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Additional file 1. Example of conceptual scheme.

Supplemental material, sj-pdf-1-pmj-10.1177_02692163221102000 for Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial by Lara Pivodic, Annelien Wendrich-van Dael, Joni Gilissen, Stefanie De Buyser, Luc Deliens, Chris Gastmans, Robert Vander Stichele and Lieve Van den Block in Palliative Medicine

ObjectivesPalliative sedation for existential suffering (PS-ES) is considered a controversial practice to control refractory suffering at the end of life. This study aims to explore Belgian palliative care physicians’ perceptions regarding the ethics of PS-ES.MethodsThis nationwide qualitative study follows a Grounded Theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 23 Belgian hospitals and hospices (Flanders, Brussels, Wallonia). We analysed the data using the Qualitative Analysis Guide Of Leuven and we followed the Consolidated Criteria for Reporting Qualitative Research guidelines.ResultsThe data revealed that Belgian palliative care physicians have difficulty characterising ES and distinguishing it from other types of suffering. They express mixed attitudes towards PS-ES and employ a wide range of ethical arguments in favour and against it, which are mainly linked to the four principles of biomedical ethics.ConclusionSince there is a lack of consensus among Belgian palliative care physicians about PS-ES, further research is needed to clarify their attitudes. A better understanding of physicians’ underlying presuppositions can provide more insight into their perceptions of ES and PS-ES and provide further insight for establishing good practices in ES management at the end of life.

ispartof: pages:1-62 status: Published online

BACKGROUND: The 21-item Nurses' Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. OBJECTIVES: The objective of this study was to make a Dutch translation of the Nurses' Moral Courage Scale to describe the level of nurses' self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. RESEARCH DESIGN: A forward-backward translation method was applied to translate the English Nurses' Moral Courage Scale to Dutch, and a pilot study was conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. PARTICIPANTS: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. FINDINGS: The readability and understandability of the Dutch Nurses' Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale (α = .914) and all subscales. Nurses' mean score of the 21-item Nurses' Moral Courage Scale was 3.77 (standard deviation = 0.537). The total Nurses' Moral Courage Scale score was associated with age (p < .001), experience (p < .001), professional function (p = .002), level of education (p = .002) and personal interest (p < .001). DISCUSSION AND CONCLUSION: The Nurses' Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice. ispartof: Nursing Ethics vol:29 issue:1 pages:1-17 ispartof: location:England status: published

Supplemental Material, sj-pdf-3-nej-10.1177_0969733021994187 for Differences in advance care planning among nursing home care staff by Gilissen Joni, Wendrich-van Dael Annelien, Gastmans Chris, Vander Stichele Robert, Deliens Luc, Karen Detering, Van den Block Lieve and Pivodic Lara in Nursing Ethics

Supplemental Material, sj-pdf-2-nej-10.1177_0969733021994187 for Differences in advance care planning among nursing home care staff by Gilissen Joni, Wendrich-van Dael Annelien, Gastmans Chris, Vander Stichele Robert, Deliens Luc, Karen Detering, Van den Block Lieve and Pivodic Lara in Nursing Ethics

Supplemental Material, sj-pdf-1-nej-10.1177_0969733021994187 for Differences in advance care planning among nursing home care staff by Gilissen Joni, Wendrich-van Dael Annelien, Gastmans Chris, Vander Stichele Robert, Deliens Luc, Karen Detering, Van den Block Lieve and Pivodic Lara in Nursing Ethics

The aim of this study was to search for all available reviews, guidelines and analyses and make a literature overview and comparison between countries as a corner stone for a further research with a goal of making our national pediatric and neonatal end-of-life guidelines. We conducted a literature search in February 2018 and in September 2019 in bibliographic databases and grey literature sources for the time period from 1990 to 2019. Search strategies in were conducted using MeSH terms and keywords related to ‘pediatric’, ‘neonatal’, ’ guidelines’, ‘end of life’, ‘palliative care’ and ‘intensive care unit’ terms. Only documents satisfying all of the inclusion and exclusion criteria were included in the review. This resulted in 11 eligible documents. Most of the articles, eight of them are focused on neonatal issues and only three mention specificity of pediatric problems. Among all articles five are general guidelines with examples of diagnosis, five have week by week algorithm and classification of neonatal interventions and three have obstetrical algorithms of prenatal interventions, one article talks about perinatal prognostic factors, four about starting provisional intensive care and reassessment when in doubtful cases, six have a list of clinical procedures in end-of-life decisions, four articles point out a prevalence of neurological impairment after survival as a relevant clinical factor in future end-of-life decisions, four tackle with question of active euthanasia, two recommend palliative care after forgoing life-sustaining treatment with examples of diagnosis, three distinguish different modes of forgoing life- sustaining treatment and two mention organ donation after death. Clinical guidelines on EOLD are intended as a general framework to help all decision-making parties, but because of uniqueness of every physician, parent, child, diagnosis and underlaying background there are still grey zones that tackle with ethical issues and individual decisions outside the guidelines are always possible.