Using simulation to teach nursing students how to deal with a euthanasia request.

Nursing students are confronted with euthanasia during their internship and certainly during their later career but they feel inadequately prepared in dealing with a euthanasia request. This study presents a simulation module focused on euthanasia and evaluates nursing students' perceptions after they have completed the simulation practice. The 'euthanasia module' consisted of a preparatory online learning module, a good-practice video, an in-vivo simulation scenario, and a debriefing session. The module's content was validated by four experts in end-of-life care. The module was completed by three groups of students from two different University Colleges (n = 17 in total). The students were divided into three groups: one with no previous simulation education experience, one with all students having previous experience, and another with a mix of experiences. After completing the entire module, each group had a discussion regarding their perceptions and expectations concerning this simulation module. Thematic content analysis was conducted on audio-recorded group interviews using NVIVO® software, involving initial open coding, transformation into specific themes and subthemes through axial coding, and defining core themes through selective coding, with data analysis continuing until data saturation was reached. Students generally found the online learning module valuable for background information, had mixed perceptions of the good-practice video, and appreciated the well-crafted scenarios with the taboo of euthanasia emerging during simulations, while the debriefing process was seen as enhancing clinical reasoning abilities. Students considered the simulation module a valuable addition to their education and nursing careers, expressing their satisfaction with the comprehensive coverage of the sensitive topic presented without sensationalism or taboos. This subject holds significance for nations with established euthanasia laws and those lacking such legal frameworks. The findings of this study can aid teachers in developing and accessing euthanasia simulation training programs, contributing to broader education's emphasis on integrating euthanasia-related knowledge and skills.

Adaptation, implementation, and evaluation of an online health sciences training program for brief smoking intervention: A pre-post study in four European countries.

BACKGROUND: Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students. OBJECTIVES: The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes. DESIGN: A pre-post evaluation study with a satisfaction assessment tool was used. SETTING: Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated. PARTICIPANTS: One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program. METHODS: All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test. RESULTS: Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10). CONCLUSIONS: The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.

Nursing students' view on their future role and skills regarding euthanasia due to unbearable mental suffering: A mixed-method Study.

AIM: To explore final-year bachelor nursing students' view on their future role and skills regarding euthanasia due to unbearable mental suffering (UMS-euthanasia) and to discover possible education needs. BACKGROUND: Since UMS-euthanasia is legal in Belgium, nursing students will be confronted with this issue during their future internship, or professional career. Graduated nurses believe to have an important role in the process of euthanasia where good communication skills and sufficient legal knowledge are essential. DESIGN: Mixed-methods sequential explanatory design. METHODS: First, a questionnaire was administered to all final-year bachelor nursing students at eight university colleges in Flanders (October 2020 and March 2021). Second, qualitative information was collected by organising focus groups with these students to gain more insights into the quantitative results (October 2021). RESULTS: The final-year nursing students from the survey (n = 249) and from the three focus groups (n = 21) see a clear future role for themselves in the decision-making process, as well as in supporting the patient and family before, during and after UMS-euthanasia, but not in assisting in administering UMS-euthanasia. However, they also indicate they lack knowledge and skills in dealing adequately with UMS-euthanasia. Psychiatric internship alumni perceive a diminished role for themselves in the preparatory acts (p < 0.05). Ever involved in euthanasia shows a statistically significant difference in the demand for simulation. CONCLUSIONS: Nursing students see an important role for nurses in UMS-euthanasia but feel inadequately prepared to take on this role. A combination of theoretical knowledge, clinical experience, open discussions, reflection and simulation is an opportunity to prepare nurses for their future role.

Nursing students' attitudes regarding euthanasia due to unbearable mental suffering: Cross-sectional study using the adapted and validated Euthanasia Attitude Scale.

AIM: To explore final year nursing students' attitudes towards euthanasia due to unbearable mental suffering by using the adapted and validated Euthanasia Attitude Scale. DESIGN: Cross-sectional survey. METHODS: Explorative, descriptive cross-sectional study conducted using an e-mail survey between October 2020 and March 2021 by a sample of final-year baccalaureate nursing students (n = 273) from eight of the eleven Flemish university colleges. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations. The psychometric properties of the Euthanasia Attitude Scale were assessed, including reliability and validity. Independent-sample Mann-Whitney U-test was used to investigate relation between demographic and education-related data, and domain and total score of the UMS-EAS-NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels, Belgium. RESULTS: McDonald's omega was 0.838 for the total Euthanasia Attitude Scale scores, supporting the validity of the questionnaire. A statistically significant difference in 'Naturalistic beliefs' score was found relating to the year of birth. There are clinically important results between those students who have been involved in euthanasia and those who have not. CONCLUSIONS: Most of the final-year nursing students supported the probability of patients' access to euthanasia due to unbearable mental suffering. To monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter. IMPACT: To date, no large-scale study has examined nursing students' attitudes towards euthanasia because of unbearable mental suffering. It is expected that nursing students may be confronted with such a euthanasia request during an internship, or later in their professional career, in countries where euthanasia is legal. Students showed a high acceptability towards UMS-euthanasia. Clinically significant differences were found for students who had ever been involved in euthanasia.

