Research Proposal on "Euthanasia Do the Nurses Working in Palliative"

Research Proposal 7 pages (2305 words) Sources: 8

[EXCERPT] . . . .

Euthanasia

Do the nurses working in palliative care view voluntary euthanasia more favorably than do the nurses working on general hospital unit?

The topic of voluntary euthanasia has sparked an intense debate on a global level. Palliative care nurses are faced with this ethical controversy every day on the job. As they care for those facing the end of their life, they must confront the issues quality of life and death with dignity on a daily basis. This gives palliative care nurses a unique perspective on the issue of voluntary euthanasia. Nurses in the general hospital unit do not face theses issues as often as palliative care nurses do. General hospital nurses are in an all out battle every day to preserve life, regardless of what it takes, even if it is just for one more day. These two nurses have different experiences concerning end of life issues. The purpose of this study is to examine the differences in attitude that exist between palliative care and general hospital nurses.

Theoretical Framework

Euthanasia is the practice of ending a life in a painless manner. There are many different techniques used in euthanasia, but these are not the issue in this research study. Euthanasia is a topic that can quickly divide a group into two opposing views. There are those who will quickly defend a person's right to make a conscious decision that their life is no longer worth living and take their own life. The other side will consist of those that feel life is precious and that every moment counts, even if it means severe pain for the patient. These two groups have various reasons for their opinions. Some are based on religion and som

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e are based on personal experiences.

These issues divide the group, but one question increases the divide even more. The topic of assisted suicide can spark a frenzy. This is the practice of helping someone to end their life that no longer has the means to do it themselves. There are many legal and moral issues that come into play. It is not the purpose of this research study to take sides on these issues. It is simply to examine the opinions of two different groups of nursing students and its affect on their views on euthanasia.

The study will examine the issue using nursing students working in both palliative care and the general hospital setting. It is expected that these students will begin to form their opinions about euthanasia and quality of life issues early in their practice.

Hypothesis and Research Questions

The central research question of the study will ask, "Do nursing students working in a palliative care setting view euthanasia more favorably than those working in general hospital nuts?" In order to examine this issue more closely, the research will focus on the following hypotheses.

H1: Nursing students working in palliative care facilities will have significantly higher positive score regarding the favorability of euthanasia than nursing students working in a general hospital unit.

H0: The null hypothesis states that nursing students working in palliative care facilities will not have significantly higher positive score regarding the favorability of euthanasia than nursing students working in a general hospital unit.

This hypothesis would fulfill the requirements of the research study. However, it is the intention to develop a better understanding of how they developed their unique perspectives. Therefore, the research study will study the following additional research questions.

How do nurses from different specialties judge the acuity of the illness?

What level of acceptability do they attach to patient self-imposed euthanasia, as opposed to physician-assisted suicide?

What factors do they attach to quality of life?

What factors had the greatest impact on their viewpoint?

This hypothesis and set of research questions will help not only to answer the primary research question: they will provide an in-depth understanding of the processes involved in the formation of their opinions.

Rationale

This study will use a survey to explore the hypothesis and factors surrounding the research questions. It will focus on their response to the case of a terminally ill patient receiving a lethal dose of medication to hasten death. The patient will be unable to administer the dose themselves and the nurse will be placed in the hypothetical situation of administering the lethal dose. The study will explore their reactions to this issue.

Nursing students were chosen for this study, as they are just beginning to develop their sense of moral clarity in their professional careers. This study will examine several factors that influence the development of their choices. It is critical that nursing students develop a strong sense of their views and define their opinions regarding the matter of euthanasia so that they can better advocate for their patients.

Chapter 2: Review of Literature

The topic of euthanasia has received vast academic attention as society and practitioners struggle to defend their positions and develop standards of practice regarding the issue. One of the caveats in this type of topic is that one can often find considerable information on the subject, but much of it will be found to contain a considerable degree of bias. The following literature review will highlight recent works that directly address research into different specialties and their reactions to euthanasia.

