5th Annual Mixed Methods Conference 8th to 11th July 2009. Nurses’ attitudes to euthanasia: a Q methodological study

Nurses’ attitudes to euthanasia: a Q methodological study
Abstract: Euthanasia is an important issue for nurses as technological advances allow patients to be kept alive using artificial means. Nurses’ attitudes to euthanasia are of particular importance because of their close involvement in the care of the dying patient. Q methodology enables data to be collected and systematically analysed through factor analysis but also allows an element of subjectivity.

Janet Holt, Senior lecturer in the School of Healthcare at the University of Leeds and Ethics, Learning and Teaching Consultant, Health Sciences and Practice, Higher Education Academy, presented the methods and results of her study. She identified the aims as:
• To explore diversity in nurses’ subjective understanding of voluntary active euthanasia
• To investigate similarities and differences in these understandings in nurses with different clinical experiences.
Janet initially gathered information from groups of nurses working in Intensive Care, Hospice and Nursing Home environments. From this, and information from the literature (both academic and popular) she was able to put together a number of statements (120) representing views on this issue. Some of these are listed below to give an idea of these. These formed the Q set.
• Euthanasia would prevent distress for the patient
• Euthanasia could be abused by the family for financial gain
• Patients might ask for euthanasia for the wrong reasons
• Euthanasia is too big a responsibility for a nurse
There were 60 participants. They were asked to read the Q set and sort them into “agree”, “don’t agree” and “neutral”. After this step participants were asked to place them on a “Q grid” where statements were sorted from strongly disagree through neutral to strongly agree.
At this stage participants also completed a booklet writing comments about the process they were engaging in and the statements themselves.
After factor analysis Janet was able to identify three understandings of nurses’ attitudes to euthanasia. These are identified below.
Factor 1 Cautiously Supportive of Euthanasia: Euthanasia was not considered to be morally wrong, defined as murder or something that would raise conscientious objections, Euthanasia was not felt to be in conflict with the nurses role, important criteria were having strict guidelines to follow, a nurse having the right to refuse, being personally involved with the patient and being sure it was what the patient wanted, nurses were more likely to work in ICUs, have more than 10 years experience, be educated to at least diploma level, have moderate or no religious beliefs
Factor 2 Against Euthanasia: Euthanasia was considered morally wrong, in conflict with the nurses role, too big a responsibility for nurses, Euthanasia would reduce public confidence in nurses, rather than being a means to control distress, decisions about Euthanasia were felt to potentially add to the patients distress, nurses worked in nursing homes and hospices, more likely to have moderate or strong religious beliefs, most had more than ten years experience in their speciality and half of them were educated to diploma or degree level
Factor 3 Supportive of Patient Autonomy: this area focused more on the patient experience, patients being able to plan and make choices about their death were important issues, Euthanasia was not considered to be morally wrong, defined as murder or in conflict with the nurses role, there was some doubt whether these nurses would administer Euthanasia or not, nurses worked across all three clinical specialities, had moderate religious beliefs, had more than ten years experience in the speciality and were educated to at least diploma level.
Janet’s use of Q methodology led her to conclude that it is an appropriate method to explore complex and socially contested concepts allowing data to be collected and systematically analysed through factor analysis. Additionally, the notes made by participants about the process and statements allowed further exploration.

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