How nurses cope with patient death: A systematic review and qualitative meta-synthesis

Bereavement coping strategies among healthcare professionals: A qualitative systematic review and meta-synthesis

OBJECTIVES

Coping with a patient's death is one of the most challenging events faced by healthcare professionals in clinical practice. A broad understanding of the coping strategies used by healthcare professionals is fundamental to the development of effective interventions and the provision of good bereavement care. This review aims to systematically synthesize the coping experience of healthcare professionals in the course of their work when they are confronted with patient deaths.

METHODS

PubMed, Embase, ScienceDirect, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus, and Wiley online library were searched in April 2023 with no restriction on publication date. A 3-stage thematic synthesis method was applied for data integration and analysis.

RESULTS

Thirty studies involving 545 participants met the inclusion criteria and scored a high level on quality assessment ranging from 9.0 to 10.0. Six themes were identified: emotional coping, cognitive coping, behavioral coping, relational coping, spiritual coping, and occupational coping.

SIGNIFICANCE OF THE RESULTS

Overall, the coping strategies used by healthcare professionals in response to bereavement were found to be unique and multidimensional. Understanding how healthcare practitioners use emotional, cognitive, behavioral, relational, spiritual, and professional strategies to cope with bereavement will prove extremely beneficial in helping them to manage their grief, and can furthermore promote their professional growth and ensure the provision of excellent bereavement care for patients.

Investigation of the effect of nurses' professional values on their perceptions of good death: a cross-sectional study in Türkiye

BACKGROUND

The care of patient individuals in the good death process should be planned based on nursing values. The aim of the study is to determine nurses' perceptions of a good death and its relationship with nursing values.

METHODS

The study is descriptive and cross-sectional and was completed with 210 nurses. Data were collected using the Nurse Information Form, Good Death Scale, and Revised Nursing Professional Values Scale. In the study, an attempt was made to reach nurses across Türkiye over a three-month period using the snowball sampling method without calculating the sample size beforehand. Descriptive statistics, Kruskal Wallis and Mann Whitney U test, LSD test, Spearman correlation and linear regression analyzes were used in the study.

RESULTS

The nurses' Good Death Scale total mean score was 53.52 ± 7.11, and The Revised Nursing Professional Values Scale mean score was 97.77 ± 15.71. There was a moderate, positive, statistically significant relationship between the nurses' Good Death Scale total mean scores and the Revised Nursing Professional Values Scale total mean scores (r = 0.522; p < 0.001).

CONCLUSIONS

Value-based educational activities may be effective in helping nurses have positive perceptions about a good death.

On Between Death and Life: Intensive Care Nurses

The aim of this study is to explore intensive care nurses' perceptions and experiences about death and dying patient. This study included 15 nurses from a university hospital's intensive care units (paediatric and internal medicine). Data were collected through face-to-face, in-depth and individual interviews using the "Nurse Information Form" and "Semi-Structured Interview Form". Six major themes and sixteen sub-themes were identified on the nurses' perceptions and experiences with death. After the nurses described their perceptions of death, their responses, approaches, coping mechanisms, and effects on the dead and dying patient in care and factors affecting perceptions of death were defined. Our findings suggest that nurses, particularly those working in intensive care, should be educated/trained on death, and dying patient care. Thus, orderly psychological support should be provided to nurses.

Readiness of nurses when faced with a patient's death

Introduction

The death of a patient negatively affects the professional dimension of nurses' functioning and also their private lives, where professional experiences and emotions are often transmitted.

Aim of the study

The main aim of the study was to discover how the nursing staff assessed their self-efficacy in dealing with the death of a patient.

Materials and methods

The researchers used a diagnostic survey method and a self-authored survey, Life Satisfaction Scale (SWLS), Coping Inventory for Stressful Situations (CISS), Generalized Self-Efficacy Scale (GSES), Courtauld Emotional Control Scale (CECS), The Death Anxiety and Fascination Scale with the Death Anxiety Subscale. The study group consisted of 287 individuals.

Results

Working in a hospital is stressful in the opinion of 79.44% of the respondents. 39.37% of the respondents feared death. In the course of work, the death of a patient in the department was sometimes experienced by 34.84% of the respondents, always experienced by 29.97%. The respondents usually did not make their compassion for a dying patient based on the patient's position in society (57.84%). In the case of the majority (84.67%) of the respondents, the employer did not provide mental support for the staff in difficult situations. The majority of the respondents did not feel the need to broaden their knowledge of death and dying (64.11%).

Conclusion

The surveyed nurses most often presented low or average life satisfaction, high self-efficacy, average levels of stress and coping in all three styles (with a preference for avoidance-oriented), and a high level of death fascination and an average level of death anxiety. The majority of the nurses in difficult situations and when a stressful situation occurred did not receive support from their employer or from physicians, but could count on the assistance of fellow nurses and a divisional nurse. The majority of the respondents felt that psychological support in their work was important and would gladly benefit from it. Although most nurses did not feel the need to broaden their knowledge of death/dying, they would take part in such a course if it were possible.

Exploring the concept and management strategies of caring stress among clinical nurses: a scoping review

Objective

The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of caring stress, a scoping review study was designed. This scoping review aimed to investigate the concept of caring stress among clinical nurses and examine the strategies used for its management.

Methods

This review employed a scoping review methodology to comprehensively map the essential concepts and attributes of the phenomenon by drawing on a wide range of sources. International databases including PubMed, Scopus, Web of Science, Google Scholar, and Scientific Information Database (SID) were searched to gather relevant studies published until October 1, 2023. MESH terms included "caring stress", "care", "stress", "nurse", and "stress management" were used. Two reviewers independently collected data from full-text papers, ensuring that each paper underwent assessment by at least two reviewers.