Quality of Life/Death

Nurses in a palliative care situation reported experienced with hospice patients that had chosen to stop eating and drinking in an attempt to hasten their death. This study found that many of the patients in the study died within 15 days. They rated their death experience as being an 8 on a scale of 0-9 with 9 being the most favorable (Gasini et al., 2003). A survey of members of the American Association of Critical Care Nurses providing a "good death" was a major theme (Beckstrand, 2006). This study concluded that time constraints, staffing patterns, communication challenges, and treatment decisions that favored the physician's rather than the patient's needs were the main challenges that stood in the way of a death with dignity (Beckstrand, 2006).

A similar study to the proposed study was conducted in Belgium. This study compared the involvement of nurses in the care of patients requesting euthanasia. The study compared nurses in the general hospitals and a palliative care unit in Belgium. The study found that although, euthanasia was illegal in Belgium, nurses stated that they had an important role in caring for patients that had requested euthanasia. They experienced a spectrum of emotions ranging from conflict to frustration. They felt that these feelings hindered their ability to provide quality care (De Bal, 2006). In a study involving Dutch nurses, the nurse was typically the first person with whom the patient discussed their wishes for euthanasia (Van Bruchem-vande Schuer, 2008). In 15.4% of the cases, the nurses administered the medications themselves.

Practitioner Differences

In a study that compared the views and practices of U.S. oncologists, it was found that 22.5% supported physician-assisted suicide and 6.5% supported euthanasia. Of the oncologists surveyed, 3.7% had performed euthanasia and 10.8% had performed physician-assisted suicide (Emanuel et al., 2000). In another study, it was found that 66% of the physicians surveyed supported physician-assisted suicide and felt that it should be legal (Lee et al., 1996). The study found that 46% were willing to administer a lethal dose. Nearly 21% of the physicians reported having received a request for suicide in the past (Lee et al., 1996). The latter study was performed in Oregon, where the euthanasia issue has received a considerable amount to media coverage.

Mobley (2007) examined the level of moral distress among nurses in a critical care unit. This study found that the frequency of moral distress was highest for nurses that were under 33 years of age and that has been working in the critical care unit for less than 4 years. The study also found that moral distress increased for nurses that had been in the CCU for over 7 years. A recent study at Rhode Island Hospital Critical Care Nurse Internship found that it is difficult to determine how nurses will react under stressful clinical situations (Badger, 2008). This article categorized reactions into four major categories: acute bereavement, moral distress, secondary trauma and performance guilt.

The concept of caring for the critically ill is viewed from many different approaches. Both nurses and relatives placed a higher importance on nursing behaviors that demonstrated a level of technical competence over emotional responses (O'Connell, 2008). This study demonstrates how the actions of nurses are perceived by others and can offer guidance to help develop better standards of practice in the future. Integrating quality of care between critical and palliative care is essential to the improvement of care of the dying patient (Ferrell, 2007). Many nursing programs that focus on critical care do not provide training in palliative care issues. This type of cross training greatly improves the experienced of the dying (Ferrell, 2007). Having a role model or mentor played a crucial role in the development of professional attitudes… READ MORE

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Quoted Instructions for "Euthanasia Do the Nurses Working in Palliative" Assignment:

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Please follow the guide line:

GUIDELINE FOR RESEARCH PROPOSAL

The following criteria will be used to evaluate the final written research proposal and presentation.

Chapter 1: Introduction (half page)

Research problem (background and significance)

Statement of Purpose of the study

Conceptual framework/Theoretical Approach (one page)

Definition of concepts

Diagram/map if possible

Research questions and/or hypotheses (half page)

Our Concept/research question is:

Do the nurses working in palliative care view voluntary euthanasia more favorably than do the nurses working on general hospital units.

