9 August 2022

Assisted dying: AUT study highlights need to support emotional impact on nurses

Assisted dying became available in New Zealand only in November last year, but there are already signs that indicate need for enhanced support to nurses to strengthen their ‘reflexivity’.

As nurses increasingly encounter voluntary assisted dying, a new AUT-led research highlights an increased support – procedurally and psychologically.

“We know what the ethical issues are, but less is known about how nurses navigate their emotional responses to assisted dying in the workplace,” says Dr Margaret Sandham, Senior Lecturer of Nursing at the AUT School of Clinical Sciences.

Dr Sandham – a registered nurse and clinical psychologist, led an international team of nurses to author a systematic review published in the Journal of Advanced Nursing.

Project collaborators included Emma Hedgecock (Oceania Healthcare nurse practitioner), Dr Melissa Carey (University of Auckland, and University of Southern Queensland, and Dr Rebecca Jarden (University of Melbourne).

Ministry of Health data, released last week, shows that 143 people had an assisted death between 7 November 2021 and 30 June 2022. These assisted deaths took place at private residences (79 percent), aged care facilities (9.1 percent), district health board facilities (7.7 percent), and hospice (4.2 percent).

Since Nov 2021, nurses have made a vital contribution to end-of-life care and are often at the bedside preparing the patient and their whānau for death, and supporting whānau through bereavement.

The focus so far has primarily been on the moral and ethical implications of legalising assisted dying, and whether organisations will provide this service or take a stance of conscientious objection.

“We found that nurses would benefit from clear policy, psychological support and specific guidance around difficult end-of-life conversations as more countries transition to providing assisted dying services.”

This is the first metasynthesis, integrating qualitative data from previous studies to inform new perspectives, of the lived experiences of nurses who had participated in assisted dying at any stage, from the initial request to the end-of-life.

“The nurses in our review strongly articulated the complexity and emotional burden they carried in providing the best patient care they could, alongside learning and undertaking the unfamiliar and weighty practice of assisted dying,” says Dr Sandham.

Three key themes emerged from the review: “the importance of an orderly procedure; importance of  beautiful death(facilitating a meaningful patient and whānau experience, and helping the patient to die in a way that they have chosen with dignity and peace), and addressing the psychological and emotional impact.”

Researchers found that nurses valued clear policy to keep them legally, ethically and procedurally safe. “Clear policy should be provided by nursing governing bodies as well as the workplace and framed in a way that is enabling and supportive rather than fear-driven, which could unnecessarily discourage nurses from being involved in assisted dying,” says Dr Sandham.

The review shows need for advanced communication skills as nurses were, at times, unprepared for the ‘heavy conversations’ that came from patients requesting assisted dying.

While nurses did not specifically raise the issue of professional supervision, the study noted, this type of support may help strengthen nurse reflexivity – the ability to examine how their emotional needs and responses might influence behaviour – when navigating complex ethical and emotional areas, such as end-of-life care.

In New Zealand, so far 130 doctors, nurses or medical staff have signed up for the end-of-life-care, which is said to be most restrictive euthanasia legislation in the world.

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