Results

Out of 104,094 articles initially searched, 22 articles were included in this study. High workloads, transmitting the infection, stressful thoughts, stressful emotions, and stressful communications were the significant concepts and factors of caring stress among nurses. Also, rest breaks during patient care shifts, playing music in the ward, and denial of critical situations were examples of positive and negative coping and management ways to reduce caring stress.

Conclusion

Effective stress management strategies can lead to better patient care and safety. Stressed nurses are more likely to make errors or become less vigilant in their duties, impacting patient outcomes. By addressing caring stress, clinical practice can prioritize patient well-being. Further research is required to delve deeper into this critical issue concerning nurses in the future.

The Effect of a Repeated Standardized Patient-Based End-of-Life Care Training Program on Nursing Students' Knowledge, Attitudes, and Emotions Toward End-of-Life Patients

BACKGROUND

Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it.

AIM

This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients.

METHOD

This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test.

RESULTS

The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills.

CONCLUSION

Universities should integrate repeated standardized patient-based into nursing curricula.

Intensive Care Nurses' Experiences Related to Dying Patients: A Qualitative Study

OBJECTIVE

To describe intensive care nurses' experiences of caring for dying patients.

METHOD

This study was carried out between July 15, 2019, and September 15, 2019, in a university hospital's intensive care unit. We conducted in-depth semi-structured interviews with a purposive sample of 14 intensive care nurses to describe their experiences related to patient deaths. Qualitative thematic analysis was used to identify, analyse and report the identified themes.

RESULTS

Four themes were identified: (I) Emotions experienced the first time their patient passed away; (II) feelings and thoughts on impact of death; (III) difficulties encountered when providing care and (IV) coping methods with this situation.

CONCLUSION

Despite the passage of time, nurses are unable to forget their death experiences when they first encountered. They oftentimes use ineffective methods of coping and were negatively affected physically and emotionally.

The impact of psychological distress, socio-demographic and work-related factors on coping strategies used by nurses during the COVID-19 pandemic: A cross-sectional study

AIM

This study aimed to determine factors associated with coping strategies used by nursing staff during the COVID-19 pandemic in Iran.

DESIGN

Cross-sectional study.

METHODS

A convenience sample of 365 nurses were selected from referral hospitals for COVID-19 patients in Tabriz, Iran between February 2022 and July 2022. An online self-administered questionnaire was distributed through social media platforms, including WhatsApp and Instagram. The survey package included a modified Brief COPE scale, socio-demographic and work-related questions, and a measure of psychological distress. Multiple regression analysis examined associated factors with coping strategies in SPSS. The study adhered to the STROBE guidelines for reporting.

RESULTS

The mean age of participants was 31.2 (7.3) years old. Of the 365 participants, 209 (58.9%) used maladaptive coping strategies, and 214 (57.6%) reported experiencing psychological distress. Psychological distress was the strongest predictor of maladaptive coping strategies (β = 4.473, p < 0.001). Female nurses (β = 3.259, p < 0.05), nurses who were under 35 years of age (β = 3.214, p < 0.05), nurses with fewer than ten years of experience (β = 2.416, p < 0.001), those who worked in COVID-19 ICUs (β = 4.321, p < 0.001), floor nurses (β = 2.344, p < 0.001), and those who worked two or more years in COVID-19 settings (β = 3.293, p < 0.001) had higher mean scores in maladaptive coping strategies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach

AIM

The study described the perception and attitude of Saudi male nursing students towards death and dying.

METHODS

This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data.

RESULTS

The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals.

CONCLUSION

The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Registered Nurses' attitudes towards end-of-life care: A sequential explanatory mixed method study

AIMS

To examine registered nurses' attitudes about end-of-life care and explore the barriers and facilitators that influence the provision of high-quality end-of-life care.

DESIGN

A sequential explanatory mixed methods research design was used.

METHODS

An online cross-sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end-of-life care. Following the survey, a subset of registered nurses were interviewed using individual semi-structured interviews.

RESULTS

Four hundred and thirty-one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end-of-life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end-of-life care. The facilitators included gaining support from colleagues and patients' families.

CONCLUSION

This study has identified that while registered nurses hold generally favourable attitudes towards end-of-life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings.

RELEVANCE TO CLINICAL PRACTICE

Education providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross-section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture-specific knowledge which will also enhance communication and coping methods.

REPORTING METHOD

This study used the Mixed Methods Article Reporting Standards (MMARS).

Nurses' Perception and Performance of End-of-Life Care in a Tertiary Hospital

Purpose

This study aimed to identify levels of perception and performance of end-of-life care among nurses and to investigate correlations between perception and performance.

Methods

This cross-sectional descriptive survey included 321 nurses from a tertiary hospital in Seoul, Korea. The participants had at least 6 months of work experience and had been involved in end-of-life care at least once, in either ward or intensive care unit settings. A structured questionnaire was utilized to assess their perception and performance of end-of-life care.

Results

The mean score for perception of end-of-life care was 3.23±0.34, while the score for performance of end-of-life care was 3.08±0.34. There was a significant positive correlation between nurses' perception of end-of-life care and their performance in this area (r=0.78, P<0.001).

Conclusion

It is necessary to change perceptions regarding end-of-life care and to develop systematic and standardized education programs including content such as assessing the hydration status of dying patients, evaluating mental aspects such as suicidal ideation, and providing spiritual care for nurses working in end-of-life departments.

"Time and life is fragile": An integrative review of nurses' experiences after patient death in adult critical care

INTRODUCTION

Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses' experiences after patient death.

AIM

The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care.

