Engaging with patients who desire death: Interpretation, presence, and constraint

Wright, David; Chirchikova, Marina; Véronique, Daniel; Bitzas, Vasiliki; Elmore, James; Fortin, Marie-Laurence

doi:10.5737/236880762715664

Cited by 17 publications

(15 citation statements)

References 40 publications

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“…Registered nurses found these initial conversations complicated because potential requests were often couched in indirect and veiled language. Although it is not uncommon for palliative patients to express a wish to die (Wright et al, 2017), this does not necessarily mean they are requesting MAiD. Thus, highly developed communication skills and effort were required to clarify the nature of the request amid time-pressured clinical environments.…”

Section: Discussionmentioning

confidence: 99%

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study

Pesut

Thorne

Schiller

et al. 2020

Global Qualitative Nursing Research

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Nurses play a central role in Medical Assistance in Dying (MAiD) in Canada. However, we know little about nurses’ experiences with this new end-of-life option. The purpose of this study was to explore how nurses construct good nursing practice in the context of MAiD. This was a qualitative interview study using Interpretive Description. Fifty-nine nurses participated in semi-structured telephone interviews. Data were analyzed inductively. The findings illustrated the ways in which nurses constructed artful practice to humanize what was otherwise a medicalized event. Registered nurses and nurse practitioners described creating a person-centered MAiD process that included establishing relationship, planning meticulously, orchestrating the MAiD death, and supporting the family. Nurses in this study illustrated how a nursing gaze focused on relationality crosses the moral divides that characterize MAiD. These findings provide an in-depth look at what constitutes good nursing practice in MAiD that can support the development of best practices.

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Section: Discussionmentioning

confidence: 99%

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study

Pesut

Thorne

Schiller

et al. 2020

Global Qualitative Nursing Research

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“…These emotions were descriptively laid on a platform of 'interpretative therapeutic engagement', where they seemed to aid in the larger philosophical and societal discourse around MAiD. 46 Dimension 3: Emotions that resonate with professional values (studies referenced 28 30 34 39 47-61) These included emotions that resonated with professional values like 'competency and perfection', 'intimate care', 'colloque singulier' (singular language of trust and conscience in context of therapeutic relationship) and various degrees of commitment ranging from 'contractual' to 'sacrificial'.…”

Section: Thematic Synthesismentioning

confidence: 99%

Emotional impact on healthcare providers involved in medical assistance in dying (MAiD): a systematic review and qualitative meta-synthesis

2022

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BackgroundMedical assistance in dying (MAiD) traverses challenging and emotionally overwhelming territories: healthcare providers (HCPs) across jurisdictions experience myriad of affective responses secondary to possible tensions between normative and interwoven values, such as sanctity of life, dignity in death and dying and duty to care.ObjectiveTo determine the emotional impact on HCPs involved in MAiD.MethodsInclusion restricted to English language qualitative research studies from four databases (OVID Medline, EMBASE, CINAHL and Scopus), from beginning until 30 April 2021, and grey literature up to August 2021 were searched. Key author, citation and reference searches were undertaken. We excluded studies without rigorous qualitative research methodology. Included studies were critically appraised using the Joanna Briggs Institute’s critical appraisal tool. Analysis was conducted using thematic meta-synthesis. The cumulative evidence was assessed for confidence using the Confidence in the Evidence from Reviews of Qualitative Research approach.ResultsThe search identified 4522 papers. Data from 35 studies (393 physicians, 169 nurses, 53 social workers, 22 allied healthcare professionals) employing diverse qualitative research methodologies from five countries were coded and analysed. The thematic meta-synthesis showed three descriptive emotional themes: (1) polarised emotions including moral distress (n=153), (2) reflective emotions with MAiD as a ‘sense-making process’ (n=251), and (3) professional value-driven emotions (n=352).DiscussionThis research attempts to answer the question, ‘what it means at an emotional level’, for a MAiD practitioner. Legislation allowing MAiD for terminal illness only influences the emotional impact: MAiD practitioners under this essential criterion experience more polarised emotions, whereas those practising in jurisdictions with greater emphasis on allaying intolerable suffering experience more reflective emotions. MAiD practitioner’s professional values and their degree of engagement influence the emotional impact, which may help structure future support networks. English language literature restriction and absence of subgroup analyses limit the generalisability of results.

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“…Third, MAiD is new to Canada. Even though healthcare providers have always received requests to hasten death, only now do they have the legal authority to do so [22,23]. Further, the experience of the death itself is vastly different from a normal death [8].…”

Section: Delegation: Supports As a Reflection Of Sociocultural Contextmentioning

confidence: 99%

The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death

et al. 2020

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Background: Medical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government's decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses' experiences and nursing practice. Methods: The study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account. Results: Nurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses' moral responses to MAiD were most effective in supporting nurses' well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD. Conclusions: Data obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients' lives, without suitable supports, find themselves caught between the proverbial rock and hard place.

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Engaging with patients who desire death: Interpretation, presence, and constraint

Abstract: ABSTRACT

Cited by 17 publications

References 40 publications

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study

Emotional impact on healthcare providers involved in medical assistance in dying (MAiD): a systematic review and qualitative meta-synthesis

The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death

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