Canada's legalization of Medical Assistance in Dying (MAiD) in 2016 has had important implications for nursing regulators. Evidence indicates that registered nurses perform key roles in ensuring high-quality care for patients receiving MAiD. Further, Canada is the first country to recognize nurse practitioners as MAiD assessors and providers. The purpose of this article is to analyze the documents created by Canadian nursing regulatory bodies to support registered nurse and nurse practitioner practice in the political context of MAiD. A search of Canadian provincial and territorial websites retrieved 17 documents that provided regulatory guidance for registered nurses and nurse practitioners related to MAiD. Responsibilities of registered nurses varied across all documents reviewed but included assisting in assessment of patient competency, providing information about MAiD to patients and families, coordinating the MAiD process, preparing equipment and intravenous access for medication delivery, coordinating and informing health care personnel related to the MAiD procedure, documenting nursing care provided, supporting patients and significant others, and providing post death care. Responsibilities of nurse practitioners were identified in relation to existing legislation. Safety concerns cited in these documents related to ensuring that nurses understood their boundaries in relation to counseling versus informing, administering versus aiding, ensuring safeguards were met, obtaining informed consent, and documenting. Guidance related to conscientious objection figured prominently across documents. These findings have important implications for system level support for the nursing role in MAiD including ongoing education and support for nurses' moral decision making.

BackgroundMembership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.MethodsMEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.ResultsThirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider’s behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.ConclusionsConceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1953-x) contains supplementary material, which is available to authorized users.

No abstract

Objectives: This study examined how childhood residential moves and non-normative school transitions are associated with a sense of belonging and depression in young adults, and how parental and peer relationships may serve as moderators of these associations. Methods: The participants were 487 young adults (358 females, 129 males; mean age = 19 years, age range = 17 to 30) who completed retrospective measures of family instability, parental and peer support (the Attachment History Questionnaire; Pottharst, 1990), depression (the Centre for Epidemiologic Studies-Depression scale; Kohout et al., 1993), and the Psychological scale from the Sense of Belonging Instrument (Hagerty & Patusky, 1995). Results: The bivariate associations for residential moves and school transitions were weak, but there were significant interactions involving parental attachment and peer support. The interaction patterns revealed that when parental attachment or peer support were high, sense of belonging was high and depression scores were low, even when there were many residential moves and school transitions. However, for people with more impoverished relationship contexts, outcomes were more positive (for six out of eight interactions) when there was more mobility. Conclusion: The findings provide a more nuanced perspective on the correlates of residential moves and school transitions than what has been previously reported in the literature.