We would like to explore the issue of how healthcare workers from different specialties or departments and different levels of illness acuity feel in regards to physician-assisted voluntary euthanasia. We intend to conduct a survey to test the level of acceptability felt by different healthcare workers in response to a situation of a terminally ill patient receiving lethal medication in assistance of achieving death.

You need to make a case for the study to be done with nursing students. Developing a sense of moral clarity regarding the personal views of assisted suicide is critical so that nurses can advocate for the patients.

Chapter 2: Review of Literature (3 pages)

Articles primary sources, no secondary sources (past two-five years)

Articles (older, classic references)

Synthesis across studies (literature is reviewed by idea and key variables, not a particular study)

Demonstrating gaps in the literature (reason for doing the study)

Please also use these articles for the Literature Review:

One of the study that looked at nurses***** experiences with hospice patients who refused food and fluids to hasten death found that nurses reported that patients stopped eating and drinking and themselves as *****˜pointless***** and their quality of life poor. This particular study shows that 85% of patient died within 15 days and rated their death 8 on a scale of 0-9 and 9 being a very good death. This article also support that nurses reported patient who voluntarily choose to stop eating died a *****˜good***** death within two weeks and wanted to control their life. (Gazini et. al., 2003).

Emanuel and his colleague did a study to find the attitudes and practices of U.S oncologist regarding euthanasia and physician assisted suicide and found that 22.5% of the oncologist supported physician assisted suicide and 6.5% supported euthanasia. They looked at 3299 oncologist and they found that 3.7% of the surveyed oncologist had performed euthanasia and 10.8% had performed physician assisted suicide. (Emanuel et. al., 2000)

One of the study done by Lee and his colleague that supports our view found that 66% of the physicians support that physician assisted suicide should be legal in some cases. This study was done in order to find the views of the physicians related to legalizing physician assisted suicide. They did a survey in Oregon and 2761 physicians responded to the survey and they found that 46% willing to prescribe a lethal dose. 21% of the physicians reported that they received the request for suicide in past. (Lee et. al., 1996)

References:

Emanuel EJ, Fairclough D, Clarridge BC, et al. Attitudes and practices of U.S. oncologists regarding euthanasia and physician-assisted suicide. Ann Intern Med. 2000;133:527-532

Ganzini M.D.,M.P.H, Linda, Elizabeth R. Goy Ph.D., Lois L. Miller Ph.D., R.N., Theresa A. Harvath R.N., Ph.D., Ann Jackson M.B.A., and Molly A. Delorit B.A. "Nurses' Experiences with Hospice patients Who Refuse Food and Fluids to Hasten Death." The New England Journal of Meicine 349 (2003): 359-65.

Lee MA, Nelson HD, Tilden VP, et al. Legalizing assisted suicide: views of physicians in Oregon. N Engl J Med. 1996;334:310-315

Chapter 3: Methods (2 pages)

Design: rationale for the design;

Sample: (inclusion and exclusion criteria and rationale) sampling methods and a sample size.

Setting: (kind of place/facility, refer to letter of support and attach letter to proposal and attach to the IRB application

Measurement: (attach all data collection instruments to proposal/IRB application; each instrument should have the title of your study; your name(s) along with credentials (Graduate Student DePaul University)

*****¢ Description of each data collection/measuring instrument (who developed the instrument, what is its name, what it is designed to measure (refer to your concepts); number of questions/items; describe validity and reliability*; time for completion (respondent burden)

*****¢ *Validity (if developed for the purpose of your study, must establish validity (using experts who are given the purpose of the study and asked to determine the match between the purpose and the measuring instrument; if developed by someone else, go to the original source, state whether valid and what approach was taken to support validity)

*****¢ *Reliability (if developed for the purpose of your study, propose test-retest reliability (see text for description) or inter-rater reliability (see text for description) or internal consistency reliability (coefficient alpha; see text for description; if developed by someone else (go to original source for description) however, must still establish reliability using your sample

*****

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