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Gabay G. The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry. DEATH STUDIES 2024:1-12. [PMID: 38696822 DOI: 10.1080/07481187.2024.2348058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.
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Affiliation(s)
- Gillie Gabay
- Faculty of Social Sciences, Achva Academic College, Shikmim, Israel
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Stewart-Lord A, Baillie L, Green L, Murphy F, Leary A. Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation. BMJ Open 2022; 12:e066832. [PMID: 36600439 PMCID: PMC9772680 DOI: 10.1136/bmjopen-2022-066832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the End-of-Life and Bereavement Care model (SWAN) from conception to current use. DESIGN A realist evaluation was conducted to understand what works for whom and in what circumstances. The programme theory, derived from a scoping review, comprised: person and family centred care, institutional approaches and infrastructure. Data were collected across three stages (May 2021 to December 2021): semi-structured, online interviews and analysis of routinely collected local and national data. SETTING Stage 1: Greater Manchester area of England where the SWAN model was developed and implemented. Stage 2: Midlands. Stage 3: National data. PARTICIPANTS Twenty-three participants were interviewed: Trust SWAN leads, end-of-life care nurses, board members, bereavement services, faith leadership, quality improvement, medicine, nursing, patient transport, mortuary, police and coroners. RESULTS Results from all three stages were integrated within themes, linked to the mechanisms, context and outcomes for the SWAN model. The mechanisms are: SWAN is a values-based model, promoting person/family-centred care and emphasising personhood after death. Key features are: memory-making, normalisation of death and 'one chance' to get things right. SWAN is an enablement and empowerment model for all involved. The branding is recognisable and raises the profile of end-of-life and bereavement care. The contextual factors for successful implementation and sustainability include leadership, organisational support, teamwork and integrated working, education and engagement and investment in resources and facilities. The outcomes are perceived to be: a consistent approach to end-of-life and bereavement care; a person/family-centred approach to care; empowered and creative staff; an organisational culture that prioritises end-of-life and bereavement care. CONCLUSION The SWAN model is agile and has transferred to different settings and circumstances. This realist evaluation revealed the mechanisms of the SWAN model, the contextual factors supporting implementation and perceived outcomes for patients, families, staff and the organisation.
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Affiliation(s)
- Adele Stewart-Lord
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Lesley Baillie
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Laura Green
- School of Health Sciences, Divisionof Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Fiona Murphy
- Palliative /End of Life /Bereavement, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Corporate Services, Liverpool Royal Foundation Trust, Liverpool, UK
| | - Alison Leary
- Institute of Health and Social Care, London South Bank University, London, UK
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Green L, Stewart-Lord A, Baillie L. End-of-life and immediate postdeath acute hospital interventions: scoping review. BMJ Support Palliat Care 2022:bmjspcare-2021-003511. [PMID: 35896320 DOI: 10.1136/spcare-2021-003511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospital remains the most common place of death in the UK, but there are ongoing concerns about the quality of end-of-life care provision in this setting. Evaluation of interventions in the last days of life or after a bereavement is methodologically and ethically challenging. AIM The aim was to describe interventions at the very end of life and in the immediate bereavement period in acute hospitals, with a particular focus on how these are evaluated. METHOD A scoping review was conducted. Studies were restricted to peer-reviewed original research or literature reviews, published between 2011 and 2021, and written in the English language. Databases searched were CINAHL, Medline and Psychinfo. RESULTS From the search findings, 42 studies were reviewed, including quantitative (n=7), qualitative (n=14), mixed method (n=4) and literature reviews (n=17). Much of the current research about hospital-based bereavement care is derived from the intensive and critical care settings. Three themes were identified: (1) person-centred/family-centred care (memorialisation), (2) institutional approaches (quality of the environment, leadership, system-wide approaches and culture), (3) infrastructure and support systems (transdisciplinary working and staff support). There were limited studies on interventions to support staff. CONCLUSION Currently, there are few comprehensive tools for evaluating complex service interventions in a way that provides meaningful transferable data. Quantitative studies do not capture the complexity inherent in this form of care. Further qualitative studies would offer important insights into the interventions.
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Affiliation(s)
- Laura Green
- Faculty of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Adele Stewart-Lord
- Department of Allied Health Sciences, London South Bank University, London, UK
| | - Lesley Baillie
- Florence Nightingale Foundation Chair, London South Bank University, London, UK
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Boven C, Dillen L, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review. J Pain Symptom Manage 2022; 63:e295-e316. [PMID: 34695567 DOI: 10.1016/j.jpainsymman.2021.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Globally, people most often die within hospitals. As such, healthcare providers in hospitals are frequently confronted with dying persons and their bereaved relatives. OBJECTIVES To provide an overview of the current role hospitals take in providing bereavement care. Furthermore, we want to present an operational definition of bereavement care, the way it is currently implemented, relatives' satisfaction of receiving these services, and finally barriers and facilitators regarding the provision of bereavement care. METHODS An integrative review was conducted by searching four electronic databases, from January 2011 to December 2020, resulting in 47 studies. Different study designs were included and results were reported in accordance with the theoretical framework of Whittemore and Knafl (2005). RESULTS Only four articles defined bereavement care: two as services offered solely post loss and the other two as services offered pre and post loss. Although different bereavement services were delivered the time surrounding the death, the follow-up of bereaved relatives was less routinely offered. Relatives appreciated all bereavement services, which were rather informally and ad-hoc provided to them. Healthcare providers perceived bereavement care as important, but the provision was challenged by numerous factors (such as insufficient education and time). CONCLUSION Current in-hospital bereavement care can be seen as an act of care that is provided ad-hoc, resulting from the good-will of individual staff members. A tiered or stepped approach based on needs is preferred, as it allocates funds towards individuals-at-risk. Effective partnerships between hospitals and the community can be a useful, sustainable and cost-effective strategy.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium.