DESIGN

A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.

RESULTS

From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses; (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support; and (iii) nurses' emotional response to patient death including coping mechanisms.

CONCLUSIONS

Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.

Influencing factors of nurses' short-term bereavement reactions after patient death

An online cross-sectional survey was performed among 181 nurses in mainland China who experienced their most recent patient death within the last month. Multivariate linear regressions were used following bivariate analysis to identify influencing factors for their short-term professional bereavement reactions. More intensive reactions were associated with the nurse's fewer experiences of patient death; the nurse's employment in the intensive care unit rather than the emergency, oncology, geriatrics, or internal medicine departments; and the patient experiencing more pain in the last few days. Higher reaction scores were also reported by nurses who lost the patient more than 1 week prior.

Hospital-Based Interventions to Address Provider Grief: A Narrative Review

CONTEXT

Provider grief, i.e., grief related to the death of patients, often forms an ongoing and profound stressor impacting healthcare providers' ability to maintain their sense of well-being, avoid feeling overwhelmed, and sustain quality and compassionate patient care over time.

OBJECTIVES

This narrative review presents findings on the types of interventions hospitals have offered to physicians and nurses to address provider grief.

METHODS

Searches of PubMed and PsycINFO were conducted for articles (e.g., research studies, program descriptions and evaluations) focused on hospital-based interventions to help physicians and nurses cope with their own grief.

RESULTS

Twenty-nine articles met inclusion criteria. The most common adult clinical areas were oncology (n = 6), intensive care (n = 6), and internal medicine (n = 3), while eight articles focused on pediatric settings. Nine articles featured education interventions, including instructional education programs and critical incident debriefing sessions. Twenty articles discussed psychosocial support interventions, including emotional processing debriefing sessions, creative arts interventions, support groups, and retreats. A majority of participants reported that interventions were helpful in facilitating reflection, grieving, closure, stress relief, team cohesion, and improved end-of-life care, yet mixed results were found related to interventions' effects on reducing provider grief to a statistically significant degree.

CONCLUSION

Providers largely reported benefits from grief-focused interventions, yet research was sparse and evaluation methodologies were heterogenous, making it difficult to generalize findings. Given the known impact provider grief can have on the individual and organizational levels, it is important to expand providers' access to grief-focused services and to increase evidence-based research in this field.

Palliative care nurses' experiences of stress, anxiety, and burnout: A thematic synthesis

OBJECTIVES

This systematic literature review aimed to critically appraise empirical evidence investigating palliative care (PC) nurses' experiences of stress, anxiety, and burnout.

METHODS

Six databases (PsycINFO, MEDLINE, Scopus, CINAHL, PubMed, and Web of Science) covering literature within psychology, medicine and healthcare, and social sciences were searched from inception until December 2020. Studies were eligible if they included qualitative literature reporting on experiences of nurses working in a PC setting of stress, anxiety, or burnout, and were published in English. Eighteen studies satisfied the review's inclusion criteria and were considered relevant to the review aims. Critical appraisal was undertaken using the Critical Appraisal Skills Programme Qualitative Checklist.

RESULTS

Thematic synthesis identified three main themes: When work becomes personal, The burden on mind and body, and Finding meaning and connection. The findings suggested that stress, anxiety, and burnout are deeply personal feelings experienced by nurses both on an emotional and physical level. Additionally, PC nurses' experiences can differ in meaning and strength depending on their relationships with patients, patients' families, and colleagues.

SIGNIFICANCE OF THE RESULTS

The synthesis highlighted that PC nurses' experiences are complex, encompassing clinical and organizational challenges, and the personal impact their work has on them. Having a greater understanding of the factors that contribute to PC nurses' experiences may help in PC nurses' core training and continuing professional education, as well as the provision of effective supervision and staff support.

An Exploratory Study of ICU Pediatric Nurses' Feelings and Coping Strategies after Experiencing Children Death

BACKGROUND

This study aims to explore the feelings and experiences of nursing staff when faced with the death of a pediatric patient in the ICU.

METHODOLOGY

A qualitative study based on hermeneutic phenomenology was conducted through semi-structured interviews. Ten nurses (30% of staff) from the Pediatric Intensive Care Unit of a referral hospital were interviewed in April 2022. Text transcripts were analysed using latent content analysis.

RESULTS

Content analysis indicated that the interviewees had feelings of sadness and grief; they had a misconception of empathy. They had no structured coping strategies, and those they practiced were learned through personal experience, not by specific training; they reported coping strategies such as peer support, physical exercise, or strengthening ties with close family members, especially their children. The lack of skills to cope with the death and the absence of support from personnel management departments were acknowledged. This can lead to the presence of compassion fatigue.

CONCLUSIONS

The feelings that PICU nurses have when a child they care for die are negative feelings and sadness, and they possess coping strategies focused on emotions learned from their own experience and without institutional training support. This situation should not be underestimated as they are a source of compassion fatigue and burnout.

Nurses' practices and their influencing factors in palliative care

Background

In 2017, the Chinese government launched a pilot project in palliative care, in which Shanghai was a pioneer. Nurses play a key role in palliative care services as they are the main providers improving the quality of services for patients and their families. However, little is known about practices and influencing factors in the field of palliative care from a nursing perspective in China. This is an original empirical study that has meticulously analyzed the interrelationship and intensity between practices and other factors among nurses in the initial stage of palliative care in primary healthcare institutions in Shanghai, China.

Methods

A descriptive-correlational study design was used to sample 2,829 eligible palliative care nurses by purposive sampling survey in 225 healthcare institutions in Shanghai, China. Descriptive analyses were performed using IBM SPSS 24.0 software. Structural equation modeling was applied to analyze the data by AMOS 20.0. Data were collected using the well-designed Knowledge, Attitudes, and Practices of Hospice Care (KAPHC) scale.

Results

The final model showed a good model fit. Self-efficacy directly influenced practices (β = 0.506, P < 0.01) and indirectly influenced practices (β = 0.028, P < 0.01) through intention. Subjective norm directly influenced practices (β = 0.082, P < 0.01) and indirectly influenced practices (β = 0.030, P < 0.01) through intention. Intention (β = 0.152, P < 0.01) and knowledge (β = 0.068, P < 0.01) directly influenced practices. Perceived susceptibility (β = -0.027, P < 0.01), perceived benefits (β = -0.017, P < 0.01), and perceived barriers (β = -0.014, P < 0.01) indirectly influenced practices through intention.

Conclusion

This study provided evidence of the associations of knowledge, perceived susceptibility, benefits, barriers, subjective norm, self-efficacy, intention, and practices among nurses concerning palliative care and interventions improving their actual work practices. Our findings revealed that self-efficacy, intention, and subjective norms greatly influenced practices. It is imperative to take interventions that focus precisely on self-efficacy, intention, and subjective norms to improve nurses' practices.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.

[Emotional distress and trauma at the threshold of death: health issues and levers for action]

The emotional load and the confrontation with the end of life and death that health professionals regularly endure are occupational health and public health issues. Understanding their deleterious effects on the health of caregivers is only a first step, which must be followed by the identification of the various levers of action that can be mobilized.

Self-described Nursing Responses Experienced During Care of Dying Patients and Their Families: A Phenomenological Study

Critical care nurses care for dying patients and their families. Little is known about the feelings and experiences of critical care nurses and how they are affected when they provide end-of-life care. Study purpose was to understand lived experiences, responses, and feelings of critical care nurses providing end-of-life care. A descriptive phenomenological design with purposive sampling was used to recruit 19 critical care nurses who cared for dying patients and their families. Interviews were recorded and transcribed verbatim. Nurses were asked open-ended questions about experiences and responses while providing end-of-life care. Coliazzi's method of data analysis was used to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodological rigor was established. Responses included personalizing the experience, sadness, ageism, anger, frustration, relief, and stress. Factors contributing to clinicians' lived experience included previous experiences with death affecting how the experience was personalized among others. Critical care nurses may be unprepared for feelings and responses encountered during end-of-life care. Preparation for feelings and responses encountered during end-of-life care in nursing education and critical care orientation classes is essential. Future research should study optimal mentoring, teaching, and preparation for providing optimal end-of-life care. Study results have implications for practice, education, and research.

Relationship between Death Coping and Death Cognition and Meaning in Life among Nurses: A Cross-Sectional Study

To explore nurses' ability to cope with death and its relationship with death cognition and meaning in life in the context of Chinese traditional culture. 1146 nurses from six tertiary hospitals were recruited. Participants completed the Coping with Death Scale, the Meaning in Life Questionnaire, and the self-made Death Cognition Questionnaire. Multiple regression analysis revealed that the search for meaning, the understanding of "good death", receiving education related to life-and-death, cultural aspect, the presence of meaning, and the number of patient deaths experienced in career explained 20.3% of the variance in the ability to cope with death. Lacking a correct understanding of death, nurses are not sufficiently prepared to deal with death and their ability to cope with death is influenced by the unique cognition of death and the sense of the meaning in life in the context of Chinese traditional culture.

Complicated grief and related factors among nursing staff during the Covid-19 pandemic: a cross-sectional study

BACKGROUND

The challenging working conditions during the Covid-19 pandemic created a perfect storm that can seriously impact nurses' physical and psychological well-being. Our study aimed to investigate complicated grief and its related factors among nursing staff during the Covid-19 pandemic.

METHODS

This is a cross-sectional study. The participants comprised 375 nurses selected by the convenience sampling method from designated wards for patients with Covid-19 in 3 hospitals in Tabriz, Iran. Participants completed a survey containing demographic and clinical questions, the Inventory of Complicated Grief, and the Multidimensional Scale of Perceived Social Support. Multiple regression analysis was used to identify the associates of nurses' grief. The STROBE guidelines were followed in reporting the study's findings.

RESULTS

A significant proportion of participants (57.6%) were found to be suffering from complicated grief. Gender, educational background, type of ward, type of nursing role, type of working shift, years of nursing work experience, and experience working in the Covid-19 settings remained the significant associates of nurses' grief in the regression analysis.

CONCLUSION

Due to frequent exposure to patients' deaths, healthcare providers are at increased risk of suffering from complicated grief during the Covid-19 and post-pandemic. If it remains unresolved, complicated grief can result in significant health problems and the experience of burnout among nurses. Governments, health authorities, and nursing managers should support nurses who work in Covid-19 settings to reduce the adverse impact of the pandemic on nurses' health and well-being.

Relationship Between Physician's and Nurses' Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients

We aimed to determine the relationship between the attitudes of healthcare professionals towards futile treatment and their approach to death and terminally ill patients. We collected the data from nurses-physicians working in the intensive care unit, using the Nurses' Attitudes towards Futile Treatment Scale (NAFTS) and Approach to Death and Dying Patients Attitude Scale (ADDPAS). Avoidant attitudes displayed towards death and terminally ill patients increase as futile treatment is administered more. Health workers who work in the intensive care unit and witness futile treatment more frequently in the clinic are of the opinion that futile treatment should not be performed.

Perspectives of family-centred care at the end of life during the COVID-19 pandemic: A qualitative descriptive study

AIM

To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID-19 pandemic.

BACKGROUND

To minimise the transmission of COVID-19, stringent infection prevention and control measures resulted in restricted hospital access for non-essential workers and visitors, creating challenges for the provision of family-centred care at the end of life.

DESIGN

Qualitative descriptive approach based on naturalistic inquiry.

METHODS

At a large public hospital in Melbourne, Australia, individual semi-structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID-19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting.

RESULTS

Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements; (ii) nurse-family communication; (iii) family-centred care and interrupted connections; (iv) well-being and negative emotions; and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy.

CONCLUSIONS

Negative consequences for communication and the patient-family connection at the end of life were felt deeply. The evolving COVID-19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply.

RELEVANCE TO CLINICAL PRACTICE

Technology-facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family-centred approach to care and emphasising the patient-family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies.

PATIENT OR PUBLIC CONTRIBUTION

Bereaved family members contributed their first-hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.

(Dis)Agreement with Dysthanasia, Religiosity and Spiritual Experience as Factors Related to Nurses' Workload during End-of-Life Care

This study intended to investigate whether the workload of nurses in the course of providing end-of-life care correlated with their religiousness, spiritual experience and level of agreement with dysthanasia procedures. The respondents included 279 nurses from four Croatian hospitals. A structured and validated instrument was applied. Almost 90% of respondents are religious, and almost 45% of them have daily spiritual experiences. Respondents, especially those with high levels of religiousness and spiritual experience, express a low level of agreement with dysthanasia (mean = 58.21; score = 25−125). Moreover, nurses self-rated (on a scale of 1−5) their workload as quite high, especially when performing contradictory tasks imposed on them by their superiors (mean = 3.05) and during direct contact with dying patients and their family members (mean = 2.56). This significantly highest level of workload was experienced by the youngest nurses (p = 0.01) and nurses with little work experience (p < 0.01). This study also indicated that nurses who agree with dysthanasia experienced a higher level of workload when providing end-of-life care (r = 0.178; p < 0.01), while more frequent spiritual experiences reduced the level of workload (r = −0.205; p < 0.01). A deeper understanding of nurses’ attitudes toward dysthanasia, as well as of their religiousness and spiritual experiences, may ensure the collection of data beneficial to the timely identification of potential risks caused by workload.

Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.

Investigation of The Relationship Between Nursing Students' Fear of Death and Their Perceptions of Patient Care

Amaç: Bu araştırma hemşirelik öğrencilerinin yaşadıkları ölüm korkusu ile hasta bakım algıları arasındaki ilişkinin incelenmesi amacıyla gerçekleştirilmiştir. Yöntem: Araştırma kesitsel, tanımlayıcı ve ilişki arayıcı tipte olup araştırmanın örneklemini, Ekim-Kasım 2021 tarihleri arasında bir üniversitenin hemşirelik bölümünde öğrenim gören 326 öğrenci oluşturmuştur. Verilerin toplanmasında, ‘Kişisel bilgi formu’, ‘Ölüm korkusu Ölçeği’ ve ‘Bakım Davranışları ölçeği-24’ kullanılmıştır. Veriler yüz yüze toplanmış olup form ve ölçeklerin doldurulması ortalama 15 dakika sürmüştür. Bulgular: Çalışmaya katılanların çoğunun 280’inin (%85,9) kadın olduğu, 179’unun (%54,9) ölmekte olan hasta bakımı ile ilgili bilgi kaynaklarını okuduğunu, 245 öğrencinin (%75,2) çevresinde ölüm olgusuyla karşılaştığı, 306’sının (%93,9) yaşam sonu dönemde olan hastaya bakım verme deneyiminin olmadığı ve 175’inin (%53,7) ölümden korktuğu belirlenmiştir. Cinsiyete bağlı olarak kadınların hem ölüm korkusunun hem de yaşam sonu hasta bakımı hemşirelik algılarının, BDÖ-24 Ölçeği alt boyutlarından bağlılık ve saygılı olma alanlarında daha yüksek puan aldıkları belirlenmiştir. Yaşam sonu dönemde bir hastaya bakım verme deneyimi olmayan hemşirelik öğrencilerinin, ölüm korkusu ve bakım davranışları arasında anlamlı bir fark olmadığı belirlenmiştir (p&gt;0,05). Sonuç: Hemşirelik öğrencilerinin hemşirelik bakım algıları yüksektir. Kadın öğrencilerin hem ölüm korkuları hem de hemşirelik bakımı algıları erkeklerden yüksek olarak bulunmuştur. Yaşam sonu dönemde olan hastaya bakım verme deneyimi olmayan hemşirelik öğrencilerinin daha fazla güvence verme algısına sahip oldukları belirlenmiştir. Öğrencilerin yaşam sonu dönemde olan hastaya güvence verme algılarının yüksek olması açık bir şekilde yaşam sonu hemşirelik bakımı konusunda yetersiz bilgiye sahip olduklarını göstermektedir. Bu nedenle lisans eğitimi boyunca yaşam sonu dönem hasta bakımı ve ölüm korkusu konularında müfredatta daha fazla başlığın ve eğitim metodlarının yer almasının gerekli olduğu düşünülmektedir.

The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study

Background

Chinese clinical nurses are increasingly confronting patient death, as the proportion of hospital deaths is growing. Witnessing patient suffering and death is stressful, and failure to cope with this challenge may result in decreased well-being of nurses and impediment of the provision of “good death” care for patients and their families. To our knowledge, few studies have specifically explored clinical nurses’ experiences coping with patient death in mainland China. 

Objective

We aimed to explore nurses’ experiences coping with patient death in China in order to support frontline clinical nurses effectively and guide the government in improving hospice care policy.

