Nurses' Values and Perspectives on Medical Aid in Dying

Davidson, Judy E.; Bojorquez, Genesis; Upvall, Michele J.; Stokes, Liz; Bosek, Marcia Sue DeWolf; Turner, Martha; Lee, Young-Shin

doi:10.1097/njh.0000000000000820

Cited by 11 publications

(9 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The quantitative analysis 5 (blinded) also indicated that nurses who had more knowledge about MAID were more likely to endorse MAID. In this analysis, participants were often confused about the scope of practice boundaries and needed more information to make a knowledgeable choice about their position regarding MAID.…”

Section: Discussionmentioning

confidence: 97%

“…The findings provide context and credibility to the quantitative results previously reported. 5 Previously, we uncovered a finding new to the discourse on MAID that nurses who defined themselves as spiritual were more likely to promote the practice of MAID, whereas religious nurses were more likely to be against the practice of MAID. Here, we learn that spiritual nurses found it a sacred duty to honor the patient’s wishes, and an honor to be authentically present for them at the end of life.…”

Section: Discussionmentioning

confidence: 99%

“…Electronic survey construction/validation has been detailed elsewhere. 5 Briefly, experts created the research aim and research questions followed by constructing draft survey questions to answer the research questions. The survey questions were validated through expert review and face validity testing with end users using the Lynn method iteratively until acceptable content validity index was obtained and participants of the validation process confirmed that all important topics were included in the questions to answer the research questions.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Nurses’ values on medical aid in dying: A qualitative analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Nurses’ values on medical aid in dying: A qualitative analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Stigma for staff objecting to participation . A policy allowing the presence of nurses during ingestion of aid-in-dying medication may pressure those who wish to support patients but limit the scope of their participation 10…”

Section: Arguments Supporting Leave-the-room Hospice Policiesmentioning

confidence: 99%

Hospice Nurse Ethics and Institutional Policies Toward Medical Aid in Dying

Abbott

Kerwin

Holdèn

et al. 2023

AJN, American Journal of Nursing

View full text Add to dashboard Cite

A significant number of hospices in U.S. jurisdictions where medical aid in dying is legal have implemented policies that require nurses to leave the room when a patient ingests aid-in-dying medication. Two questions with ethical implications arise from these policies: (1) Is it ethically supportable for a hospice to require that staff leave the room while a patient ingests aid-in-dying medication? and (2) Does this requirement compromise the nurse's professional commitment to the patient and family? This article reviews the origins of this common policy, as well as nursing codes of ethics and professional organization policy statements as they relate to nursing commitments to patients. It finds that an institutional policy requiring nurses to leave the room while a patient ingests aid-in-dying medication risks violating professional nursing standards, reinforces stigma regarding medical aid in dying, and potentially abandons patients and loved ones at a critical time in their passage toward a desired and legal death. The authors describe a case that depicts these three potential risks, concluding that even if such policies are not legally prohibited by state aid-in-dying statutes, hospices should eliminate them or at least be transparent about the practice and its rationale before accepting patients who request medical aid in dying.

show abstract

“…First and second survey hyperlinks were distributed via email (35,36). The survey prompted delirium experts to view each domain's video content and evaluate corresponding quiz items (questions), rating each for 1) relevance (Likert scale; 1 = "Not Relevant" to 4 = "Highly Relevant"), 2) clarity (yes/no), and 3) importance (Likert scale; 1 = "Not Essential" to 3 = "Essential") (32), along with 4) domain and Playbook content comprehensiveness (yes/no) (32,(35)(36)(37)(38). The first round of quiz content validation included relevance, clarity, and importance ratings on multiple-choice items as well as comprehensiveness ratings on domains and the entire Playbook.…”

Section: Meaningmentioning

confidence: 99%

Development and Validation of an ICU Delirium Playbook for Provider Education

Makhija

Fine

Pollack

et al. 2023

Critical Care Explorations

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an “ICU Delirium Playbook” to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention. DESIGN: Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital “ICU Delirium Playbook.” Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews. SETTING: Online validation survey, virtual focus group, and virtual interviews. SUBJECTS: The validation group included six delirium experts in the fields of critical care, geriatrics, nursing, and ICU education. The face validation group included nine ICU nurses, three of whom participated in the semi-structured feedback interviews. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 44-question quiz had excellent content validity (average scale-level content validity index [S-CVI] of individual items = 0.99, universal agreement S-CVI = 0.93, agreement κ ≥ 0.75, and clarity p ≥ 0.8). The focus group participants completed the Playbook in an average (sd) time of 53 (14) minutes, demonstrating significant improvements in pre-post quiz scores (74% vs 86%; p = 0.0009). Verbal feedback highlighted the conciseness, utility, and relevance of the Playbook, with all participants agreeing to deploy the digital education module in their ICUs. CONCLUSIONS: The ICU Delirium Playbook is a novel, first-of-its-kind asynchronous digital education tool aimed to standardize delirium detection and prevention practices. After a rigorous content and face validation process, the Playbook is now available for widespread use.

show abstract

Nurses' Values and Perspectives on Medical Aid in Dying

Cited by 11 publications

References 22 publications

Nurses’ values on medical aid in dying: A qualitative analysis

Nurses’ values on medical aid in dying: A qualitative analysis

Hospice Nurse Ethics and Institutional Policies Toward Medical Aid in Dying

Development and Validation of an ICU Delirium Playbook for Provider Education

Contact Info

Product

Resources

About