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.

The psychosocial aid response after the 22/03/2016 attacks in Belgium: a community case study.

Introduction: After the terrorist attacks, early psychosocial care is provided to people considered at risk of developing mental health issues due to the attacks. Despite the clear importance of such early intervention, there is very few data on how this is registered, who is targeted, and whether target-recipients accept such aid. Methods: Using registry data from the Centre General Wellbeingwork (CAW), a collection of centers in the regions Brussels and Flanders that provide psychosocial care, we examined the early psychosocial care response after the terrorist attacks of 22/03/2016 in Belgium. Results: In total, 327 people were listed to be contacted by the CAW, while only 205 were reached out to (62.7%). Most were contacted within a month (84.9%), and were victims of the attacks (69.8%). Overall, the majority was female (55.6%). Conclusion: Overall, target recipients were witnesses and survivors of the attacks, though a large proportion of people were not reached by the early outreach.

A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks.

Introduction: Terrorist attacks can cause severe long-term mental health issues that need treatment. However, in the case of emergency responders, research is often vague on the type of stressors that emergency responders encounter. For example, in addition to the threat that they work under, studies have shown that ill-preparation adds to the stress experienced by emergency responders. However, few studies have looked into the experience of emergency responders. In this study, we looked at the experience of emergency responders during the 22 March 2016 terrorist attacks in Belgium. Methods: We used a qualitative design, in which we interviewed different types of emergency responders. Police officers, nurses, soldiers, firefighters, and Red Cross volunteers were included. Interviews were coded by two researchers and analyzed using a thematic approach. Results: Four large themes were developed: constant threat and chaos, frustrations with lack of preparedness and training, ethical decisions, and debriefings. In addition, although emergency responders encountered constant threat, they often felt that they were ill-prepared for such attacks. One specific example was their lack of training in tourniquet usage. Furthermore, in a disaster setting, the emergency responders had to make life-and-death decisions for which they were not always prepared. Finally, debriefings were conducted in the aftermath of the attacks. Whereas most were perceived as positive, the debriefings among police officers were viewed as insufficient. Conclusions: Emergency responding to terrorist attacks has many different dimensions of events that can cause stress. Our study revealed that preparation is key, not only in terms of material but also in terms of ethics and debriefings.

Post-what stress? A review of methods of research on posttraumatic stress during COVID-19.

BACKGROUND: Post-traumatic stress (PTS) was extensively investigated during the COVID-19 pandemic. However, numerous researchers have raised concerns regarding the adherence of many of these studies to the diagnostic criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). This review aimed to provide insight into the methodology of research on PTS during the COVID-19 pandemic. METHODS: Two independent reviewers examined a total of 1129 studies published between 1/01/2020 and 1/07/2023. The investigation focused on the scales employed to assess PTS, the diagnostic framework used (DSM or ICD), whether there was referral to an index-event in the PTS measurement and country where data collection took place. RESULTS: Among the 1129 studies, 70.0% did not provide any indication of an index-event to which PTS symptoms were attributed. Only 11.3% of the studies explicitly indicated an index-event associated with the PTS symptoms. Furthermore, 54.1% of the studies utilized scales based on DSM-IV criteria. Finally, the majority of PTS-studies had data collections in China, United States and Italy. CONCLUSION: A limited number of studies conducted during the COVID-19 pandemic reported use of an index-event in their PTS measurement. Furthermore, most studies used scales based on a previous iteration of the most used diagnostical system, namely the DSM. This delay in the implementation of new diagnostic criteria, may impair the clinical relevance of scientific studies.

Optimizing sexuality of young women with breast cancer: how can the breast clinic help?

BACKGROUND: Breast cancer treatment can lead to sexual dysfunction which, in general, impacts younger women more. Being well informed and having good social support are important elements in dealing with this dysfunction. AIMS: This study aims to explore how specialized breast clinics can help young women with questions or problems regarding their sexual health by fulfilling their information and social support needs. METHOD: A thematic analysis was used for 16 interviews with young women (18-45 years) diagnosed with breast cancer, in Belgium. RESULTS: Participants report a lack of information on sexual issues and find the information insufficiently tailored to young women. The empathy of healthcare providers and their communication skills play an important role in whether sexual issues can be discussed. Finally, they indicate that more attention should be paid to their partner (relationship). CONCLUSION: The breast clinic might help young women by giving more specific advice on what is sexually allowed (or not) during treatment, by informing them about lubricants and sex toys, by adapting brochures and information sessions to young women, by investing in the partner's well-being and their relationship, and by training healthcare providers better.

