Evolving nursing roles in assisted dying services in New Zealand: A scoping review
Notice bibliographique
Résumé
BACKGROUND: The implementation of New Zealand's End-of-Life Choice Act 2019 provides a unique lens for examining the early-stage implementation of assisted dying policy. As legislation expands globally, nurses are emerging as central yet under-examined actors in delivering assisted dying care. This review addresses the urgent need to understand how nursing roles evolve in newly legalised contexts. OBJECTIVE: This scoping review aimed to understand the experiences, roles, and challenges faced by registered nurses and nurse practitioners in delivering assisted dying services under the End-of-Life Choice Act in Aotearoa New Zealand. METHOD: The scoping review followed Joanna Briggs Institute guidelines. A systematic search was performed across ProQuest Central, Scopus, PubMed, and CINAHL to identify literature published between 2021 and 2025. Two screened the articles and extracted the data. A convergent, segregated approach was used for thematic synthesis. RESULTS: Nineteen studies were included, spanning anticipatory commentary and experiential data after the End-of-Life Choice Act came into force. Four themes were identified. First, evolving nursing roles revealed fragmentation: nurse practitioners administer life-ending medication but remain excluded from eligibility assessments. In contrast, registered nurses act as frontline coordinators yet are legally barred from initiating discussions. Experiential accounts added unanticipated burdens, including family management, logistical coordination, and supporting colleagues without formal preparation. Second, ethical dimensions extended beyond legal safeguards. Anticipatory sources predicted value conflicts, while experiential studies described lived moral distress, fractured team dynamics from conscientious objection, and confidentiality risks in small communities. Third, preparedness and support showed a marked gap. While early literature assumed structured training and clear guidance, experiential findings reported uneven preparation, reliance on informal peer networks, and culturally unsafe or absent emotional support. Debriefing was valued but inconsistently delivered. Finally, contextual variations shaped implementation. Hospices diverged between integration and resistance, aged residential care exposed nurses to family conflict and role ambiguity, rural practice intensified inequities and professional isolation, and community nurses often became central coordinators of home-based deaths. Māori perspectives were largely absent. CONCLUSIONS: New Zealand's assisted dying policy creates a fragmented framework for nursing roles, confirmed by anticipatory projections and lived experience. This contrasts with integrated approaches in countries such as Canada, while also exposing gaps in preparedness, ethical support, and cultural responsiveness. Addressing these challenges requires legislative refinement, consistent support systems, and Māori-led, longitudinal research across diverse care contexts. Social media abstract: New Zealand's assisted dying policy fragments nursing roles, creates ethical tensions, and leads to access inequities. Cultural safety and the integration of the nurse practitioner role are essential. #PalliativeCare #NursingPolicy.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,077 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,012 | 0,016 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,006 | 0,006 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».