Mireille Lavoie

The Attitude of Canadian Nurses Towards Advance Directives

This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals.

The dying person: An existential being until the end of life

This article explores the experience of death from the perspective of existential philosophy, for the purpose of finding ways to humanize end-of-life nursing care. A person in his or her final days is seen by the caregiver as a being seeking the continual creation of his human becoming, from the experience of sickness to death. From the moment the torment of suffering begins, a person needs a presence of humanistic professionalism that embraces the values of the nursing profession.

Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review

BackgroundWhile a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians’ and nurses’ motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not.MethodsThe following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia.ResultsThis paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient’s life expectancy.ConclusionsThe present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where euthanasia is legal are needed.

Psychosocial determinants of physicians’ intention to practice euthanasia in palliative care

BackgroundEuthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians’ intention to practice euthanasia in palliative care and verifying whether respecting the patient’s autonomy is important for physicians.MethodsA validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada.ResultsThe response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients’ wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control—physicians’ evaluation of their ability to adopt a given behavior—(OR = 4.35; 95%CI: 1.44-13.15), moral norm—the appropriateness of adopting a given behavior according to one’s personal and moral values—(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude—factual consequences of the adoption of a given behavior—(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians’ moral norm was related to the ethical principle of beneficence.ConclusionsOverall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients’ final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.

Beyond nursing nihilism, a Nietzschean transvaluation of neoliberal values

Like most goods-producing sectors in the West, modern health-care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsches concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life-affirming values for nursing culture and practice.

Psychosocial determinants of nurses’ intention to practise euthanasia in palliative care

Background: Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. Research objective: The purpose of this study was to identify the psychosocial determinants of nurses’ intention to practise euthanasia in palliative care if it were legalised. Research design: A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. Participants and research context: A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. Ethical considerations: The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. Findings: The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1–7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50–6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58–5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Discussion: Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses’ moral norm was related to beneficence, an ethical principle. Conclusion: To our knowledge, this is the first study to identify nurses’ motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses’ moral norm and intention.

Developing palliative care competencies for the education of entry level baccalaureate prepared Canadian nurses.

Educational preparation of health professionals for Palliative and End of Life Care (PEOLC) is inadequate, and nurses are no exception. In 2004, the Canadian Association of Schools of Nursing struck a Task Force to develop PEOLC competencies to address this issue. The development of national PEOLC nursing competencies involved a multi-step, emergent, interactive, and iterative process. An overarching principle guiding this process was building national consensus about the essential PEOLC specific competencies for nurses among experts in this field while simultaneously generating, revising, and refining them. There have been three stages in this iterative, multi-step process: 1) Generating a preliminary set of competencies, 2) Building a national consensus among educators and experts in the field on PEOLC specific competencies for nurses, and 3) Refining the consensus based competencies for curriculum development. Ongoing follow up work for this project is focusing on the integration of these competencies into nursing curricula.

Nursing, Healthcare, and Culture: Views From Canada and Taiwan for the Year 2050:

This column presents a dialogue with Canadian nurse scholar Mireille Lavoie and Taiwanese nurse scholar Yea-Ing Lotus Shyu, who share their own vision and their understanding of their countrys vision of nursing, health-care, and quality of life in the year 2050.