Methods

Clinical nurses were recruited using purposive and snowball sampling between June 2020 and August 2020. We gathered experiences of clinical nurses who have coped with patient death using face-to-face, semi-structured, in-depth interviews. Audio recordings were transcribed verbatim and analyzed using thematic analysis.

Results

Three thematic categories were generated from data analysis. The first was “negative emotions from contextual challenges.” This category involved grief over deaths of younger persons, pity for deaths without family, and dread related to coping with patient death on night duty. The second category was “awareness of mortality on its own.” Subthemes included the ideas that death means that everything stops being and good living is important because we all die and disappear. The third category was “coping style.” This category included focusing on treating dying patients, recording the signs and symptoms, and responding to changes in the patient’s condition. It also involved subthemes such as avoiding talk about death due to the grief associated with dying and death, and seeking help from colleagues.

Conclusions

Clinical nurses’ emotional experiences are shaped by intense Chinese filial love, charity, and cultural attitudes towards death. Reasonable nurse scheduling to ensure patient and staff safety is a major priority. “Good death” decisions based on Chinese ethical and moral beliefs must be embedded throughout hospital care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01054-8.

Workplace Stress in Portuguese Oncology Nurses Delivering Palliative Care: A Pilot Study

Oncology nurses often face complex end-of-life issues, underlining their need for specific training in palliative care. In this context, nurses experience several emotional and psychological dilemmas, which are often difficult to manage and result in high levels of workplace stress. This study aimed to determine the levels and work-related factors of workplace stress among oncology nurses. A descriptive baseline study was performed as part of a large four-phase study based on quantitative data collected from Portuguese oncology nurses. Of the 32 participating nurses, most were women, and the mean age was 42.69 ± 10.04 years. Overall, nurses revealed moderate levels of stress. Younger nurses with less professional experience had difficulties dealing with issues related to death and dying. This pilot study supported the development of a program of six Stress Management Training Workshops (SMTW) to reduce stress and increase adaptative strategies. Assessing workplace stress among oncology nurses should be the focus of intervention by managers and institutional leaders.

Nurses and nursing students' experiences on pediatric end-of-life care and death: A qualitative systematic review

BACKGROUND

End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas.

OBJECTIVE

This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients.

DESIGN

The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program.

DATA SOURCES

This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021.

RESULTS

Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries.

CONCLUSION

This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings.

Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families

BACKGROUND

Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families.

OBJECTIVE

The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals.

METHOD

This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis.

RESULTS

Two themes emerged: (1) living with conflicts intrinsic to the relationships, which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience, which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful.

CONCLUSIONS

The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts.

IMPLICATIONS FOR PRACTICE

This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.

Care after death in children's hospices: recommendations for moving and handling, and for managing physiological deterioration

BACKGROUND

Children's hospices provide a range of services for babies, children and young people who have a life-limiting or life-threatening condition, including care after death in specialist 'cool bedrooms'. Care after death is a challenging but important element of hospice care.

AIM

The aims of the study were to identify the practices of staff providing care after death in UK children's hospices, notably their moving and handling practices and their management of physiological deterioration, and to produce recommendations that promote safe and consistent practice in moving and handling and in managing physiological deterioration after death in UK children's hospices.

METHOD

An electronic survey was sent to all 54 UK children's hospices. Free-text responses were analysed using deductive content analysis and used to add depth to the quantitative findings.

FINDINGS

Out of 54 children's hospices, 33 responded to the survey. There were great variations in the way hospices delivered care after death, notably in length of stay, interventions and equipment. The lack of consistent practice grounded in evidence-based policy and training may mean that some staff experience higher levels of stress and anxiety than others and that some staff take risks when providing care after death, particularly to express empathy towards bereaved families.

CONCLUSION

Recommendations are made about moving and handling a child's body after death and managing its physiological deterioration. Hospices can use these recommendations to develop policy and training, standardise what is expected of staff and support practitioners in adequately caring for children after death.

Experience of Pediatric Patient Death, Moral Distress, and Turnover Intention among Pediatric Nurses at a Tertiary Hospital in South Korea: A Cross-Sectional Study

Background: Pediatric nurses are particularly vulnerable to moral distress and turnover due to frequent experiences with patient death combined with limited pediatric palliative resources and related support. Objective: This study examined pediatric nurses' experiences of pediatric patient death, moral distress, and turnover intention and identified the correlations between them as well as the mediating role of moral distress. Methods: This cross-sectional study conducted an online survey with 161 pediatric nurses working in a tertiary hospital in Seoul, South Korea. The survey comprised questions to assess nurses' experience of pediatric patient death and turnover intention and a validated instrument to measure their moral distress. Logistic regression was used to examine the relationships between study variables, and structural equation modeling was performed to determine the mediating effect of moral distress. Results: Pediatric nurses (N = 161) reported high levels of moral distress with a mean score of 101.06 (standard deviation = 70.528) on the pediatric version of the Moral Distress Scale. Turnover intention increased 1.01 times for every 1 U increase in moral distress. Moral distress fully mediated the relationship between the experience of pediatric patient death and turnover intention. Conclusion: Pediatric patient death had an indirect effect on turnover intention through moral distress among pediatric nurses. Reducing pediatric nurses' moral distress caused from experiencing patient death may help minimize their turnover intention.

Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care

PURPOSE

New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model.

DESIGN AND METHODS

Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey.

RESULTS

Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL.

PRACTICE IMPLICATIONS

This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children. Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.

Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study

BACKGROUND

The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences.

AIMS AND METHODS

This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients.

RESULTS

Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support.

CONCLUSION

Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.

