Understanding Australian Nurses' Intentions to Respond to Requests for Legal Assisted Dying
Date
2021
Authors
Wilson, Michael Richard
Editors
Advisors
Wiechula, Richard
Cusack, Lynette
Cusack, Lynette
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Thesis
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Abstract
Background. As assisted dying becomes a legal end-of-life choice in Australia, nurses will frequently encounter requests about or for that option. It is well established in nursing research that nurses can experience ambivalence in responding to these questions, regardless of individual attitudes toward assisted dying. The theory of planned behaviour guided this research to explore and explain how nurses in Australia intend to respond and how psychosocial influences shape those responses. Specifically, this research examines how attitudes, subjective norms, perceived control, and ethical beliefs inform response intentions. Method. To assess the impacts of those variables, this study had three objectives: 1) identify the range of possible responses; 2) assess the impact of the psychosocial variables on those intentions using data from an online survey distributed to members of professional nursing bodies; 3) identify patterns of intentions to form profiles of nursing cohorts, and examine the psychosocial variables that distinguish these profiles. A mixed-method approach was employed for these objectives. First, the range of intended responses was identified using Q-methodology that classified the subjective views of 45 nurses who work in typical end-of-life settings. Second, using survey data from 377 nurse respondents, the likelihood of an intended response was calculated as an interaction (or main effect) of attitude and the other variables of normative, control and ethical beliefs, using generalised linear modelling processes. Third, using k-means cluster analysis, five profiles were identified of nurses who shared similar patterns of intentions, and multinomial logistic regression calculated the likelihood of a psychosocial variable predicting a nurse's membership in a profile. Results. Most nurses would intend to explore the meaning of the request and assess the requestor's needs, and a large proportion of nurses would deflect the request to consider palliative alternatives based on some objection to the request. All nurses intended to refer the request to the responsible doctor regardless of their attitude toward assisted dying. The strength of each of those intentions, measured by the mean score of each intention, formed five different patterns of intentions that constituted profiles of Facilitators, Expediters, Compliers, Objectors, and Detached. The strength of respondents’ belief in beneficence predicted membership in most profiles, but only the Expediter profile reflected a balance of beneficence and respect for autonomy. The expectations of significant others to assist with a request predicted membership in all profiles except for Objectors and Detached. Conclusion. The results demonstrate the multiplicity of a nurse’s intentions in responding to requests for assisted dying and the beliefs that shape those intentions. Examining this issue with mixed-method design using regression models extends the knowledge base in a useful way for a profession adjusting to a legally novel and ethically contentious medical choice. These results have implications for organisational policy and professional development. Nurses can be supported for these encounters by knowing the law relevant to their role, understanding professional guidelines, and cognitively rehearsing their response to mitigate ambivalence in responding to requests while respecting patient autonomy.
School/Discipline
Adelaide Nursing School
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 2022
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals