Exploring family members’ experiences during a death process in the emergency department: A grounded theory study

Family members' experiences of bereavement in the emergency department: A meta-synthesis of qualitative studies

The emergency department (ED) is one of the places where patient deaths frequently occur. Understanding family members' experiences of bereavement would help provide individualized bereavement care. We conducted a meta-synthesis to synthesize family members' experiences of bereavement in the ED and assess the impact of bereavement on their lives. We searched seven international electronic databases. Five studies were selected and critically appraised. Thematic analysis was employed. Five themes (with 13 subthemes) were derived: suffering sudden changes and are severely impacted, multiple feelings and needs of waiting, final farewell, personal and family difficulties after leaving the ED, and journey through grief. Family members endured agonizing waits to see and learn more about their family members' condition. Family members reported the need for effective follow-up resources. Findings revealed that it would be helpful if the EDs could provide sensitive and respectful care to family members.

Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence

AIM

To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals.

METHODS

A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review.

RESULTS

Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death.

CONCLUSION

Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes.

RELEVANCE TO CLINICAL PRACTICE

This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.

Families' experiences of grief and bereavement in the emergency department: A scoping review

AIM

Death is a frequent event in the emergency department, and many family members experience grief and bereavement. However, little is known about what families experience. The aim of this study was to explore previous findings about families' experiences of grief and bereavement in the emergency department to clarify and understand their experience.

METHODS

A scoping review was chosen as the design for this research. Studies were searched from four electronic databases. The obtained studies were screened independently by two reviewers and selected by mutual agreement of the entire team based upon the eligibility criteria. All relevant data were extracted, and thematic analysis was conducted to assess families' grief and bereavement experiences in the emergency department.

RESULTS

The database searches initially resulted in 982 studies; these were finally narrowed to 20 studies for data extraction. Publication years ranged from 1987 to 2020. The studies were conducted across nine countries; most were from the United States and had a qualitative research design. Analysis elicited the following themes: "lack of information," "breaking bad news," "being present during resuscitation," "chaotic environment," "psychosocial reaction in bereavement," and "support and care needs from healthcare professionals."

CONCLUSION

These themes reveal challenges in providing support and care from emergency nurses to bereaved families, including inadequate provision of information, poor design of the emergency department due to the lack of privacy, and families' unmet support and care needs. Emergency nurses need to better understand families' experience of grief and bereavement.

Atitudes dos enfermeiros frente à morte no contexto hospitalar: diferenciação por unidades de cuidados

RESUMO Objetivo identificar a ocorrência da morte nas unidades de cuidados, bem como analisar os registros e as atitudes dos enfermeiros frente à morte no contexto hospitalar. Método estudo quantitativo, descritivo, transversal, com participação de 900 enfermeiros de um hospital do Norte de Portugal. Com recurso à triangulação de fontes de dados, a coleta realizou-se de fevereiro a março de 2018 através de questionário e observação de registros efetuados pelos enfermeiros. Para análise dos dados, usou-se estatística descritiva e analítica. Resultados são as unidades de medicina que apresentam maior número de mortes, sendo no turno da noite que se registra um valor mais elevado de ocorrências. Com relação às atitudes dos enfermeiros frente à morte, à exceção do evitamento, todas as outras evidenciam tendência semelhante entre o grupo profissional, independentemente da sua área de atuação. Os registros de enfermagem apresentam maior incidência ao nível da função ao invés de focados no domínio da pessoa. Conclusão e implicações para a prática além da aquisição de conhecimentos através da participação em formações sobre a morte e o processo de morrer, o acompanhamento e apoio dos profissionais, poderão desempenhar um papel fundamental na preparação dos enfermeiros para cuidar das pessoas em fim de vida.

How to care for the brought in dead and their relatives. A qualitative study protocol based on interpretive description

AIM

This project has two aims: (a) What do relatives to brought in dead (BID) describe as helpful and supportive care when they arrive at the emergency department to see and say goodbye to a deceased? (b) What do nurses describe as good nursing practice for BID persons and their relatives and what may hinder or facilitate this practice in an emergency setting?

DESIGN

A qualitative study in the methodology interpretive description.

METHODS

Data will be collected through three data sources: Individual interviews with relatives to BID persons, participant observations of relatives to BID persons during their presence in the emergency department and focus group interviews with emergency nurses.

DISCUSSION

Brought in dead persons and their relatives are received and cared for in emergency departments by emergency nurses. Knowledge of how to render care for the relatives to BID persons in an acute setting including what skills and competences this require of the nurses is warranted. We need to explore, describe, and comprehend the experiences of both the relatives and the nurses to point out potential areas of improvement.

IMPACT

This study is a protocol of an Interpretive Description study offering insight into considerations and reflections in designing the study.