Teaching End-of-Life Decision Making to Undergraduate Nursing Students

This presentation highlights the development, implementation, and results of an educational session with undergraduate nursing students about end-of-life decision making. The purpose of this qualitative thematic analysis study was to explore student perspectives of end-of-life decision making following an education session. The aims were to 1) develop themes from student feedback on end-of-life decision making and 2) refine educational strategies to teach end-of-life decision making to nursing students. The study was conducted with 72 junior level baccalaureate nursing students enrolled in an undergraduate gerontological nursing course. An interactive lecture was developed, following short philosophical ethics readings, which brought the students up to date on the history of end-of-life discussions, key cases, and different frameworks to approach a cluster of ethical issues associated with end-of-life care. A debate pedagogical model was employed as an engaging activity in which students directly applied recently learned concepts. In the debate activity, students were divided into two teams. Each team was assigned a position, which was a specific response to the case question: Should practitioners assist in their patient’s committing suicide? Should practitioners offer medical aid in dying? Each team conferred, presented their position, responded to the arguments or reasons from the opposing position. The session ended with a debrief by the course instructors. In the first semester, 31 nursing students completed four open-ended questions following the class. Results included increased student confidence discussing end-of-life issues and identification of two concepts commonly referred to in end-of-life care discussions and in bioethics, autonomy and dignity.

Phenomenological Study of Muslim Nurses’ Experience During End-Of-Life Decision Making

<p class="paragraph" align="center">ABSTRACT</p><p class="paragraph"><strong>Objectives</strong>: This study examines the significance of Muslim nurses' lived experiences in the Intensive Care Unit (ICU) when it comes to End-of-Life (EOL) decisions (ICU)</p><p class="paragraph"><strong>Methods</strong>: The research was carried out at an intensive care unit (ICU) of a government hospital in Central Java, Indonesia. Fourteen nurses were chosen as participants after meeting the inclusion criteria: Muslims with at least three years of experience in the ICU and experienced to involved in end of life decision making process in an ICU. Data were gathered using in-depth interview. The result the transcribed and analyzed by using van Manen’s hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria.</p><p class="paragraph"><strong>Results: </strong>Four theme themes emerged from nurses' engagement in EOL decision-making. Feeling dilemma, being in uncertain time, receiving overwhelming role, and evading the process. Van Manen's four lived world of body, time, relation, and space are reflected in these subjects.</p><p class="paragraph"><strong>Conclusion</strong>: The purpose of this study was to illustrate the meaning of Muslim nurses' EOL decision-making in the ICU and to affect nursing policy addressing EOL decision-making education in ICU settings.</p>

“It was one of those complicated cases”: health practitioners’ perspectives and practices of providing end-of-life care for people with profound intellectual and multiple disability

Background Due to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD. Methods Seven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data. Results Four main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments. Conclusions Due to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability.

Solutions of Matrix Games Involving Linguistic Interval-Valued Intuitionistic Fuzzy Sets

In real-life decision-making challenges, experts quite frequently have a preference for expressing their perspective in natural linguistic terms rather than definite numerical format. These linguistic representation has been utilized to resolve plenty of decision-making problems. This paper displays the thorough study of matrix games where in the payoffs are characterized through linguistic interval-valued intuitionistic fuzzy sets (LIVIFSs). Solution of these matrix games are attained by resolving a duo of linear or nonlinear programming problems, originated through non-linear bi-objective programming problems. Finally, a numerical example is used to demonstrate the applicability of the suggested approach.

Negotiating euthanasia: Civil society contesting ‘the completed life’

Autonomy and independence have become crucial elements of end-of-life decision making. Opinions on the latter are, however, strongly contested in public discourses. This contribution analyses arguments in favour of and against a Dutch civil society initiative which promotes the extension of the legislation on euthanasia. The authors investigate Dutch newspapers associated with three groups: religious, liberal and humanist perspectives, and do so by utilising quantitative and qualitative elements from a discourse-analytical perspective, raising the following questions: Which stances can be identified? How do different parties position themselves with regard to a ‘completed life’ and a ‘good death’? To what extent do these positions create demarcations between ‘us’ and ‘them’? The authors show that the debate developed along the lines of three key topoi: the topos of autonomy, the topos of human worth and the topos of embeddedness. The authors thereby identify how the different discursive positions define different visions of dying as ‘legitimate’ and as a proper end to a completed life.