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit (L.D.), Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group (L.V.D.B.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels Health Campus (Building C), Laarbeeklaan 103, 1090 Brussels, Belgium & Campus Ghent University Hospital (Entrance 42 K3), Ghent, Belgium; Department of Family Medicine and Chronic Care (L.V.D.B.), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
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Grant M, Hudson P, Forrest A, Collins A, Israel F. Developing a model of bereavement care in an adult tertiary hospital. AUST HEALTH REV 2020; 45:110-116. [PMID: 33353586 DOI: 10.1071/ah19270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/15/2020] [Indexed: 11/23/2022]
Abstract
Objectives Hospitals are the most common place of death in Australia. Bereavement care is recognised by national standards as being central to providing high-quality care at the end of life, and has significant health implications on morbidity, mortality and health service usage. Despite this, bereavement care is not routinely or systematically provided in most Australian hospitals. This study aimed to develop a comprehensive, evidence-based model of bereavement care specific to the needs of an acute Australian adult tertiary hospital. Methods This study used a multiple-methods design, which included a scoping literature review, a survey of current institutional bereavement practices, interviews with bereaved family members and staff focus groups and the development of a model of bereavement care for the acute hospital service through advisory group and expert consensus. Results Staff and bereaved family members strongly supported a systematic approach to bereavement, perceiving the need for greater support, training, coordination and follow-up. In all, 10 core elements were developed to support a structured model of bereavement care provision and follow-up for the acute hospital organisation. Conclusions This evidence-generated model of care promotes the provision of quality and systematic bereavement care in the acute hospital setting. What is known about the topic? Acute hospitals are the most common place to die in Australia, yet there is a lack of understanding of how bereavement care is or should be provided in these environments. The bereavement period is associated with increased use of health services and worse morbidity and mortality, and thus has significant implications for public health. The provision of bereavement care in acute hospitals is often sporadic, often involving untrained staff who may not provide evidence-based care. What does this paper add? This paper describes the development of a comprehensive, evidence-based model of bereavement care specific to the needs of an Australian acute hospital. What are the implications for practitioners? Developing a consistent approach to bereavement for the acute care sector has the potential to support staff, minimise conflict at the end of life, facilitate recognition of those suffering from difficult bereavement and proactively engage services for these people. It is hoped that such a model of care can find relevance across acute hospitals in Australia, to improve the quality and consistency of bereavement care.
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Affiliation(s)
- Matthew Grant
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Department of Palliative Medicine, St Vincent's Hospital, Melbourne, Vic. 3065, Australia; and Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia. ; and Corresponding author.
| | - Peter Hudson
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Vrije Universiteit Brussel, Brussels, Belgium; and Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Annie Forrest
- Mission Directorate, St Vincent's Hospital, Melbourne, Vic. 3065, Australia.
| | - Anna Collins
- Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia.
| | - Fiona Israel
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ;
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Ekberg K, Schuetz S, Timmer B, Hickson L. Identifying barriers and facilitators to implementing family-centred care in adult audiology practices: a COM-B interview study exploring staff perspectives. Int J Audiol 2020; 59:464-474. [DOI: 10.1080/14992027.2020.1745305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katie Ekberg
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Simone Schuetz
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Barbra Timmer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Sonova AG, Stafa, Switzerland
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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CE: Original Research: Helping Health Care Providers and Staff Process Grief Through a Hospital-Based Program. Am J Nurs 2019; 119:24-33. [DOI: 10.1097/01.naj.0000569332.42906.e7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jors K, Tietgen S, Xander C, Momm F, Becker G. Tidying rooms and tending hearts: An explorative, mixed-methods study of hospital cleaning staff's experiences with seriously ill and dying patients. Palliat Med 2017; 31:63-71. [PMID: 27160701 DOI: 10.1177/0269216316648071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIM Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying. DESIGN Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis. SETTING Large university clinic in southern Germany. PARTICIPANTS A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff ( n = 240) working at the clinic in September 2008, and response rate was 52% (125/240). RESULTS Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1-3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless. CONCLUSION Cleaning staff perceive that they have an important role in the clinic-not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death.
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Affiliation(s)
- Karin Jors
- 1 Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Tietgen
- 1 Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carola Xander
- 1 Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Momm
- 2 Department of Radio-oncology, St. Josefsklinik Offenburg, Offenburg, Germany
| | - Gerhild Becker
- 1 Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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