Exploring Nurses' Perceptions on Euthanasia: Research Report

This research report delves into the contentious subject of euthanasia and the perspectives of nurses, particularly those in palliative care, in Australia. The report begins with an abstract summarizing the research proposal, which aims to investigate nurses' attitudes towards their potential involvement in euthanasia, given its increasing legalization globally. It includes a thorough literature review, examining previous research on the topic, such as studies conducted in Finland and Iran, which explore nurses' attitudes, cultural influences, and communication challenges related to euthanasia. The report then presents a detailed research proposal, outlining the research aim, question, and methodology, including the use of face-to-face interviews to gather qualitative data. The proposal also addresses ethical considerations, such as obtaining ethical approval and ensuring participant confidentiality, and provides a timeline for the research project. The report highlights the significance of the research in understanding the preparedness of nurses to handle euthanasia requests, especially in light of its legal status in several Australian states, and the influence of psychological and social factors on nurses' decision-making processes.

Running head: NURSING RESEARCH
Nursing research
Name of the student:
Name of the University:
Author’s note

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Abstract:
This research proposal looks at the controversial topic of euthanasia and the nurse’s
attitude towards involvement in euthanasia in Australia. Research in this area is important
considering the rise in legalization of euthanasia in different countries and the role of nurses in
handling patients with euthanasia request. The report provides review of past work done on the
topic and provides methodology on the manner in which research will done with nursed working
in palliative care in Australia. The ethical considerations and time line for research is also
considered.

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Table of Contents
Task 1-Research plan:......................................................................................................................3
Task 2: Literature review:................................................................................................................4
Task 3: Proposal:.............................................................................................................................7

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Task 1-Research plan:
Research aim:
The main aim of this research is to explore the feelings of palliative care nurse regarding
involvement in euthanasia. The research done in this area will help to identify whether adequate
number of nurses will be available to provide lethal drugs to patient as part of Euthanasia. This
research is also significance because more and more number of countries are now making
Euthanasia legal (Hudson et al., 2015), thus bringing forward the concern regarding how nurses
will handle such cases.
Research question:
The research question for the task is ‘What are feelings and perceptions of nurses
towards involvement in the process of euthanasia?
Method:
As the main aim of this research is to get detailed insights regarding the feelings of
euthanasia in palliative nurses, qualitative research design with face to face interview method is
the most appropriate process for the literature review. As individual participant’s values such as
age, gender and religious affiliation can have an impact on participant’s response, demographic
characteristics will be evaluated too. As euthanasia is a controversial issue, socio-economic,
emotional and physical variables will also influence research activity. Hence, research methods
needs to be developed keeping this in mind.

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Task 2: Literature review:
Previous research literature done on Euthanasia has covered many vital points about
nurse’s perception towards Euthanasia. Terkamo-Moisio et al., (2017) focused on exploring the
attitude towards euthanasia in Finnish nurse by means of a cross-sectional web based survey.
This research was necessary because of under-representation of nurse’s feeling towards
euthanasia in current literature. As nurse’s work related characteristics, demographic
characteristics and cultural characteristics could affect study results, those parts were also
included in the questionnaire. All ethical considerations related to study approval, nature of study
and informed consent requirement were maintained. The findings of the study revealed that
majority of nurses were ready to accept euthanasia particularly single unmarried nurses. Thus,
this study mainly indicated that single nurses and those with least experience were in favor of
euthanasia compared to widower. Overall, the study showed that Finnish nurses were confident
about involvement in euthanasia as they had enough information on topic. The validity and
efficacy of the study was enhanced by statistical analysis of response in participants with
different religion, marital status and work characteristics. As euthanasia is a topic that arouses
strong feelings and emotions, this acted as a barrier in collecting response from some
participants. This study is significant as it has shown that nurse favor euthanasia in accordance
with the ethical principle of beneficence (Fenton, 2016). The study proposed application and
dissemination of research finding in nursing education and while addressing ethical issues at the
end of life care (Terkamo-Moisio et al., 2017).
Naseh, Rafiei & Heidari, (2015) investigated about the Iranian Muslim nurse’s attitude
towards euthanasia. Research in this area was necessary to find out how attitude towards
euthanasia can different in a Islamic country, where Islamic views does not favor people to die

