According to the American Medical Association (AMA), physician-assisted suicide (PAS) is defined when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.” A variety of terms have historically been used to describe an event when a physician uses lethal medications on a terminally ill patient for the purpose of easing their suffering. The term “physician-assisted suicide” was conceptualized to accurately reflect the relationship between the doctor and patient while denoting the etymological roots of suicide as “auto-killing” or “self-killing.” After years of courtroom and political battles, California, Colorado, the District of Columbia, Montana, Oregon, Vermont, and Washington are the only U.S. states that currently allow PAS as a result of the Death With Dignity Act enacted in 1997. As of January 1, 2019, Hawai’i will be added to that list.
The perception of PAS is a highly controversial topic within the nursing profession because it centers on the decision of terminating a human life to ease physical and emotional agony. For centuries, issues related to PAS have been zealously debated, with neither advocates nor opponents gaining much ground. Currently, those who favor PAS view the process as a peaceful and painless death while those who oppose it believe that the consequence of any form of suicide will ultimately result in irreparable legal and ethical ramifications. With recent societal and technological advancements in science and medicine, choices involving both life and death have become much more complicated in recent years. As a result of this worldwide controversy in health care, many nurses nationwide are now forced to deal with this ethical dilemma head on.
Risks and Benefits
Like many controversial topics in contemporary society, there are numerous risks and benefits nurses must be familiar with when it comes to justifying PAS. Those who support PAS argue that people should have the right to choose the timing and manner of their death in the event of an adverse clinical aftermath. Proponents of PAS strongly believe that allowing a patient to needlessly suffer can cause additional pain and distress, which can ultimately eliminate whatever shred of dignity the patient may possess. As a result of this realization, many proponents believe that PAS can provide patients with a unique treatment alternative to their incessant agony.
Despite the urgings of proponents however, many opponents argue that the sanctity of human life should be continually honored and respected in spite of physical or emotional discomfort. The argument contends that only God Himself has the authority to give and take life, and that individuals should not be allowed to take any life, including their own.
Lastly, the potential for PAS is tremendously high in vulnerable populations because of their lack of access to quality health care. Since PAS may become a cost-containment strategy that can lead to serious litigation if not performed properly, opponents strongly forbid PAS to stop these abuses from occurring.
The Impact of Nursing in Physician-Assisted Suicide
PAS is an exceptionally controversial issue because it encompasses both legal and medical ramifications centered on the individual’s unique moral and ethical principles. With the ever-expanding ability to both prolong and end life, nurses must not only remain cognizant but also prepared for any and all repercussions associated with life and death situations.
Suicide is a rising epidemic in today’s contemporary society. According to the World Health Organization (WHO), globally nearly one million people die each year at their hands, by an act of suicide and more than thirty thousand people die annually in the United States alone. Since the risk for suicide is largely determined on a continuum, the severity of suicidality can vary with individual circumstances. Because of this realization, nurses play a pivotal role in suicide prevention because they often have the greatest number of opportunities to identify and recognize suicidal patients and tendencies in the health care arena.
Suicide Screening Strategies
While many hospitals are working diligently to comply with the Joint Commission in implementing suicide-screening questions, there is limited evidence available to guide suicide risk initiatives in the inpatient clinical setting. To help resolve this issue, researchers developed the Ask Suicide-Screening Questions to Everyone in Medical Settings tool (asQ’em), aimed to identify suicidality in the inpatient units and subspecialties. The asQ’em two-item screening tool is a unique instrument designed specifically for nurses to administer to medical-surgical patients at risk for suicidal tendencies and predispositions. Due to the straightforward nature of the asQ’em suicide-screening questionnaire, researchers have found it to be an efficacious method in properly recognizing suicidality in susceptible patients across the health care setting.
Applicability in the Clinical Setting
Although suicide risk assessments are an essential tool in the hospital setting, there is a growing body of evidence suggesting the underutilization of suicide screenings among medical-surgical patients. As a psychiatric-mental health nurse, I understand the importance of assessing patients for suicidality because it provides me with vital information on how to properly care for patients suffering from suicidal thoughts.
The asQ’em suicide-screening questionnaire is a tremendous tool that can be easily implemented in all inpatient units because it consists of two questions that determine if patients are at risk for suicide as a result of their present thoughts or past behaviors. Based on their answers, nurses can consequently determine if the patient exhibits enough significant emotional distress to ensure proper safety measures are in place before subsequent inpatient treatment and stabilization.
As a result of this realization, increased efforts must be made to ensure suicide-screening tools are readily available to not only uncover meaningful clinical data but also promote safe holistic nursing practices to preserve the health and well-being of suicidal patients nationwide.
Due to the ever-evolving nature of health care in contemporary society, more and more nurses are being looked upon as transformational nurse leaders among the scientific community. If you are interested in becoming a transformational nurse leader yourself, here are the five steps you must take to inspire change among your patients and your colleagues alike.
1. Set a Vision
Having a vision is an essential characteristic of a transformational nurse leader because it addresses the “why” and “how” of their actions. Transformational nurse leaders must not only be inspirational but also courageous in conveying their unique beliefs and viewpoints in order to bring their vision to life.
2. Foster Creativity
It’s imperative for potential transformational nurse leaders to foster creativity because it encourages innovation and adaptation to change. The transformational leadership style is vital to this approach because it identifies areas in which change is required while inspiring followers to embrace innovation in the clinical setting.
3. Communicate Effectively
A transformational nurse leader who communicates effectively not only focuses on what other individuals are attempting to convey but also essential themes important to those individuals. Effectual communicators adapt their communication style based on each individual’s ability to process and comprehend the interaction successfully despite cultural and socioeconomic differences.