The effect of death anxiety in nurses on their approach to dying patients: A cross-sectional study

PURPOSE

This study was conducted to determine death anxiety levels in nurses and to examine its effect on their approach to dying patients.

DESIGN AND METHODS

The study was conducted with 240 nurses. Study data were collected by Personal Information Form, Thorson-Powell Death Anxiety Scale, and Approach to Death and Dying Patients Attitude Scale.

FINDINGS

According to the total scores of the nurses included in the study, it was determined that they experienced mild death anxiety and exhibited a moderate attitude of avoidance towards death and dying patients.

CONCLUSION

This study showed that as the death anxiety of nurses increased, their avoidance attitudes towards dying patients decreased.

Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals' experiences

BACKGROUND

Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients' feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals' experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named "remote home care" in palliative home care for patients with cancer.

METHODS

A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis.

RESULTS

Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care.

CONCLUSION

The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients' personal priorities. However, health-care professionals' uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.

A genealogy of what nurses know about 'the good death': A socio-materialist perspective

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

Confronting behaviour in palliative care: a qualitative study of the lived experience of nursing staff

BACKGROUND

Little research examines the extent and impact of aggressive or uncomfortable 'confronting behaviour' experienced by palliative care nurses, despite palliative wards being an emotionally labile environment.

METHODS

Qualitative data on nurses' experiences of confrontation were collected from 17 palliative care nurses at a major metropolitan hospital via a focus group and individual interviews. Data were analysed using inductive thematic analysis.

FINDINGS

Results indicated that family members were the main perpetrators and tolerance of confrontation varied dependent on the characteristics of the aggressor. Confrontation was described as arising in response to grief, and because of misunderstandings of palliative care goals. Nurses reported a perceived lack of appreciation for their work from some patients' families and feelings of discontent with the nature and amount of structured support available following a confrontation. Informal workplace support helped nurses to deal with these incidents and, despite bad experiences, nurses affirmed their commitment to working in this area.

CONCLUSION

The findings demonstrate the demands placed on nurses working in palliative care, and the importance of compassion in moderating the impact of a challenging environment.

Family interview for organ and tissue donation: good practice assumptions

OBJECTIVES

to identify information that can support creating good practice assumptions to develop family interview for organ and tissue donation.

METHODS

this scoping study, conducted in two Brazilian hospitals in the southern, between April and December 2017, included integrative review and consultation with 15 families who experienced interview for organ donation. For data analysis, thematic content analysis was used.

RESULTS

three categories emerged: communication of death, which shows the need to know the history of hospitalization of patients; emotional support, the team must have mastery of the stages of mourning; information about donation, professionals need to know the stages of the donation process and respect families' time.

FINAL CONSIDERATIONS

good practice assumptions point to the need for team training, respect for family time and the use of simple language.

Nobody Dies Alone in the Electronic Patient Record-A Qualitative Analysis of the Textual Practices of Documenting Dying and Death

In this study, we analyse the electronic patient record (EPR) as a genre and investigate how a death is documented as part of the EPR, that is, what kind of textual practices can be found, and how they can be understood based on extracts from 42 EPRs from medical wards in Norwegian hospitals. Following from our analysis, we see four distinct patterns in the documentation of patient death: a) registering the bare minimum of information, b) registering a body stopped working, c) documenting dying quietly and placing it in peaceful surroundings, and d) highlighting the accompanied death. The textual practices of documenting the transition to death in the EPR make death appear manageable and sanitised, depicting death as either uneventful or good. While the EPR genre is steeped in biomedical language, other discourses relating to death can be seen as ways to accommodate the ideal of a dignified death.

Patient's Death From the Perspective of Nursing Students

Introduction: An exceedingly small amount of scientific research concerns the response to patient death among nursing students. There was a need to examine their perspective on patient death with which they experience during their studies. The authors wanted to check the subjective assessment of students' preparation for patient death and their perception of classes conducted in this area. Methods: The research used the diagnostic survey method and was conducted in May 2019 using Google Form on social media. The 467 nursing students answered 14 questions in the original questionnaire about their experience with patient death. The analyzed data were expressed as median, minimum and maximum values, or percentage, as appropriate. Comparison of groups was performed using the Mann-Whitney U-test or the Kruskal-Wallis test. The relationship between variables was analyzed with Spearman correlation coefficient or contingency coefficient (the χ²-test). Results: The authors analyzed 452 responses of nursing students, and 86.3% of them encountered death of a patient in the course of their studies. In the second-year master's studies, this value reached 99.3%. Among the most frequently mentioned accompanying emotions, students mentioned "reflection on the fragility of life" and "compassion." Students do not feel sufficiently prepared for the death of a patient. Conclusions: Nursing students encounter the death of a patient very often and very early. Although the curriculum includes content related to the care of a dying patient, students believe that there is still too little of it and that it does not prepare it in a satisfactory manner. Students feel different, often negative emotions related to patient death, and also have various methods of dealing with such a situation. They also feel the need to increase education in this area.

Healthcare professionals' values about and experience with facilitating end-of-life care in the adult intensive care unit

OBJECTIVES

To evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.

RESEARCH DESIGN

Using a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.

SETTING

General adult intensive care unit at a tertiary referral hospital.

RESULTS

Compared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).

CONCLUSION

Findings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.

Social acceptance of death and its implication for end-of-life care

AIMS

To understand how the social patterns about death influence end-of-life care from the perspective of healthcare professionals.

DESIGN

A qualitative study according to the theory of Glaser and Strauss.

METHODS

A purposeful sample of 47 participants with different roles (nurses, physicians and clinical psychologists) were involved in four focus groups and 17 interviews in 2017-2019. Responses were audio-recorded, transcribed verbatim and analysed using computer-assisted qualitative data.

