"A rewarding conclusion of the relationship": staff members' perspectives on providing bereavement follow-up

“What She Told Us Made the world of Difference”: Carers’ Perspectives on A Hospice at Home Service

This paper explores the expectations and needs of current and bereaved carers whose relatives received care at home from a palliative care team. Aim: A hospice at home service was established in 2006 to provide patients with care in their own homes. We examined whether this model of care was helpful in mitigating carers’ burden and in enabling terminally ill patients to be cared for and die at home. Methods: This study utilized a survey and interviews. Participants were carers in the midwest of Ireland. Survey responses from 122 carers were analyzed using SPSS 18.0 (SPSS Inc., 2009); interviews with 15 carers were also conducted. Results: Carers’ expectations of the service were often exceeded, and quality of care dimensions were rated highly. Future improvements could include facilitating discussions on place of death and offering bereavement support. Conclusion: The service is supporting carers in facilitating their relatives’ choice to die at home.

The "Liaison" in Consultation-Liaison Psychiatry: Helping Medical Staff Cope with Pediatric Death

Pediatric consultation-liaison clinicians are well positioned to provide support, guidance, and systemic recommendations about how to help medical clinicians cope with the stresses of working with dying children. Interventions to support sustainability in this work need to occur at the institutional and team-based levels as well as in individual practice. Shared clinical work around challenging cases provides opportunities to engage with medical clinicians about their difficult experiences and provide reflection and support. Psychiatry services may also be in a role of advocating for institutionally based interventions that can help their medical colleagues.

A Bereavement Common Assessment Framework in Palliative Care: Informing Practice, Transforming Care

This article describes the development of a bereavement assessment framework for the Western Australia Country Health Service Palliative Care Services bereavement program. The framework is grounded in a clearly articulated evidence base, integrating research from the bereavement field that has informed the development of a standardized assessment framework referred to as the bereavement common assessment framework (B-CAF). The B-CAF identifies the many facets of experiences of the bereaved, creating a holistic and contextual assessment and providing professionals with a tool to enhance assessment and intervention practices. The palliative–curative model of care has also been reconceptualized to recognize that earlier interventions may mitigate adverse outcomes in bereavement. This framework may have implications for further research and service delivery of bereavement support programs.

Bereavement Services Offered in Adult Intensive Care Units in the United States

BACKGROUND

Losing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs.

OBJECTIVE

To describe current bereavement follow-up services in adult ICUs.

METHOD

A cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of Critical-Care Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression.

RESULTS

A total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care.

CONCLUSIONS

The study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.

Nurses' experiences providing bereavement follow-up: an exploratory study using feminist poststructuralism

AIMS AND OBJECTIVES

To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges.

BACKGROUND

Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking.

DESIGN

Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases.

METHODS

Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships.

RESULTS

The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered.

CONCLUSIONS

Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work.