Background Medical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government's decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses' experiences and nursing practice. Methods The study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account. Results Nurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses' moral responses to MAiD were most effective in supporting nurses' well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD. Conclusions Data obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients' lives, without suitable supports, find themselves caught between the proverbial rock and hard place.

中文翻译：

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MAiD 的艰难险阻：立法辅助死亡背景下护理实践的定性研究。

背景 临终医疗救助 (MAiD) 于 2016 年 6 月在加拿大合法化。加拿大政府决定立法协助死亡，这种方法需要高度的义务、精确性和授权，这给医疗保健和医疗保健带来了独特的挑战。用于护理实践。本研究的目的是更好地了解辅助死亡的立法方法对护士经验和护理实践的影响。方法 本研究采用以解释性描述为指导的定性方法。对 59 名注册护士和执业护士进行了半结构化访谈。使用定性分析软件对访谈进行录音、转录和管理。分析遵循数据沉浸、开放编码、持续对比分析、以及构建主题和解释性帐户。结果 本研究中的护士描述了在其工作环境中如何实施 MAiD 以及可用于指导其实践的实践支持方面存在很大差异。支持或缺乏支持 MAiD 的系统的开发主要是由具有影响力的领导职位的人推动的。在这种有影响力的实践变化期间，支持一系列护士对 MAiD 的道德反应的工作场所在支持护士的福祉方面最为有效。参与者提到了团队合作在提供高质量 MAiD 相关护理方面的重要性；但是，许多人在没有团队利益的情况下工作。与 MAiD 相关的护理工作非常复杂，主要是因为在系统中需要以患者为中心的护理，而这些系统并不总是组织起来支持这种护理。在缺乏足够的实践支持的情况下，一些护士选择限制他们参与 MAiD。结论 本研究中获得的数据表明，一些工作场所环境仍然缺乏必要的支持，护士无法自信地满足 MAiD 立法方法所需的精确度。如果没有可获得的姑息治疗、足够的提供者、支持团队、实践支持以及允许护士对 MAiD 做出一系列反应的环境，护士会觉得他们在法律和道德上都处于危险之中。寻求提供与患者生命中如此重要时刻相一致的富有同情心的护理的护士，如果没有适当的支持，就会发现自己陷入了众所周知的困境和艰难的境地。结论 本研究中获得的数据表明，一些工作场所环境仍然缺乏必要的支持，护士无法自信地满足 MAiD 立法方法所需的精确度。如果没有可获得的姑息治疗、足够的提供者、支持团队、实践支持以及允许护士对 MAiD 做出一系列反应的环境，护士会觉得他们在法律和道德上都处于危险之中。寻求提供与患者生命中如此重要时刻相一致的富有同情心的护理的护士，如果没有适当的支持，就会发现自己陷入了众所周知的困境和艰难的境地。结论 本研究中获得的数据表明，一些工作场所环境仍然缺乏必要的支持，护士无法自信地满足 MAiD 立法方法所需的精确度。如果没有可获得的姑息治疗、足够的提供者、支持团队、实践支持以及允许护士对 MAiD 做出一系列反应的环境，护士会觉得他们在法律和道德上都处于危险之中。寻求提供与患者生命中如此重要时刻相一致的富有同情心的护理的护士，如果没有适当的支持，就会发现自己陷入了众所周知的困境和艰难的境地。一个支持团队、实践支持以及允许护士对 MAiD 做出一系列反应的环境，护士觉得他们在法律和道德上处于危险之中。寻求提供与患者生命中如此重要时刻相一致的富有同情心的护理的护士，如果没有适当的支持，就会发现自己陷入了众所周知的困境和艰难的境地。一个支持团队、实践支持以及允许护士对 MAiD 做出一系列反应的环境，护士觉得他们在法律和道德上处于危险之中。寻求提供与患者生命中如此重要时刻相一致的富有同情心的护理的护士，如果没有适当的支持，就会发现自己陷入了众所周知的困境和艰难的境地。