4. Inspire Positive Change
To become a successful transformational nurse leader, an individual must also be charismatic and inspire real positive change across generational gaps. A transformational nurse leader must know how to inspire change because it not only promotes self-reliance but also trust in others to commit to their vision.
5. Be a Role Model
Lastly, knowing how to be a role model is a crucial trait of the transformational nurse leader because it motivates others to become better versions of themselves. Nurses who are not only transparent but also honest embody the value of integrity that is vital in promoting trust among their followers. Leaders who display integrity are consistent when it comes to their actions, values, and expectations and are considered reliable and trustworthy. Therefore, individuals who yearn to be transformational nurse leaders must be willing to demonstrate their commitment to excellence by striving to become a positive example to those around them.
Due to nursing’s involvement in examining phenomena within a contextual health care framework, phenomenology is not only conducive to the discovery of information but also the development of nursing knowledge essential to the profession.
The phenomenological approach is increasingly being utilized as the method for nursing research studies because it is comprised of data collection tools such as open-ended questions and observational cues appropriate for nursing research practices and methodologies. Phenomenology is also quite useful to qualitative nurse researchers because it can be an effective vehicle for illuminating and clarifying fundamental issues in the health care sector.
Because the science of nursing is concerned with treating individuals holistically, many nurses recognize the significance of individuals’ experiences and support them in exercising control over their health and well-being. Based on this understanding, phenomenology plays a pivotal role in the nursing profession because it values not only the individual’s experience but also the principles and modalities of their holistic healing into daily life and clinical practice.
Current and Postmodern Influence on Nursing
The current and postmodern philosophical schools of thought play an integral role in the nursing profession because of its contribution to the creation and development of nursing science and theory.
Some of the ways these philosophies helped contribute to the nursing profession were through the promotion and utilization of multiple methods for the development of scientific understanding and incorporation of different techniques to improve overall understanding of humanistic idiosyncrasies.
By developing and applying the discipline-specific knowledge that was required, different philosophical theories and perspectives were able to aid in recognizing the relationships of human responses to health issues while addressing the biological, behavioral, and cultural domains of nursing science simultaneously.
Based on this reality, modernism and postmodernism not only dislodged the authority of a single research paradigm in nursing science but also emphasized the meaning of integration of qualitative and quantitative research into a holistic and dynamic model to improve nursing practice in the clinical setting.
Why Phenomenology is Imperative in Nursing
Due to the nature of its theoretical teachings, phenomenology has become an important philosophical worldview in the nursing profession. Phenomenology not only requires nursing researchers to understand it as a philosophy but also as a phenomenon tied to human consciousness in the form of lived experiences. This realization illustrates the significance of phenomenology as a fundamental field of inquiry in the nursing profession and the scientific community at large.
Therefore, by having a deeper understanding of phenomenological philosophy, nurses are not only able to make important clinical decisions but also innovative and progressive approaches vital to improving patient care processes in the clinical health care sector and beyond.
As an individual who holds himself to a high professional standard, I have grown to recognize three distinctive qualities that I believe every great nurse should possess: compassion, integrity, and perseverance.
Compassion is not merely the sympathy you show toward a friend or family member in need, but rather the empathy that drives you to act on an inner desire to help those around you. In the summer of 2008, I was fortunate to take part in a medical mission trip overseas serving the underserved populations in the Philippines. During my time abroad, I was inspired by the amount of compassion the nurses and medical staff exemplified in the clinical setting. As a volunteer, I was astonished not only by the sheer magnitude of homelessness that has stricken the country, but also by the positive impact that I was making on a daily basis. By allowing myself to be immersed in the service of others, I have grown to appreciate the many blessings that God has given me, and develop an unyielding compassion toward others that I believe is essential in today’s rapidly growing society.
The second quality that I believe a great nurse must possess is integrity. Integrity means doing the right thing at all times and in all circumstances, whether or not anyone is watching. During my tenure as an emergency room nurse, I was assigned to care for a little girl complaining of a headache. The father confided in me that her symptoms began after she was inadvertently hit in the head with a soccer ball. The medical doctor on staff quickly dismissed the girl as having a “minor headache” and told the father that ice and rest was all that she required. As a nurse of integrity, I did not feel comfortable sending the little girl home after she confided in me that she never had a headache this painful before. Seeing her grimace in pain, I urgently requested the doctor to have a computed tomography (CT) and magnetic resonance imaging (MRI) scan prepared for the patient. Despite the doctor’s initial objection and reluctance, he finally agreed, and upon evaluation of the final results, we discovered a small intracranial hemorrhage that was beginning to form. Seeing the tears of gratitude the father displayed allowed me to recognize the importance of doing the right thing even in the midst of adversity. It was this realization that has continued to fuel my innate desire to remain truthful and transparent in all aspects of my nursing care while fostering the deep interpersonal relationships that I form with my patients.
Lastly, the quality of perseverance plays a vital role in determining an excellent nurse. When I first began nursing school, I was completely unprepared for the academic expectations that were required of me. Due to my immaturity, my grades suffered immensely during the early stages of my academic career and I was humiliated and rejected from numerous nursing schools. Despite the constant vilification and dejection that seemed to surround me during this tremendously dark period of my life, I remained optimistic knowing that I had a purpose in this world. Within the next couple of months, I decided to make a conscientious effort to become more academically driven and was eventually accepted into West Coast University’s nursing program where I excelled scholastically, receiving numerous awards such as the Perennial Dean’s List, the Kaiser Permanente RN Scholarship, and ultimately culminating to my successful graduation in 2013.
As I look back on what I have accomplished over the years, I feel extremely blessed to have been surrounded by amazing individuals who inspired me to be the nurse that I am today. And it is because of this realization that I have come to recognize that being a great nurse is not measured by how intelligent you are but rather your commitment to providing indelible and compassionate care to those who seek it.