health of its members.

IMPLICATIONS FOR NURSING PRACTICE

Findings will allow nurses to implement interventions for the maintenance or improvement of family integrity.

Selecting symptom instruments for cardiovascular populations

The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.