Involvement of nurses in caring for patients requesting euthanasia in Flanders (Belgium): a qualitative study

Nele De Bal, Bernadette Dierckx de Casterlé, Tina De Beer, Chris Gastmans
International Journal of Nursing Studies 2006, 43 (5): 589-99

BACKGROUND: Although nurses worldwide are confronted with euthanasia requests, how nurses experience their involvement in euthanasia remains unclear.

OBJECTIVES: To explore nurses' involvement in the care for patients requesting euthanasia.

DESIGN: A qualitative grounded theory strategy.

SETTING: Two general hospitals (A, B) and a palliative care setting in Flanders (Belgium).

PARTICIPANTS: Nurses who fulfilled the following inclusion criteria: (a) Dutch-speaking; (b) working for at least one year in hospital A or B; (c) working at least part-time (50%); and (d) ever received a euthanasia request. We collected data using purposeful sampling, superseded by theoretical sampling in a palliative care setting. The sample included one intensive care nurse, one oncology nurse, eight palliative care nurses, and five internal medicine nurses. All but five were women. Their age ranged from 24 to 49 years.

METHODS: We conducted one-on-one semi-structured interviews between November 2001 and September 2002. Grounded theory was applied for guiding data collection and analysis. The trustworthiness of data was ensured by several strategies.

RESULTS: Although euthanasia was still illegal, the nurses unanimously stated that they had an important role in caring for patients requesting euthanasia. Their personal and intense involvement caused them to experience a spectrum of emotions, chief among them being a sense of powerlessness. Several elements contributed to the nurses' conflicted involvement. Nurses became frustrated if the context (e.g., lack of time) hindered their efforts to provide compassionate care. The palliative care setting and its associated culture (group mentality, care philosophy) created the opportunity for nurses to take time to holistically support patients and their relatives.

CONCLUSIONS: Hospital nurses are confronted with patients' euthanasia requests. Each stage of this process requires that the nurses possess specific competencies. Their willingness to personally care for these patients, in addition to their specific care expertise, allows them to be skilled companions.

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