Exploring The Feelings Of Palliative Care Nurse Towards Euthanasia: A Qualitative Study

Practise Euthanasia in Palliative Care

Background

Question:

Discuss about the Practise Euthanasia in Palliative Care.

The main aim of this research is to explore the feelings of palliative care nurse regarding involvement in euthanasia. The research done in this area will help to identify whether adequate number of nurses will be available to provide lethal drugs to patient as part of Euthanasia. This research is also significance because more and more number of countries are now making Euthanasia legal (Hudson et al., 2015), thus bringing forward the concern regarding how nurses will handle such cases.

As the main aim of this research is to get detailed insights regarding the feelings of euthanasia in palliative nurses, qualitative research design with face to face interview method is the most appropriate process for the literature review. As individual participant’s values such as age, gender and religious affiliation can have an impact on participant’s response, demographic characteristics will be evaluated too. As euthanasia is a controversial issue, socio-economic, emotional and physical variables will also influence research activity. Hence, research methods needs to be developed keeping this in mind.

Previous research literature done on Euthanasia has covered many vital points about nurse’s perception towards Euthanasia. Terkamo-Moisio et al., (2017) focused on exploring the attitude towards euthanasia in Finnish nurse by means of a cross-sectional web based survey. This research was necessary because of under-representation of nurse’s feeling towards euthanasia in current literature. As nurse’s work related characteristics, demographic characteristics and cultural characteristics could affect study results, those parts were also included in the questionnaire. All ethical considerations related to study approval, nature of study and informed consent requirement were maintained. The findings of the study revealed that majority of nurses were ready to accept euthanasia particularly single unmarried nurses. Thus, this study mainly indicated that single nurses and those with least experience were in favor of euthanasia compared to widower. Overall, the study showed that Finnish nurses were confident about involvement in euthanasia as they had enough information on topic. The validity and efficacy of the study was enhanced by statistical analysis of response in participants with different religion, marital status and work characteristics.  As euthanasia is a topic that arouses strong feelings and emotions, this acted as a barrier in collecting response from some participants. This study is significant as it has shown that nurse favor euthanasia in accordance with the ethical principle of beneficence (Fenton, 2016). The study proposed application and dissemination of research finding in nursing education and while addressing ethical issues at the end of life care (Terkamo-Moisio et al., 2017).

Naseh, Rafiei & Heidari, (2015) investigated about the Iranian Muslim nurse’s attitude towards euthanasia. Research in this area was necessary to find out how attitude towards euthanasia can different in a Islamic country, where Islamic views does not favor people to die voluntarily. A descriptive research design with the use of questionnaire package helped to collect response related to the topic from 15 registered nurses working in different wards in Iran. A Euthanasia Attitude Scale (EAS) and questionnaires were used to explore attitude towards euthanasia and data was analyzed statistically by means of SPSS software. The researcher also fulfilled ethical requirement for research by taking ethical approval for research and considering and confidentiality and informed consent requirement. No cultural considerations were analyzed as the study had homogenous participants (Only Muslim participants). The analysis of study results showed that about 57.4% nurses had negative attitude towards euthanasia, however in contrast to the research by Terkamo-Moisio et al. (2017), the study by Naseh, Rafiei & Heidari, (2015) did not showed difference in outcome on the basis of marital status. However, the weakness of the research is that cost effectiveness and efficacy component were not analyzed. This study gives the implication that availability of information’s relation to euthanasia affects attitude towards euthanasia and negative attitude in Iranian nurse might be due to this factor only. The study did not give any detail on disseminating the findings; however it proposed doing future research with focus on culture instead of religious beliefs to understand cultural influence in attitude to euthanasia. 

Research Design

The work by Denier et al., (2010) mainly extended knowledge related to the feelings of nurse while communicating for patients requesting euthanasia. The research used qualitative research design with the use of grounded theory to find out nurse’s perspective regarding involvement in care process surrounding euthanasia. The data was collected by means of qualitative in-depth interview with Flemish nurses and data were analyzed by means of detailed coding of transcripts with the use of QSR NVivo 7 software. All relevant ethical considerations were followed, but no cultural considerations in research methodology were found. The study findings revealed that openness and attentiveness and patience were necessary part of communicative attitudes during the euthanasia care process. Nurses also had good understanding about the purpose of communication during involvement in euthanasia process. Hence, the strength of this finding is that it proves that the manner in which nurses perceive their communication with patients is a crucial factor in euthanasia care process. This means that in countries where euthanasia is legalized, nurses need to upgrade their communication skills to effectively get involved in the euthanasia care process. However, as the communication process during euthanasia care is complex, implementation of appropriate nursing communication guidelines will be necessary (Terkamo-Moisio, Kvist & Pietilä, 2015). The research finding is valid as it many strategies were taken to address trustworthiness factor while analyzing the data. The author discussed regarding use of results in educational context and hospital context.

