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The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death

Authors
  • Pesut, Barbara1
  • Thorne, Sally2
  • Schiller, Catharine J.3
  • Greig, Madeleine1
  • Roussel, Josette4
  • 1 University of British Columbia Okanagan, 1147 Research Road, Okanagan, Kelowna, BC, V1V 1V7, Canada , Kelowna (Canada)
  • 2 University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada , Vancouver (Canada)
  • 3 University of Northern British Columbia, Prince George, BC, V2N 4Z9, Canada , Prince George (Canada)
  • 4 Policy, Advocacy and Strategy, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario, K2P 1E2, Canada , Ottawa (Canada)
Type
Published Article
Journal
BMC Nursing
Publisher
BioMed Central
Publication Date
Feb 17, 2020
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12912-020-0404-5
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundMedical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government’s decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses’ experiences and nursing practice.MethodsThe study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account.ResultsNurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses’ moral responses to MAiD were most effective in supporting nurses’ well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD.ConclusionsData obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients’ lives, without suitable supports, find themselves caught between the proverbial rock and hard place.

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