Using Simulation to Help Health Professions Students Learn to Talk to Clients About Suicide.

Background: Because of the high prevalence of suicide, health-care professions students need training in recognition of clients' suicidal thoughts, assessment of suicide risk, and specific narrative techniques. This study explores health-care professions students' perceptions of and feedback on a simulation module on suicidal behavior. Methods: Thematic analysis was conducted on feedback from group interviews with participants. Results: Students valued the reassuring effect of a best practice video. The sense of reality in the simulation scenarios was highly appreciated. Although being filmed was stressful for some students, reviewing and discussing key moments in the recordings appeared a major advantage. Debriefing was essential to discuss and emotionally discharge the experiences of role players and observers. Conclusions: Simulation training for caregivers on suicidal behavior can be designed and evaluated on other mental health topics as well.

Nursing Students' Attitudes, Future Role, and Knowledge Regarding Euthanasia Due to Unbearable Mental Suffering: A Single-Site Pilot Study.

BACKGROUND: This study examines the attitudes, view of their future role, and knowledge of nursing students regarding euthanasia due to unbearable mental suffering (UMS euthanasia) in Belgium. Nurses have a key role in this situation at many levels. The practice of euthanasia is expanding globally and laws are changing, making more research essential. METHOD: A cross-sectional design and online survey were used. All nursing students at a Belgian university college participated. RESULTS: The majority of nursing students had a high degree of acceptance towards UMS euthanasia and highlighted their important role in the euthanasia decision-making process, but also reported a lack of knowledge and skills. CONCLUSION: Nursing education at all levels needs to recognize this knowledge gap, taking into account the complexity and broader context of end-of-life care.

The Development of the DDads Questionnaire: Awareness, Knowledge and Attitudes of the General Population Towards Paternal Depression.

Objectives: Paternal perinatal depression affects ~10% of new fathers and is known to have a negative impact on men's relationship with their partner as well as with their baby. The attitudes of the general population toward paternal depression have received scant attention in the scientific literature. A better understanding of paternal depression might improve the health literacy of the population and also assist professionals and policy makers to adequately address this issue, to ultimately refine the existing health care alternatives for them. This paper describes the Belgian development, face and content validation of the DDads (Depression in Dads) questionnaire. Its focus is to identify the awareness, knowledge and attitudes of the general population toward paternal perinatal depression. Study Design: The DDads was developed using a three-step model with the following phases: (1) identification of the content domain, (2) item generation and (3) construction of the questionnaire. For the DDads validation a (a) Delphi method with content experts (n = 17) and (b) a cognitive debriefing method with lay experts (n = 20) were used to assess the clarity, relevance, wording and layout. Results: The questionnaire consists of three main components comprising: (1) three questions on awareness, (2) three questions on knowledge and (3) one question on attitudes and beliefs. After round one validation, all questions were considered content valid for relevance (I-CVI 0.94-1.00), and six questions for clarity (I-CVI 0.65-1.00). Scale content (S-CVI/Ave 0.93) and face validity (Face Validity Index 1.00) was obtained. One question was revised and split into two questions in a second round. For one of these questions, item content (0.80-0.93), scale content (0.92) and face validity (1.00) was reached. The one question, exploring the causes of paternal perinatal depression, remained inappropriate and was removed from the DDads. One last question was removed after interviews with lay experts. Conclusions: We developed an instrument to establish awareness, knowledge and attitudes of the general population toward paternal perinatal depression in Belgium. The DDads can be valuable in identifying knowledge gaps. It can help to inform policy makers and health professionals to identify gaps and predisposed attitudes in society toward paternal depression which may hinder appropriate management.

The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study.

WHAT IS KNOWN ABOUT THE SUBJECT?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision-making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. ABSTRACT: Introduction Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods A cross-sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self-administered questionnaires were provided to mental health nurses. Results Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision-making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions.