Attitudes of nurses toward patient-directed dying: a pilot study.

Patient-directed dying (PDD) will be an increasingly common issue faced by healthcare professionals. Nevertheless, few studies have explored nurses' attitudes toward PDD. This pilot project sets out to fill the gap regarding nurses' attitudes and values regarding PDD and perceptions of consistency or inconsistency with the American Nurses Association (2001) Code of Ethics for Nurses With Interpretive Statements (The Code). Thirteen subjects self-selected from a population of registrants attending a national ethics conference by completing an anonymous descriptive survey. The majority of subjects noted that their personal and professional values related to PDD are in agreement (regardless of their specific position). The subjects were divided on whether PDD is ethically consistent with The Code. Despite being unsure if PDD is ethically consistent with The Code, these nurses found relief of suffering to be a more compelling rationale for PDD over patient autonomy. This study offers insight into key social and professional issues in which further research is needed and offers many avenues for further investigation.

Advanced practice registered nurse intended actions toward patient-directed dying.

UNLABELLED: Patient-directed dying (PDD) (also known as physician-assisted suicide) has been a heavily debated issue in the United States since the passing of the Death With Dignity Act in Oregon in 1997. Previous research surrounding PDD has been limited to assessing the attitudes of physicians, nurses, and patients. The purpose of this study was to describe the intended actions of advanced practice registered nurses (APRNs) toward initiating PDD discussions and prescribing a lethal dose of medication under PDD legislation. A survey design was used to guide this pilot study. An investigator-developed questionnaire was disseminated electronically to APRNs on a free professional Listserve in a rural northeastern state. The final sample was composed of 16 APRNs whose area of certification were identified as 63% family, 31% adult, 6% psychiatric/mental health, and 13% other. Hospice and palliative care employment experience was reported by 75% of the sample. RESULTS: The APRN subjects were more willing to engage in PDD discussions than to prescribe under PDD legislation. The APRNs reported an increased willingness to initiate discussions and prescribe when patient pain and suffering were explicitly stated. Seventy-five percent of APRNs viewed their personal and professional opinions regarding PDD to be synonymous even though 50% were unsure as to whether PDD was consistent with the American Nurses Association (2001) Code of Ethics for Nurses. CONCLUSIONS: Advanced practice registered nurses reported increased intent to discuss than actively participate through means of prescriptive authority under PDD legislation. The depiction of pain and suffering may have an impact on APRN intention to act in cases of PDD. RECOMMENDATIONS: Increased awareness and education surrounding professional codes for APRNs, particularly regarding PDD, are needed.

Identifying ethical issues from the perspective of the registered nurse.

A review of the formal ethics consultations performed at a rural academic medical center during 2006 revealed that only 5 of 72 consultations were initiated by nurses. A descriptive exploratory convenience study used a 3-item survey to collect information from registered nurses who provide direct patient care at the rural academic medical center. The purpose of this study was to (1) identify and describe the ethical issues perceived by registered nurses employed at a rural academic medical center and (2) analyze the variables influencing the registered nurses' ethical decision making and the process used by these registered nurses when resolving ethical issues.The 17 registered nurses who completed the survey identified a total of 21 ethical issues that they had experienced during the last year. The ethical issues that nurses recalled were significantly more likely to be relationship issues, whereas issues documented within the ethics consultation service were significantly more likely to involve limiting treatment. Communication was a major variable influencing nurse's ethical decision making. Nurses felt the ethical issue resolved satisfactorily when the patient's needs were met, communication occurred with the patient and/or family, the entire healthcare team was involved and in agreement, and there was sufficient time available to make a decision. The nurses did not feel that the ethical situation was resolved satisfactorily when not handled from the patient's perspective; the patient suffered; there was a lack of teamwork, agreement, and/or support; and the process took too long. The nurses' recommendations for resources needed to assist with the resolution of ethical issues included accessible ethics mechanisms, education, improved interprofessional relationships and collaboration, and unbiased support for patient and family decision making. Implications for nurse managers are discussed and future research questions are identified.

Do psychiatric advance directives protect autonomy?

A psychiatric advance directive (PAD) is a legal resource that allows a person to document his or her wishes about receiving mental health services in the event that he or she is unable to provide consent at a future time. Advantages for completing a PAD include promoting the person's autonomy and authentic self, minimizing harms, and promoting beneficence. However, more research is needed to describe the positive and negative consequences associated with completing and implementing a PAD in the clinical setting.