Aims and objectivesTo explore how Flemish nurses working in hospitals and home care experience their involvement in the care of patients requesting euthanasia 15 years after the legalisation of euthanasia.BackgroundEuthanasia was legalised in Belgium in 2002. Despite prior research that charted the experiences of nurses in euthanasia care before and right after legalisation in Belgium, it remains unclear how Flemish nurses currently, 15 years after the legalisation, experience their involvement.DesignA grounded theory design, using semi‐structured in‐depth interviews.MethodsWe interviewed 26 nurses working in hospitals or in home care, who had experience with caring for patients requesting euthanasia. Data were collected using a purposive sample and then a snowball sample. Data collection and data analysis were conducted simultaneously. Data were analysed by using the Qualitative Analysis Guide of Leuven. The study adhered to the COREQ guidelines.ResultsCaring for a patient requesting euthanasia continues to be an intense experience characterised by ambivalence. The nature of euthanasia itself contributes to the intensity of this care process. The nurses described euthanasia as something unnatural and planned that generated many questions and doubts. Nevertheless, most interviewees stated that they were able to contribute to a dignified end of life and make a difference, giving them a profound feeling of professional fulfilment. However, when nurses were not able to contribute to good euthanasia care, they struggled with strong negative feelings and frustrations.ConclusionAlthough the results suggest some subtle shifts in nurses' experiences over time, they do not indicate perceptions of euthanasia as a normal practice by the nurses involved.Relevance to clinical practiceThe study reveals the need for more clarification of nurses' ethical responsibility in euthanasia care and their role as moral agents.

No abstract

No abstract

Background Since 2009, hospital quality policy in Flanders, Belgium, is built around a Quality-of-Care Triad, which encompasses accreditation, public reporting and inspection. Policy makers are currently reflecting on the added value of this Triad. Methods We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence-base of the impact accreditation, public reporting and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length-of-stay, readmissions, patient satisfaction, adverse outcomes, failure-to-rescue, adherence to process measures and risk aversion. The impact of accreditation, public reporting and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative. Results We identified 69 studies, of which 40 on accreditation, 24 on public reporting, three on inspection and two on accreditation and public reporting concomitantly. Identified studies reported primarily low-level evidence (level-IV, n=53) and were heterogenous in terms of implemented programs and patient populations (often narrow in public reporting research). Overall, a neutral categorization was determined in 30 papers for accreditation, 23 for public reporting and 4 for inspection. Ten of these recounted mixed results. For accreditation, a high number (n=12) of positive research on adherence to process measures was discovered. Conclusion The individual impact of accreditation, public reporting and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.

Background Quality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy. Objective First, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy. Methods In this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed. Results QI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents. Conclusions Hospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up.