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voluntarily. A descriptive research design with the use of questionnaire package helped to collect
response related to the topic from 15 registered nurses working in different wards in Iran. A
Euthanasia Attitude Scale (EAS) and questionnaires were used to explore attitude towards
euthanasia and data was analyzed statistically by means of SPSS software. The researcher also
fulfilled ethical requirement for research by taking ethical approval for research and considering
and confidentiality and informed consent requirement. No cultural considerations were analyzed
as the study had homogenous participants (Only Muslim participants). The analysis of study
results showed that about 57.4% nurses had negative attitude towards euthanasia, however in
contrast to the research by Terkamo-Moisio et al. (2017), the study by Naseh, Rafiei & Heidari,
(2015) did not showed difference in outcome on the basis of marital status. However, the
weakness of the research is that cost effectiveness and efficacy component were not analyzed.
This study gives the implication that availability of information’s relation to euthanasia affects
attitude towards euthanasia and negative attitude in Iranian nurse might be due to this factor
only. The study did not give any detail on disseminating the findings; however it proposed doing
future research with focus on culture instead of religious beliefs to understand cultural influence
in attitude to euthanasia.
The work by Denier et al., (2010) mainly extended knowledge related to the feelings of
nurse while communicating for patients requesting euthanasia. The research used qualitative
research design with the use of grounded theory to find out nurse’s perspective regarding
involvement in care process surrounding euthanasia. The data was collected by means of
qualitative in-depth interview with Flemish nurses and data were analyzed by means of detailed
coding of transcripts with the use of QSR NVivo 7 software. All relevant ethical considerations
were followed, but no cultural considerations in research methodology were found. The study

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findings revealed that openness and attentiveness and patience were necessary part of
communicative attitudes during the euthanasia care process. Nurses also had good understanding
about the purpose of communication during involvement in euthanasia process. Hence, the
strength of this finding is that it proves that the manner in which nurses perceive their
communication with patients is a crucial factor in euthanasia care process. This means that in
countries where euthanasia is legalized, nurses need to upgrade their communication skills to
effectively get involved in the euthanasia care process. However, as the communication process
during euthanasia care is complex, implementation of appropriate nursing communication
guidelines will be necessary (Terkamo-Moisio, Kvist & Pietilä, 2015). The research finding is
valid as it many strategies were taken to address trustworthiness factor while analyzing the data.
The author discussed regarding use of results in educational context and hospital context.
Apart from cultural and emotional determinant, Lavoie et al., (2016) focused on
examining the role of psychosocial determinants on nurse’s intention to practice euthanasia in
palliative care. Research in this area was important because psychological limitations of nurse’s
power often alleviate suffering in the context of palliative care (Renn–Żurek, Jamrozik &
Piontkowska, 2014). The study was guided by the Theory of Planned Behaviour and survey
questionnaire was developed accordingly. The study was also reviewed by the relevant Ethics
Committee and data was collected by means of self-administered questionnaire sent by mail,
however no cultural considerations were found. The results of study indicated that nurses have
positive intention to engage in euthanasia in palliative care which is consistent with many other
studies. The support of the findings with the concept of TPB enhanced the validity and
credibility of the study, however cost-effectiveness dimensions were not considered. The barriers
to conducting the study were the low response. This is acceptable because euthanasia is a subject

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with great controversy. The research proposed utilization of research outcome to improve
performance of nurse in palliative care.
The involvement of nursing staff in involvement and decision making related to
euthanasia was covered by (Francke et al., 2016). The main rational for exploring Dutch nursing
staff’s attitudes and involvement in euthanasia was no mention of nurse’s role in Dutch
euthanasia Act. Quantitative research was done with the use of survey questionnaires to collect
nationwide response from registered nurse and data was analyzed by means of multivariate
logistic regression analyses. Ethics aspects of research process were fulfilled and cultural factors
were considered by the analysis of background characteristics of participants. The results showed
that majority of nurses believed that physicians should consult nurses about euthanasia request,
however many were not aware about the legal rule related to euthanasia practice. The research
brings an important point that nurses favored involvement in decision making regarding
euthanasia and the results can be disseminated for nursing education. The only barrier in the
research was identifying ways to find out moral considerations of participants while giving
response to survey questions.
Task 3: Proposal:
Title:
The perception and feelings of Australian nurse regarding involvement in euthanasia
process.
Project details:

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Nurses working in palliative care have been challenged by euthanasia request form
patients and families. Euthanasia is a controversial topic as different ethical issues and human
rights objection are raised regarding allowing euthanasia in different countries. Although nurses
are not in the position to take decisions regarding euthanasia request, however how many nurses
would like to involved in euthanasia is a question to be raised (Naseh, Rafiei & Heidari, 2015).
In the context of Australia also, this research topic is important because euthanasis is legal in
many states of Australia. Hence, knowing Australian’s nurse perspective regarding how they feel
about decision making related to euthanasia will have great implications in preparing palliative
care nurses for involvement in euthanasia care process. The past literature explored
psychological aspects or cultural aspects separately; however this research will explore nurse’s
feeling by comparison with their psychological and social background too.
Aim:
The main aim of this research is to explore the feelings of palliative care nurses in
Australia regarding involvement in euthanasia.
Research question:
The research question for the proposal is ‘What are feelings and perceptions of nurses
towards involvement in the process of euthanasia?
Research method:
Research design: Previous research done on the topic mostly used web-based questionnaires to
collect data and save time (Terkamo-Moisio et al., 2017); Francke et al., 2016). However, critical
analysis of research literature in the literature review section indicated that there are several

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barriers in conducting research by the use of web-based questionnaires. Although web-based
questionnaires save time, however confusion regarding certain terms in the questionnaire also
influenced participant response which was seen in the research done by Francke et al., (2016).
Hence, to address this barrier, it has been planned to use face-to-face interview method with
Australian nurses working in palliative care and with the use of both open ended and close ended
questionnaires. However, to favor ease of analysis, the sample size will be restricted to 100
participants only.
Qualitative research method will be used and interview data will be transcribed verbatim.
The questionnaires will have important components like demographic characteristics, knowledge
about euthanasia law in their state, attitude towards euthanasia and psychological and social
barriers to decision making regarding euthanasia. Use of the following components in the
questionnaire is likely to address limitations found in past research and explores social,
knowledge and psychological components affecting nurse’s response towards euthanasia.
Ethical consideration: The approval for the research will be taken by one of the Human
Research Ethics Committees in Australia and the participants will be recruited for the study only
after they give informed consent for participation in research. The informed consent related
procedure will be addressed by informing all the participants about the purpose of research and
the controversy behind the topic. They will also be informed about ways by which there personal
details will be kept confidential.
Timeline: The following is the timeline for conducting this research:
Research
stages
Jan-Feb,
2018
Mar-April
2018
May-June
2018
July-August
2018
Sept-Oct
2018
Nov-Dec
2018

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Framing
research
question
Developing
research
design
Taking
ethical
approval and
meeting
funding
arrangements
Sample
recruitment
and data
collection
Data analysis
and framing
results
Discussion
and
dissemination
of study
outcome

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Funding requirement: As the process of sample recruitment and data collection will require
manpower and use of certain tools, it is necessary to make arrangement for funding the research.
This can be done by requesting for funding from HREC, as it is the major institution in Australia
that looks after funding requirement and giving research approvals for proposal submitted to the
body (Nhmrc.gov.au., 2018).
Data analysis: The data will be analyzed by means of thematic analysis to clearly give idea
about different components included in interview questionnaire. Thematic analysis will also
favor conducting research in a flexible manner as per research objective (Braun & Clarke, 2014).
Possible barrier to research: Since, euthanasia is a controversial topic, hence many participants
may be concerned about their identity or how their response will be used while conducting the
research. To address this barrier, the participants will also be informed regarding confidentiality
of their identity and using only their response for analysis instead of personal details like
identity. There are also chances of low response rate due to the use of face-to-face interview
method. This will be addressed by limiting the time to only 30 minutes.
Findings and conclusion:
The findings of the research will have useful implications for health care providers in
palliative care setting. The study outcome can be utilized to train nurses regarding decision
making in euthanasia and effectively working with physicians to support patients to take
decisions related to euthanasia. From this research, palliative care staffs may know about
psychological characteristics and social attributes that may affects nurse’s ability to get involved
in euthanasia process. Based on this identification, appropriate decisions may be taken regarding