Rebecca MacLure

My teaching and practice philosophies go hand in hand as they are based on components of collaboration and care coordination for clients and families facing end-of-life decisions in developing a care plan that respects their autonomy while addressing their unique individual care needs. By promoting empathy and kindness in relationship building, clients and family members become more open to facing care plan decisions as they arise and working together with a team to overcome these challenges.

Schuster (1993) shares how feminist scholars value people's ability to share their experiences with others while protecting their autonomy. In this way of thinking, the thoughts and opinions of all group members will be considered while collaborating to create a plan that is acceptable to all members. I am invested and involved in sharing knowledge with clients and family members. I have compassion for the client and will be present to listen to them and their family members to discuss their health care needs and engage with them in the process of dying and death. Feminist scholarship promotes body, mind, and spirit involvement and recognizes the connections and relationships required to empower actions using "context-specific approaches" to meet individual and group objectives (Schuster, 1993, p. 383). This philosophy may provide a foundation for creating holistic end-of-life care plans for patients and their families in various stages of illness and care settings. Schuster reminds us that even when facing these challenges, remember to take even the most minor opportunities to share a moment of comfort and laughter. 

My role is to educate clients, family members, and care providers to aid them in making end-of-life decisions. The information shared will consider their physical, environmental, social, cultural, and spiritual needs to create an individualized care plan. Care providers must offer education in stages as clients and families are ready to be informed and make difficult decisions. These decisions may include advanced care planning, goals of care, how they choose to die, and their preferred choice of where they spend their final hours. By assessing the client's and family member's knowledge level, the educational goals will be set and revisited as the disease process progresses and their needs evolve.

One of my first palliative care patients chose to have a MAiD assessment when their cancer treatments were completed. When they were first referred to the palliative program, they felt they could not cope with their decline in health and thought the option of MAiD might be their only way to die with dignity. They did not know about the palliative care program and its holistic symptom management and care planning goals. I saw this client regularly for one year. New personal and healthcare goals were set each week, and I assisted with a plan to reach these objectives through client education and coordination with other services. Once the palliative team set up the care plan, the client's symptoms became manageable, and meetings were planned to connect with family and friends, allowing for some final special moments. These visits were meaningful to the client, their family, friends, and care providers. This patient delayed the choice of MAiD and called to request a bed in the palliative care center (PCC) for their death. I packed their belongings, drove the client to our beautiful PCC, and helped them settle in for their final hours of life. This client was grateful for their time with loved ones, stated they were now at peace, and asked me for one final hug goodbye. 

This story is one example of many that interested me in researching the experiences of the palliative care registered nurse (RN) with MAiD in practice. My research questions for my master's thesis explored how these nurses worked with patients who considered MAiD as an end-of-life option and what challenges they faced in these situations. Their narratives shared several common threads. These included a lack of information shared, coordination, and communication of services between the palliative care and MAiD providers. These themes offer a foundation to be built upon in a future study. The palliative care RNs are experts in end-of-life care planning. They may provide unique insight into how these two teams, MAiD and palliative care, could work more closely to coordinate planning for clients regardless of whether they choose a natural or a MAiD death. 

As a scholar, I seek to conduct, synthesize, describe, interpret, and apply nursing research. I aim to develop my research skills so that my work may lead to increased understanding, improvements in practice, and additional research supporting clients, families, and care providers in developing comprehensive end-of-life care plans. 

My perspective on end-of-life care planning has evolved through my practice experience with end-of-life clients across several settings, including long-term care, hospitals, home care, and palliative care. I seek the knowledge required to improve end-of-life outcomes for clients by working with the available resources and finding ways they may work together. Although my interviews will focus on palliative care nurses' experiences with MAiD in practice, this study may yield results that extend to clients across any care setting, enabling them to receive equivalent holistic end-of-life care regardless of where or how they choose to die.

Schuster, E. A. (1993). Greening the curriculum. Journal of Nursing Education, 32(8), 381-383. https://doi.org/10.3928/0148-4834-19931001-13