Definition and validation of the nursing diagnosis label "wish to die": a research protocol.

BACKGROUND: Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care. This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis. METHODS: A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring's diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases. DISCUSSION: The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

End-of-life conversations about death and dying from volunteer perspectives: A qualitative study.

OBJECTIVES: Although often unrecognized, volunteers fulfill many essential roles in hospices and other end-of-life care settings. Volunteers complement the actions of professionals in fulfilling many extra care needs, such as delivering newspapers and tidying bedsides. We explored end-of-life conversations about death and dying between hospice volunteers and terminally ill people, with a particular emphasis on any expressed desire to die. Our 2 research questions were as follows: (1) What is the nature of end-of-life conversations between hospice patients and hospice volunteers? and (2) How do hospice volunteers experience conversations about death and dying with patients who are at the end-of-life? METHODS: We conducted semi-structured interviews using an interpretive phenomenological analysis. We recruited hospice volunteers from 4 hospices in Calgary, Edmonton, and Red Deer; 3 larger cities in the province of Alberta, Canada. RESULTS: We interviewed 12 participants to saturation. Four themes emerged: (1) trusting conversations about death and dying in the context of a safe place; (2) normalcy of conversations about death and dying; (3) building meaningful relationships; and (4) end-of-life conversations as a transformative experience. Our results emphasize the importance of preparing volunteers for conversations about death and dying, including the desire to die. SIGNIFICANCE OF RESULTS: The safe environment of the hospice, the commitment to patient confidentiality, and the ability of volunteers to meet the basic and emotional needs of dying people or simply just be present without having formal care duties that need to be completed contribute to volunteers being able to participate in timely and needed conversations about death and dying, including the desire to die. In turn, hospice experiences and end-of-life conversations provide a transformative experience for volunteers.

The Wish to Hasten Death in Patients With Life-Limiting Conditions. A Systematic Overview.

CONTEXT: A systematic review of the wish to hasten death among people with life-limiting conditions was published in 2011. Since then, other reviews and primary studies have been published that have added to knowledge regarding the conceptual definition, aetiology and assessment of the wish to hasten death. OBJECTIVES: To provide an updated synthesis of the literature on the wish to hasten death in people with life-limiting conditions. METHODS: An overview of systematic reviews and primary studies was conducted, using an integrative review method. PubMed, CINAHL, Scopus and Web of Science databases were searched, from their inception until 2023. We included all systematic reviews published to date and all primary studies not included in these systematic reviews. RESULTS: Eleven systematic reviews and 35 primary studies were included. We propose that the phenomenon may usefully be considered as existing along a continuum, defined by the extent to which thoughts of dying are linked to action. A total of nine assessment tools have been described. The reported prevalence of the wish to hasten death appears to be influenced by the wording used in assessment instruments, as well as by the cut-off used when applying a particular tool. Depression, pain, functional disability, decreased sense of meaning in life, the sense of being a burden and reduced quality of life are the most widely reported related factors. CONCLUSION: This overview underscores the need for clinical strategies that can identify different manifestations of the wish to hasten death among people with life-limiting conditions.

Responder al deseo de adelantar la muerte en pacientes al final de la vida: síntesis de recomendaciones y guías clínicas / Responding to the Wish to Hasten Death in patients at the end of life: Synthesis of recommendations and clinical guidelines

OBJETIVO: Analizar y sintetizar la literatura existente sobre guías, protocolos y recomendaciones clínicas que den respuesta a un paciente que manifiesta deseo de adelantar la muerte (DAM). MÉTODO: Revisión de la literatura. Se diseñó una estrategia de búsqueda que se implementó en MEDLINE PubMed y en el metabuscador Google Académico. Se incluyeron en la revisión los artículos, protocolos, guías o procedimientos en los que se aportaban recomendaciones sobre el modo en que los profesionales deberían abordar el DAM, publicados hasta noviembre de 2015. Se extrajeron las distintas recomendaciones con una matriz de datos que sirvió para analizar y categorizar la información. RESULTADOS: Se incluyeron las recomendaciones publicadas en una guía clínica, un capítulo de libro, 5 artículos científicos y una página web. Las categorías obtenidas fueron: el contexto legal, el contexto de la comunicación con el paciente, temas a informar, aspectos a consensuar, habilidades de comunicación del profesional y responsabilidades del profesional. CONCLUSIONES: La síntesis de recomendaciones puede facilitar la práctica clínica a la hora de abordar el DAM

OBJECTIVE: To conduct an analysis and synthesis of the literature on guidelines, protocols and recommendations that respond to a patient manifesting a wish to hasten death (WTHD). METHOD: Literature review, a search strategy was designed of MEDLINE PubMed and Google Scholar meta-search engine. Articles, protocols, guidelines and procedures published up until November 2015 and offering recommendations on how professionals should address the WTHD were classified and the various recommendations were extracted in a matrix which served to analyse and categorise the data. RESULTS: Recommendations published in a clinical guide, a book chapter, five scientific articles and a website were obtained. It was noted that the experts attach importance to: legal context, communication context, issues to be informed, and issues for consensus, communication skills and professional duties. CONCLUSIONS: A synthesis of recommendations can facilitate clinical practice in addressing the WTHD