Apart from cultural and emotional determinant, Lavoie et al., (2016) focused on examining the role of psychosocial determinants on nurse’s intention to practice euthanasia in palliative care. Research in this area was important because psychological limitations of nurse’s power often alleviate suffering in the context of palliative care (Renn–?urek, Jamrozik & Piontkowska, 2014). The study was guided by the Theory of Planned Behaviour and survey questionnaire was developed accordingly. The study was also reviewed by the relevant Ethics Committee and data was collected by means of self-administered questionnaire sent by mail, however no cultural considerations were found. The results of study indicated that nurses have positive intention to engage in euthanasia in palliative care which is consistent with many other studies. The support of the findings with the concept of TPB enhanced the validity and credibility of the study, however cost-effectiveness dimensions were not considered. The barriers to conducting the study were the low response. This is acceptable because euthanasia is a subject with great controversy. The research proposed utilization of research outcome to improve performance of nurse in palliative care.

The involvement of nursing staff in involvement and decision making related to euthanasia was covered by (Francke et al., 2016). The main rational for exploring Dutch nursing staff’s attitudes and involvement in euthanasia was no mention of nurse’s role in Dutch euthanasia Act. Quantitative research was done with the use of survey questionnaires to collect nationwide response from registered nurse and data was analyzed by means of multivariate logistic regression analyses. Ethics aspects of research process were fulfilled and cultural factors were considered by the analysis of background characteristics of participants. The results showed that majority of nurses believed that physicians should consult nurses about euthanasia request, however many were not aware about the legal rule related to euthanasia practice. The research brings an important point that nurses favored involvement in decision making regarding euthanasia and the results can be disseminated for nursing education. The only barrier in the research was identifying ways to find out moral considerations of participants while giving response to survey questions.

Previous Studies

Nurses working in palliative care have been challenged by euthanasia request form patients and families. Euthanasia is a controversial topic as different ethical issues and human rights objection are raised regarding allowing euthanasia in different countries. Although nurses are not in the position to take decisions regarding euthanasia request, however how many nurses would like to involved in euthanasia is a question to be raised (Naseh, Rafiei & Heidari, 2015). In the context of Australia also, this research topic is important because euthanasis is legal in many states of Australia. Hence, knowing Australian’s nurse perspective regarding how they feel about decision making related to euthanasia will have great implications in preparing palliative care nurses for involvement in euthanasia care process. The past literature explored psychological aspects or cultural aspects separately; however this research will explore nurse’s feeling by comparison with their psychological and social background too.

Research design: Previous research done on the topic mostly used web-based questionnaires to collect data and save time (Terkamo-Moisio et al., 2017); Francke et al., 2016). However, critical analysis of research literature in the literature review section indicated that there are several barriers in conducting research by the use of web-based questionnaires. Although web-based questionnaires save time, however confusion regarding certain terms in the questionnaire also influenced participant response which was seen in the research done by Francke et al., (2016). Hence, to address this barrier, it has been planned to use face-to-face interview method with Australian nurses working in palliative care and with the use of both open ended and close ended questionnaires. However, to favor ease of analysis, the sample size will be restricted to 100 participants only.

 Qualitative research method will be used and interview data will be transcribed verbatim. The questionnaires will have important components like demographic characteristics, knowledge about euthanasia law in their state, attitude towards euthanasia and psychological and social barriers to decision making regarding euthanasia. Use of the following components in the questionnaire is likely to address limitations found in past research and explores social, knowledge and psychological components affecting nurse’s response towards euthanasia.

