Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta‐synthesis

Abstract

Aim: Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life.Design: A qualitative meta-synthesis.Data sources: Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations.Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses.Review methods: Qualitative studies meeting the selection criteria were critically appraised, then an open card-sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD.Results: Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD. Conclusion: Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family.Impact: VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.

Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study

“…This is evident in the disparity between healthcare providers' descriptions of good practices and relatives' reports of inadequate support, as reflected during the interviews. In the context of assisted dying, the provision of bereavement care is often unsystematic (Roest et al., 2019) due to inadequate education and training (Ward et al., 2021) and inconsistent guidelines (Sandham et al., 2022). A recent study illustrates that healthcare providers often rely on trail‐and‐error and their intuition when providing bereavement care to relatives during euthanasia processes (Boven et al., 2023).…”

Health professionals' understanding and attitude towards the End of Life Choice Act 2019: a secondary analysis of Manatū Hauora – Ministry of Health workforce surveys

“…However, the statutory and professional guidelines provide limited information on nurses' scope of practice regarding AD. 14,26 Given the implications for registered nurses under the Act, New Zealand nurses' regulatory authorities and professional organisations need to support government policy statements ensuring appropriate support is given to those requested AD regardless of the nurses' stances on AD. 14,26 In the Act's statutory framework, only the role of attending nurse practitioners has been recognised as a practitioner who can legally prescribe and administer AD medication.…”

“…14,26 Given the implications for registered nurses under the Act, New Zealand nurses' regulatory authorities and professional organisations need to support government policy statements ensuring appropriate support is given to those requested AD regardless of the nurses' stances on AD. 14,26 In the Act's statutory framework, only the role of attending nurse practitioners has been recognised as a practitioner who can legally prescribe and administer AD medication. However, this must take place under the instruction of an attending medical practitioner (Section 4[b] of the Act).…”

Nursing Students’ Perceptions of Assisted Dying: A Qualitative Study

“…As such, this lack of clear legislative guidance places registered nurses and nursing students in a position of uncertainty in responding to and managing assisted dying service requests (Pesut, Thorne, Schiller, et al, 2020). Nurses value appropriate policies and guidelines to ensure their assisted dying practices are both ethical and safe (Sandham et al, 2022).…”

“…Death, dying and palliative care conversations and associated clinical practices are challenging for many registered nurses, let alone nursing students, irrespective of educational and experience level (Hussain, 2019). As such, the introduction of assisted dying services adds both a psychological and emotional toll to this clinical burden (Davidson et al, 2022;Sandham et al, 2022). Furthermore, it is well documented that pre-registration end-of-life care training is often lacking, or even missing, from the nursing education curriculum, resulting in nursing students who are inade-Nursing Students' Perceptions of Assisted Dying: A Qualitative Study Nursing Praxis in Aotearoa New Zealand quately prepared to provide care to the dying while in clinical placement (Berndtsson et al, 2019).…”