Nursing Assessment: Attitudes of Nurses on Euthanasia and Ethics

This report presents a nursing assessment that investigates nurses' attitudes and perceptions regarding euthanasia. The assessment explores the ethical, moral, and religious controversies surrounding euthanasia, as well as the role of nurses in the process, particularly in regions where it is legalized. The research, based on a literature review, examines nurses' viewpoints on euthanasia, identifies associated characteristics influencing these attitudes, and highlights potential conflicts with ethical guidelines. The study utilizes electronic databases and keywords to gather relevant papers, focusing on a cross-sectional web-based survey to understand the attitudes of Finnish nurses. The research design, data collection procedures, and limitations are critically analyzed, including the use of social media for recruitment and potential biases. The findings reveal a mixed response from nurses, with varying degrees of agreement on euthanasia and its ethical implications. The report concludes with the implications of the research for nursing education and end-of-life care, emphasizing the importance of nurses' personal ethics and their role as patient advocates.

Running head: NURSING ASSESSMENT
NURSING ASSESSMENT
Name of the Student
Name of the university
Author’s note

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1. Identification of the clinical problem
Euthanasia generates various controversies in varieties of domains like ethical moral, religious,
economic and scientific grounds. Most of the nations have legalized Euthanasia for patients who
are in a vegetative state (Poreddi, Nagarajaiah, Kondur & Math, 2013). However, any researches
on the perception of the nurses regarding euthanasia, any factors that is influencing the
perception is not yet known. Furthermore, how they are in conflict with the ethical guidelines is
not yet known. This provides the rationale for conducting this literature search.
a. Research objective
Nurses play an important role in the process of euthanasia, especially in the nations, where it has
been legalized. This is due to the fact, that they are more close to the palliative care patients.
Nurses who give reasons against euthanasia of often term it as a “slippery slope” by referring to
its possible misuse. Hence, the research objective of this paper is to understand the attitudes and
the perception of the nurses towards Euthanasia.
b. Search strategy
Electronic databases like CINAHL has been used to find out relevant papers. Various keywords
has been used for finding out relevant papers. Boolean operators like AND, OR has been used
for searching papers. Some of the keywords that has been used are- ‘Euthanasia AND nurses”,
“Assisted suicide AND ethics, Euthanasia OR assisted suicide AND perception.
The search was filtered by using certain limiters. Those full text and pdf papers were extracted
by using the limiters of publication years within 2013-2020.

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2. Research design
a. Title
Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines.
b. Author credentials
Anja Terkamo-Moisio Tarja Kvist Mari Kangasniemi Teuvo Laitila, University of Eastern
Finland, Finland; Olli-Pekka Ryynänen, University of Eastern Finland, Finland; Kuopio
University Hospital, Finland; Anna Maija Pietilä, University of Eastern Finland, Finland; Social
and Health Care Services, Finland.
c. Identified purpose of the article
The purpose of the paper is to identify the attitude of the nurses towards Euthanasia among the
Finnish nurses and the associated characters behind those attitudes.
d. Research question
What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are
associated with those attitudes?
e. Validity of the research design methodology
A cross sectional web-based survey has been conducted for understanding perception of the
nurses. An electronic questionnaire has been prepared for the study. The questionnaire addressed
four components – the demographic characteristics, the work-related characteristics and the
perception towards Euthanasia. Web-based surveys or the e-surveys are surveys that are
designed and are appealing to the researchers as it ensures fast collection of data and accuracy in

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comparison to the paper base surveys. It is also associated with fewer errors and low cost
(Maymone et al., 2017). The development of the statements regarding the attitude of the
participants consisted of the particularities of the workplace and the particular shift patterns of
their working. A qualitative research was conducted among the nurses and 13 statements were
designed based on the findings of the qualitative researches and the nurses were asked to state
their agreement with respect to the statements. CRS has been included in the questionnaire. CRS
is normally used for measuring the centrality, psychology of people in religion and religious
studies (Huber & Huber, 2012). It strengthens reliability and the validity of the research. In order
to ensure the reliability of the questionnaire, a test retest study has been tested. It is normally
used a measure of the consistency of the psychological test. However, it can be said that, it only
refers to the consistency of result and not the validity of the result.
f. Validity of the data collection procedure
The data was collected from only the nurses having Finnish language proficiency, who was
atleast 18 years of age. Nurses were recruited via social media and with the help of a public
blogs, facebook and twitter. It was justifiable for the paper to question the reliability of the social
media used as it can give access to a large population in a diverse geographical area. It can also
interest other people who are not directly associated to the Finnish nurses association. One of the
advantage of using this broader sample size, is that it can increase the generalizability of the
study, although the response rate from the study cannot be calculated. A smaller sample size is
likely to increase the chance of the type II errors skewing the results that can decrease the power
of the study. Another limitation of the recruitment procedure, is that it can introduce the
demographic selection bias by the recruitment of a population that is more internet active (Khatri
et al., 2015).

