UMS-euthanasia and nursing students' attitudes

Nursing Students’ Attitudes Regarding Euthanasia Due to Unbearable Mental Suffering: A cross-sectional Study

Abstract
Background: There is an increasing debate on euthanasia worldwide (e.g. Portugal), with some countries, such as Belgium, altering the legal framework. The euthanasia legislation in certain countries notes that 'unbearable suffering' of a mental nature may also be considered grounds for euthanasia. If such legislation becomes standard practice in the field, the consequences for healthcare workers would be significant. Since nursing students are the nurses of the future, it is important to examine their attitudes towards euthanasia due to unbearable mental suffering (UMS-euthanasia).
Objective: The current study introduces the adaptation of the validated Euthanasia Attitude Scale (EAS) with a focus on UMS-euthanasia in the Flemish (Belgium) setting, as well as final year nursing students’ attitudes towards UMS-euthanasia.
Design: Cross-sectional survey.
Setting/ participants: A sample of final-year baccalaureate nursing students (n=273) from eight of the eleven Flemish university colleges that agreed to participate.
Methods: Explorative, descriptive cross-sectional study conducted using an e-mail survey. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations by a native English speaker, a health education expert, and an end-of-life specialist. The psychometric properties of the EAS were assessed, including reliability and validity. Independent-Samples T Test was used to investigate relation between demographic and education-related data, and domain and total score of the UMS-EAS-NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels. This study was not registered.
Results: McDonald's Omega was 0.838 for the total EAS scores, supporting the validity of the questionnaire. There is a statistically significant difference in total questionnaire score between those who have been involved in euthanasia and those who have not (95% CI 0.031–0.511), as well as for ‘ethical considerations’ (95% CI 0.064–0.545). There are clinically important results for ‘Treasuring Life’ and ‘Naturalistic beliefs’.
Conclusions: This study’s sample is representative of the concerned population. McDonald's Omega quantifies the reliability allowing for some sub-domains. However, in order to compare with similar studies, the Cronbach's alpha was also calculated, and it is similar to previous studies (α=.812). Most of the final-year nursing students supported the availability of UMS-euthanasia. In order to monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter.

护理学生对因难以忍受的精神痛苦实施安乐死的态度：一项横断面研究

摘要
背景：全球范围内关于安乐死的争议日益加剧（如葡萄牙），部分国家（如比利时）已对相关法律框架进行修订。部分国家的安乐死立法明确，精神层面的"难以忍受的痛苦"亦可作为安乐死的合法化依据。若此类立法成为医疗领域的通用准则，将对医护人员产生深远影响。鉴于护理学生是未来的护理从业者，探讨其针对因难以忍受的精神痛苦实施安乐死（UMS-euthanasia）的态度具有重要意义。
目的：本研究旨在适配经效度验证的安乐死态度量表（Euthanasia Attitude Scale, EAS），使其聚焦于佛兰德斯（比利时）地区的UMS-euthanasia场景，并探究该地区护理学专业高年级学生对UMS-euthanasia的态度。
研究设计：横断面调查。
研究对象与场景：从比利时佛兰德斯地区11所大学护理学院中招募8所同意参与本研究的院校，最终纳入273名护理学专业本科高年级学生作为研究样本。
方法：本研究为探索性描述性横断面研究，采用电子邮件问卷调查法开展。正式问卷共包含21个条目，其编制基于由母语为英语者、健康教育专家及临终关怀专家独立翻译后达成的共识。本研究对安乐死态度量表的心理测量学特性进行评估，包括信度与效度。采用独立样本t检验分析人口统计学及教育相关数据与UMS-EAS-NL量表各维度及总得分的关联。本研究已通过布鲁塞尔大学医院伦理委员会的伦理审查，未进行临床试验注册。
结果：安乐死态度量表总得分的麦克唐纳Ω系数为0.838，证实了该问卷的结构效度。是否参与过安乐死相关工作的研究对象在问卷总得分（95%CI 0.031~0.511）及"伦理考量"维度得分（95%CI 0.064~0.545）上均存在统计学显著性差异。在"珍视生命"与"自然主义信念"维度上，研究结果具有临床意义。
结论：本研究样本能够代表目标人群。麦克唐纳Ω系数量化了部分子维度的信度。为便于与同类研究进行比较，本研究同时计算了克朗巴哈α系数，结果与既往研究一致（α=0.812）。大部分护理学专业高年级学生支持UMS-euthanasia的合法化。为保障照护质量，需针对这一复杂议题对护理学生开展充分的岗前培训。