Patient-reported outcome measures on mental health and psychosocial factors in patients with Brugada syndrome.

AIMS: Brugada syndrome (BrS) is a hereditary arrhythmic disease, associated with sudden cardiac death. To date, little is known about the psychosocial correlates and impacts associated with this disease. The aim of this study was to assess a set of patient-reported psychosocial outcomes, to better profile these patients, and to propose a tailored psychosocial care. METHODS AND RESULTS: Patients were recruited at the European reference Centre for BrS at Universitair Ziekenhuis Brussel, Belgium. Recruitment was undertaken in two phases: phase 1 (retrospective), patients with confirmed BrS, and phase 2 (prospective), patients referred for ajmaline testing who had an either positive or negative diagnosis. BrS patients were compared to controls from the general population. Two hundred and nine questionnaires were analysed (144 retrospective and 65 prospective). Collected patient-reported outcomes were on mental health (12 item General Health Questionnaire; GHQ-12), social support (Oslo Social Support Scale), health-related quality of life, presence of Type-D personality (Type-D Scale; DS14), coping styles (Brief-COPE), and personality dimensions (Ten Item Personality Inventory). Results showed higher mental distress (GHQ-12) in BrS patients (2.53 ± 3.03) than in the general population (P < 0.001) and higher prevalence (32.7%) of Type D personality (P < 0.001) in patients with confirmed Brugada syndrome (BrS +). A strong correlation was found in the BrS + group (0.611, P < 0.001) between DS14 negative affectivity subscale and mental distress (GHQ-12). CONCLUSION: Mental distress and type D personality are significantly more common in BrS patients compared to the general population. This clearly illustrates the necessity to include mental health screening and care as standard for BrS.

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.

Intimate and sexual feelings in psychotherapy: educational topic or still taboo?

BACKGROUND: Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately. AIMS: This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs. METHOD: In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 - June 2018), using inferential and thematic analyses respectively. RESULTS: The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change. CONCLUSION: Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

Threat through the Screen? Association between Proximity and/or Watching Media Coverage of a Terrorist Attack and Health.

INTRODUCTION: After terrorist attacks, media coverage of the attacks is extensive. There are some indications that there is an association between watching the media coverage and certain health reactions, both mental and somatic. Most studies occur in the United States and often months after the initial attack. In the current study, we investigated the terrorist attacks in Belgium on 22 March 2016. METHODS: An online cross-sectional survey was conducted one week after the attacks among the general population of Belgium. We measured hours of media watching of the terrorist attacks (hereafter media watching), adjusted scales of the Patient Health Questionaire-4 (PHQ-4) to measure mental symptoms and the Patient Health Questionaire-15 (PHQ-15) to measure somatic symptoms, proximity to Brussels (home, work and overall proximity) and background factors such as gender, age and level of education. Respondents were included if they answered the survey between 29 March 2016 and 5 April 2016. RESULTS: A total of 2972 respondents were included. Overall, media watching was significantly associated with both mental symptoms (p < 0.001) and somatic symptoms (p < 0.001), while controlling for age, gender, level of education and proximity. Watching more than three hours of media was associated with more mental and somatic symptoms (p < 0.001). Compared to proximity, media watching was, in general, a better association. For geographical factors, watching more than three hours of media indicated equally high scores for mental symptoms and somatic symptoms as work proximity (p = 0.015) and overall proximity to the attacks (p = 0.024). CONCLUSION: Media-watching is associated with acute health reactions after terrorist attacks. However, the direction of the relationship is unclear, as it might also be that people with health issues seek out more media.

Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines.

WHAT IS KNOWN ON THE SUBJECT?: Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub-par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de-escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non-coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers is also needed. ABSTRACT: INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures. AIM: The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. METHOD: A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. RESULTS: Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. DISCUSSION: In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace. IMPLICATIONS FOR PRACTICE: Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.

Managing Romantic and Sexual Feelings Towards Clients in the Psychotherapy Room in Flanders (Belgium).

It is important that therapists manage adequately their romantic and sexual feelings toward clients as it can negatively affect the psychotherapeutic relationship and may even pose a risk of sexual abuse. This study explores how psychotherapists in Flanders (Belgium) manage such feelings, by conducting both a survey (using 105 of 786 respondents for analyses, as they reported romantic feelings) and focus groups (with a total of 36 participants). Results show that most therapists never consider starting a romantic relationship with a client. They reflect profoundly on their feelings, dwell on possible consequences, while maintaining strict boundaries. Although therapists themselves highly recommend referring the client to a colleague if feelings become too intense, this rarely happens in practice. Most therapists consider talking about their romantic and sexual feelings towards clients as something very important, but only a third have disclosed their feelings in supervision, peer-supervision, or in personal therapy. Therapists indicate there is still hesitance about this due to fear of condemnation.

Dealing with cultural diversity in palliative care.

Palliative care is increasingly confronted with cultural diversity. This can lead to various problems in practice. In this perspective article, the authors discuss in more detail which issues play a role in culture-sensitive palliative care, why naive culturalism will not solve such problems and in which direction research into this aspect of care can be further elaborated.

How Therapists Experience and Manage Patients' Romantic and Sexual Feelings for Them.

OBJECTIVE: Many therapists will one day be confronted with a patient who develops romantic or sexual feelings toward them. Studies on this topic often remain theoretical in nature and less often focus on how therapists manage such situations. Therefore, this study aimed to investigate how therapists experience this occurrence and manage their feelings. METHODS: Eight focus groups were conducted with 36 participants in Flanders (Belgium). Both therapists-in-training and therapists-in-practice participated, having different educational backgrounds. The data were explored using the principles of thematic analysis. RESULTS: Therapists indicated that they try to dissuade any further development of their patients' romantic or sexual feelings by using strategies such as emphasizing their personal relational status, adjusting their appearance, and avoiding any physical contact with their patients. Some therapists question their own professional behavior, feeling guilty, confused, or insecure, wondering if they may have, in some way, provoked these feelings. Therapists who are at an earlier stage in their careers experience more difficulties managing their patients' romantic or sexual feelings toward them and worry they will not be considered a good professional therapist if such a situation occurs. CONCLUSIONS: Educational programs in psychotherapy should be more cognizant of the incidence of patients' developing romantic or sexual feelings toward therapists and provide more comprehensive and practical instruction on how to cope with such feelings.

Discussing sexual health among Flemish patients with Parkinson's disease.