RESULTS

A core category 'the theory of social patterns about death' emerged, which is explained by three categories: the culture of concealment and stubbornness towards death, the effort and internal work to make death a part of existence, and the influence of the social patterns of coping with death on end-of life care and healthcare professionals. Our results suggest that social coping with death is affected by a network of concealment and obstinacy towards death.

CONCLUSION

Recognizing death as part of life and thinking about death itself are social coping strategies. Although healthcare professionals occupy a privileged place in this process, the culture of concealment of death influences end-of-life care.

IMPACT

The social process that leads to the loneliness of the dying in our days has been theorized. However, social acceptance of death also influences healthcare professionals' attitudes towards death. Thus, healthcare professionals' own attitudes may affect the end-of-life care given to dying individuals and their families. The social patterns of death may contribute to the healthcare professionals' negative attitudes towards death. The concept of dignified death has been linked to the notion of humanization of healthcare. Death should be approached from a more naturalistic perspective by healthcare professionals, healthcare and academic institutions.

The Process of Accepting Patient Deaths among Korean Nurses: Grieving over Dying

Purpose

Nurses' acceptance of patient deaths enables them to practice holistic end-of-life care and pursue positive living. The place where most deaths occur in Korea has changed from home to medical institutions, making it necessary to understand the process through which nurses who practice end-of-life care accept patient deaths. This study aimed to obtain insight into nurses' experiences of accepting patient deaths and to develop a practical theory regarding the context of this process.

Methods

This qualitative study investigated nurses' process of acceptance of patient deaths based on grounded theory.

Results

A core category of this process was found to be "grieving over dying", which consisted of the following steps "being close by", "being attentive", "acknowledging together", and "accompanying."

Conclusion

This study established that nurses' attentiveness toward dying people is due to their grief over patient deaths, and clarified Korean nurses' process of accepting patient deaths and its related factors.

Nursing students' first experience of death: Identifying mechanisms for practice learning. A realist review

OBJECTIVES

Many studies regarding nursing student's first experience of facing the death of a patient have focused on classroom methods or exploring attitudes towards death and related fears or anxieties. This review is the first to identify the mechanisms that facilitate practice learning as a result of students' first time experience of handling a patient's death.

DESIGN

A realist review as a form of a systematic review of the literature.

DATA SOURCES

The literature search focused on the earliest death experience of baccalaureate nursing students and end-of-life care, using databases MEDLINE, CINAHL, SCOPUS, ERIC, PSYCINFO.

REVIEW METHODS

Three research questions were addressed following a five-step process of (1) defining the scope of review and developing a theoretical framework, (2) conducting a theory-driven purposive search for evidence, (3) appraising evidence and extracting data, (4) synthesizing data and drawing conclusions, and (5) disseminating findings; with iterative expert consultation and discussion to answer the five questions of any realist review: 'what works, for whom, in what circumstances, how and why'.

RESULTS

Thirteen publications were included. Practice learning involves both changes and context improvements to be assessed and discussed by managers, leaders, nurse educators-facilitators and students. The environment and nursing role models are an inherent part of practice learning. Further work is needed to theorize the twelve key outcomes laid out in this review. These proposals require further consensus and the inclusion of inputs from both students and nurses.

CONCLUSION

The student nurse receives contradictory messages during the first experience of facing the death of a patient under their care. Considering the importance of this experience, specific indicators should be developed to track and guarantee and the optimal achievement of required competencies.

Hospice care self-efficacy among clinical medical staff working in the coronavirus disease 2019 (COVID-19) isolation wards of designated hospitals: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has caused more than 462,417 deaths worldwide. A large number of patients with severe COVID-19 face death in hospital. Hospice care is truly a philosophy of care that delivers patient-centred care to the terminally ill and their families. Hospice care could provide many benefits for patients, families, and for hospice caregivers. The aim of this study is to investigate hospice care self-efficacy and identify its predictors among Chinese clinical medical staff in COVID-19 isolation wards of designated hospitals.

METHODS

A cross-sectional design was used. The Hospice Care Self-Efficacy, Self-Competence in Death Work Scale, Positive Aspects of Caregiving, and Simplified Coping Style Questionnaires were administered between February and April 2020. A total of 281 eligible medical staff responded to the questionnaires, with a response rate of ≥78.9%.

RESULTS

The mean score of hospice care self-efficacy was 47.04 (SD = 7.72). Self-efficacy was predicted by self-competence in death work (B = 0.433, P < 0.001), positive aspects of caregiving (B = 0.149, P = 0.027), positive coping (B = 0.219, P < 0.001), giving hospice care to dying or dead patients before fighting against COVID-19 (B = -1.487, P = 0.023), occupational exposure while fighting against COVID-19 (B = -5.244, P = 0.004), holding respect for life and professional sentiment as motivation in fighting against COVID-19 (B = 2.372, P = 0.031), and grade of hospital employment (B = -1.426, P = 0.024). The variables co-explained 58.7% variation of hospice care self-efficacy.

CONCLUSION

Clinical nurses and physicians fighting COVID-19 reported a moderate level of hospice care self-efficacy during this pandemic. Exploring the traditional Chinese philosophy of life to learn from its strengths and make up for its weaknesses and applying it to hospice care may provide a new framework for facing death and dying during the COVID-19 pandemic. Continuous hospice care education to improve self-competence in death work, taking effective measures to mobilize positive psychological resources, and providing safer practice environments to avoid occupational exposure are also essential for the improvement of the hospice care self-efficacy of clinical nurses and physicians. These measures help caregivers deal effectively with death and dying while fighting against the COVID-19 pandemic.