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g. Literature review justification
A literature review should contain a synthesis of the information provided in relevant papers
(Hart, 2018). The literature review that has been used in this study is informative and has focused
on some important themes like the role of the nurses in the Euthanasia process, the ethical aspect
of the attitude of the nurses towards the process of Euthanasia. The literature has been supported
by some valuable literature that describes about the prevalence of euthanasia and its ethical
implications, however, very less number of literatures are there describing about the perception
of the nurses about Euthanasia. Although, it was found from most of the papers that the nurse’s
personal ethics are more important than that of the ethical guidelines. One of the most important
part of this paper is literature review has section , that has rightfully identified the gaps in the
literature, such as lack of a clear definition, lack of explanation of the nurse’s attitude towards
Euthanasia.
h. Does the discussion relate to the research question
The discussion of the paper was entirely related to the research question. The research question
was to understand the perception of the nurses related to Euthanasia. In order to understand
viewpoint and the attitudes of the nurses, it is necessary to understand their personal values,
religious values and their compliance to the ethical standards.

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i. Sample
The sample size, was large increasing the generalizability of the study, since younger nurses
and those with higher qualification have been found to support Euthanasia.
j. Cultural and ethical consideration
Euthanasia is a sensitive topic having a strong moral conviction, hence it was necessary to take
ethical approval from the Ethics committee. The paper has mentioned about the anonymity of the
study.
k. Data analysis and presentation
The data analysis was done by using the SPSS 21. The dimensions of the religiosity was
measured and the nurses were divided in to group like- highly religious, religious and non-
religious. Cronbach’s alpha was used for assessing the reliability of the various components of
the questionnaire. It has been stated by Bujang, Omar and Baharum (2018), that Cronbach’s
alpha can evaluate the reliability of the responses of a questionnaire.
l. Limitations
Some of the essential limitations that has been pointed in this study, is a test-retest score obtained
below 0.5, which can question about the reliability of the questionnaire. Again, since euthanasia
arouse strong feelings, it can lead to some response bias by the participants. Another important
drawback is the use of a heterogeneous sample, as the nurses who did not use were not included
in the study and were excluded, where their perceptions could have been provided valuable
information Terkamo-(Moisio et al., 2017). Furthermore, the paper has also pointed out that the
participants have asked for the recent level of education and not the highest level of education

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m. Findings and conclusion
A mixed response has been obtained from the nurses and it was found that, while some of the
nurses have agreed strongly on the prevalence of the Euthanasia. While some of the nurses have
agreed to remain in compliance with the ethical guidelines, but few have supported the concept
of euthanasia, considering the ethical principle of beneficence.
3. Informing practice
The implication of this research is that the findings can be used in nursing education and in
discussion about the various ethical issues at the end care. The practical relevance of this
research is of not much significance. However, it can just provide an ideal of attitude of the
nurses towards Euthanasia. Since, they are the ones who have to remain in bedside with the
palliative care patients, they often can work as patient advocates and can take initiative, if a
patient asked for Euthanasia.

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References
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for Cronbach's Alpha Test: A Simple Guide for Researchers. The Malaysian journal of
medical sciences : MJMS, 25(6), 85–99. https://doi.org/10.21315/mjms2018.25.6.9
Huber, S., & Huber, O. W. (2012). The centrality of religiosity scale (CRS). Religions, 3(3), 710-
724.
Khatri, C., Chapman, S. J., Glasbey, J., Kelly, M., Nepogodiev, D., Bhangu, A., ... & STARSurg
Committee. (2015). Social media and internet driven study recruitment: evaluating a new
model for promoting collaborator engagement and participation. PloS one, 10(3).
Maymone, M. B., Venkatesh, S., Secemsky, E., Reddy, K., & Vashi, N. A. (2018). Research
techniques made simple: web-based survey research in dermatology: conduct and
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Terkamo-Moisio, A., Kvist, T., Kangasniemi, M., Laitila, T., Ryynänen, O. P., & Pietilä, A. M.
(2017). Nurses’ attitudes towards euthanasia in conflict with professional ethical
guidelines. Nursing ethics, 24(1), 70-86.