PURPOSE: Parkinson's disease (PD) can lead to sexual dysfunction. Yet, studies have shown that neurologists do not often discuss possible sexual health consequences with their patients. Thus, in this study, we investigated the communication on sexual health between healthcare workers and PD patients in Flanders, Belgium. METHODS: Through an online survey, PD patients were contacted. Sexual dysfunction was measured with the Arizona Sexual Experience Scale (ASEX), stage of PD with the Hoehn and Yahr scale, and self-made questions on the communication between healthcare workers and PD patients. RESULTS: In total, 100 PD patients responded, of which 23% had possible sexual dysfunction. Of these respondents, 60% had never received any information about possible sexual health consequences. More than half (58%) of the patients felt their neurologist should provide information on possible sexual health consequences, though only 14% had ever received information from their neurologist. Male respondents expressed a greater need for information than female respondents (p = .049), although no difference between both groups in receiving information was found (p = .294). In addition, low to middle educated people generally received more information than higher educated people (p = .018).. The more severe the disease is, as measured by the Hoehn and Yahr scale, the more information a patient receives (p = .012). The most frequently mentioned barriers in discussing sexual health are a lack of initiative by the neurologist (41%) and awkwardness to discuss sexuality (41%). CONCLUSION: This study showed that PD patients expect information from neurologists on possible sexual health consequences, but seldom receive information. More attention should be given to training neurologists in discussing sexual health. Table 1 Characteristics of the sample (N = 100) N % Gender  Male 59 59  Female 41 41 Education level  Lower 4 4  Middle 42 42  Higher 54 54 Relationship status  No partner 10 10  Partner 90 90 Stage of Parkinson (Hoehn & Yahr scale)  Stage 0 3 3  Stage 1 36 36  Stage 1.5 12 12  Stage 2 9 9  Stage 2.5 6 6  Stage 3 21 21  Stage 4 9 9  Stage 5 4 4 Time since diagnosis  Less than 1 years ago 10 10  1-2 years 13 13  2-5 years 32 32  5-10 years 29 29  Longer than 20 years 13 13  10-15 years 2 2  15-20 years 1 1 Received information on sexual health consequences from…  Treating neurologist 14 14  GP 9 9  Geriater 0 0  Nurses 2 2  Psychotherapist 3 3  Sexuologist 1 1  Kinesitherapist 2 2  Other 4 4 Who do you think should provide you information on sexual health consequences  Treating neurologist 58 58  GP 43 43  Geriater 3 3  Nurses 6 6  Psychotherapist 23 23  Sexuologist 17 17  Kinesitherapist 3 3  Other 2 2 How would you like to receive information on possible sexual health consequences?  Brochure 38 38  Online (e.g. website) 38 38  Posters in waiting room 3 3  Personal conversation with healthcare worker 51 51  Other 1 1 From what moment do you think possible sexual health consequences of Parkinson's disease should be discussed?  From the moment of diagnosis 52 52  From moment patient indicates he/she experiences problems 33 33  From moment that the neurologist feels it should be discussed 9 9  Should not be discussed 6 6 Need for information on possible sexual health consequences  No need 31 31  A little need 19 19  Some need 21 21  Need 24 24  A lot of need 5 5 How often has healthcare personnel given you information on sexual health consequences  Never 60 60  Seldom 25 25  Sometimes 12 12  Regularly 3 3  At every consultation 0 0 ASEX  No possible sexual dysfunction 77 77  Possible Sexual dysfunction (score equal to or higher than 19) 23 23 How important are sexual activities for you?  Not important 20 20  Slightly important 33 33  Somewhat important 22 22  Important 18 18  Very important 7 7 I avoid sexual contact because of my disease  Agree completely 8 8  Agree 16 16  Agree somewhat 30 30  Disagree 28 28  Completely disagree 18 18 I feel unsatisfied with my sex life due to my disease  Agree completely 16 16  Agree 22 22  Agree somewhat 32 32  Disagree 20 20  Completely disagree 10 10 Mean Standard deviation Age 66.97 8.88 ASEX 16.02 4.53 Table 2 Associations of ASEX, need for information, receiving information ASEX p Need for information p Receiving information p Gender  Male 16.08 0.948 55.31 0.049 48.69 0.294  Female 16.11 44.13 43.38 Education level  Low-middle 15.83 0.068 53.26 0.356 53.41 0.018  High 16.20 48.06 41.49 Need for information and receiving information scores are mean ranks due to non-parametric tests ASEX scores are means Table 3 Correlations between variables ASEX Age Need for information Receiving information Hoehn and Yahr Importance of sex life Avoiding sex Unsatisfied with sex life ASEX - - 0.04 0.27* 0.07 - 0.09 - 0.12 - 0.10 - 0.23* Age - - 0.20 0.10 0.41*** - 0.28** - 0.16 0.08 Need for information - 0.14 - 0.11 0.38*** - 0.13 - 0.46*** Receiving information - 0.22* - 0.03 - 0.08 - 0.08 Hoehn and Yahr - - 0.17 - 0.32** - 0.17 Importance of sex life - 0.24* - 0.07 Avoiding sex - 0.48*** Unsatisfied with sex life - *p < .05 **p < .01 ***p < .001 Table 4 Regression analyses B (S.E.) Exp(B) P Pseudo R2 Nagelkerke Pseudo R2 Cox & Snell Need for information 0.013 0.19 0.14  Gender - 1.23 (0.48) 0.29 0.010  Education level - 0.62 (0.43) 0.54 0.149  Hoehn and Yahr 0.01 (0.11) 1.01 0.925  ASEX 0.10 (0.06) 1.11 0.060 Receiving information 0.047 0.14 0.11  Gender - 0.53 (0.45) 0.59 0.232  Education level - 0.61 (0.41) 0.54 0.137  Hoehn and Yahr 0.29 (0.14) 1.33 0.012  ASEX 0.01 (0.05) 1.01 0.788 Table 5 Barriers to discuss sexual health % (that agree with statements) I do not feel comfortable to discuss sexuality with my neurologist 33 I wait until the neurologist begins discussing it 41 My neurologist is either too young or too old 11 My neurologist is of the other gender 26 Reasons that have to do with my faith or attitude towards sexuality 12 I do not have the feeling there is a solution for these problems (with sexual health) 31 My Parkinson related symptoms overshadow my possible sexual health problems 39 It feels awkward to discuss sexual acts like masturbation or discuss buying of sexual aiding tools 41 My family/partner/friends are present during consultation 37 Reasons that have to do with my sexual orientation 11.