Ethical consideration: The approval for the research will be taken by one of the Human Research Ethics Committees in Australia and the participants will be recruited for the study only after they give informed consent for participation in research. The informed consent related procedure will be addressed by informing all the participants about the purpose of research and the controversy behind the topic. They will also be informed about ways by which there personal details will be kept confidential.

Timeline: The following is the timeline for conducting this research:

Funding requirement: As the process of sample recruitment and data collection will require manpower and use of certain tools, it is necessary to make arrangement for funding the research. This can be done by requesting for funding from HREC, as it is the major institution in Australia that looks after funding requirement and giving research approvals for proposal submitted to the body (Nhmrc.gov.au., 2018). 

Findings

Data analysis: The data will be analyzed by means of thematic analysis to clearly give idea about different components included in interview questionnaire. Thematic analysis will also favor conducting research in a flexible manner as per research objective (Braun & Clarke, 2014).

Possible barrier to research: Since, euthanasia is a controversial topic, hence many participants may be concerned about their identity or how their response will be used while conducting the research. To address this barrier, the participants will also be informed regarding confidentiality of their identity and using only their response for analysis instead of personal details like identity. There are also chances of low response rate due to the use of face-to-face interview method. This will be addressed by limiting the time to only 30 minutes.

Conclusion:

The findings of the research will have useful implications for health care providers in palliative care setting. The study outcome can be utilized to train nurses regarding decision making in euthanasia and effectively working with physicians to support patients to take decisions related to euthanasia. From this research, palliative care staffs may know about psychological characteristics and social attributes that may affects nurse’s ability to get involved in euthanasia process. Based on this identification, appropriate decisions may be taken regarding increasing nurse’s confidence in handling euthanasia request (Elmore, Wright & Paradis, 2016). The finding of the research will be disseminated by holding conference in palliative care setting.

References:

Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers?. International journal of qualitative studies on health and well-being, 9.

Denier, Y., Gastmans, C., De Bal, N., & Dierckx de Casterlé, B. (2010). Communication in nursing care for patients requesting euthanasia: a qualitative study. Journal of clinical nursing, 19(23?24), 3372-3380.

Elmore, J., Wright, D. K., & Paradis, M. (2016). Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nursing ethics, 0969733016679468.

Fenton, K. N. (2016). A Father’s Broken Heart. The Annals of thoracic surgery, 102(6), 1786.

Francke, A. L., Albers, G., Bilsen, J., de Veer, A. J., & Onwuteaka-Philipsen, B. D. (2016). Nursing staff and euthanasia in the Netherlands. A nation-wide survey on attitudes and involvement in decision making and the performance of euthanasia. Patient education and counseling, 99(5), 783-789.

Hudson, P., Hudson, R., Philip, J., Boughey, M., Kelly, B., & Hertogh, C. (2015). Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications. Palliative & supportive care, 13(5), 1399-1409.

Lavoie, M., Godin, G., Vézina-Im, L. A., Blondeau, D., Martineau, I., & Roy, L. (2016). Psychosocial determinants of nurses’ intention to practise euthanasia in palliative care. Nursing ethics, 23(1), 48-60.

Naseh, L., Rafiei, H., & Heidari, M. (2015). Nurses’ attitudes towards euthanasia: a cross-sectional study in Iran. International journal of palliative nursing, 21(1), 43-48.

Naseh, L., Rafiei, H., & Heidari, M. (2015). Nurses’ attitudes towards euthanasia: a cross-sectional study in Iran. International journal of palliative nursing, 21(1), 43-48.

Nhmrc.gov.au. (2018).  Human Research Ethics Committees (HRECs) | National Health and Medical Research Council.  Retrieved 12 March 2018, from https://www.nhmrc.gov.au/health-ethics/human-research-ethics-committees-hrecs

Renn–?urek, A., Jamrozik, P., & Piontkowska, M. (2014). Psycho-emotional problems of nurses working in palliative care units and home-based hospices. JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE, 125(2014_4), 51-58.

Terkamo-Moisio, A., Kvist, T., & Pietilä, A. M. (2015). Multifaceted nature of euthanasia: perceptions of Finnish registered nurses. Journal of Hospice & Palliative Nursing, 17(2), 105-112.

Terkamo-Moisio, A., Kvist, T., Kangasniemi, M., Laitila, T., Ryynänen, O. P., & Pietilä, A. M. (2017). Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines. Nursing ethics, 24(1), 70-86.

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