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.

Women's experiences with being pregnant and becoming a new mother during the COVID-19 pandemic.

OBJECTIVE: During the COVID-19 pandemic a national quarantine was imposed in Belgium, which led to changes in the maternity care provision. Despite emerging literature, it remains unclear how pregnant women and women who have recently given birth experienced this period. With this study we aim to explore these women's experiences during the COVID-19 pandemic. METHODS: This qualitative study is a part of a large longitudinal study on women's health-related quality of life (HRQoL), during the COVID-19 pandemic. An open-ended question, in an online survey, asking women about their experiences during the perinatal period was analysed using a thematic analysis. RESULTS: Of the 1007 women who participated in the HRQoL-study in June 2020, 556 (55%) women answered the open question. In general, we identified a multiplicity of mixed and interconnected feelings. Many women reported negative feelings; nevertheless, the pandemic also had some positive aspects for respondents. Six overreaching themes were identified: fear of contamination, feeling isolated and unsupported, not able to share experiences, disrupted care, feeling unprepared and experience a peaceful period. CONCLUSION: Although perinatal healthcare professionals did their utmost to provide the necessary care, being pregnant or being a new mother during this pandemic was challenging at times. However, this period was also experienced as a peaceful period with lot of opportunities to rest. Some of the changes such as telework and restricted visiting policies were experienced positively by many. Lessons learned can support perinatal healthcare professionals and policy makers in the organisation of maternity care in the post-pandemic era.

Dealing with sexual boundary violation in mental healthcare institutions by government policies: the case of Flanders, Belgium.

BACKGROUND: To prevent sexual boundary violations (SBV) in mental health care institutions overall governments require these institutions to report SBV incidents to a central registry and to develop institutional guidelines how to react. In Europe SBV policies are only recently developed or implemented, as is also the case in Flanders (Belgium). The implementation of a new institutional policy is always a challenge and can encounter resistance, especially when it concerns SBV, because they remain delicate and complex. METHOD: This study evaluated the extent to which mandatory policies on SBV have been implemented in mental health care institutions in Flanders, and possible factors for (non-)implementation of these policies. An online survey was sent to the executives of all mental health care institutions in Flanders (N = 162). RESULTS: In total 56 executives of mental health care institutions filled out the survey (response rate 35%). Results showed that the implementation of an SBV policy in mental health care institutions is unfortunately inadequate and not all SBV incidents were reported to the central registry. Type of institution and opinions on the SBV policy were related to the (non-)implementation of the requirements. CONCLUSIONS: It is recommended that governments regularly communicate with mental health care institutions to better understand the concerns and difficulties concerning implementation of the required SBV policy and to support/stimulate an organisational culture of more openness and safety on this topic.

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium.

BACKGROUND: The international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium. METHODS: We identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016. RESULTS: In Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks. CONCLUSIONS: Psychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries' psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents.