Honoring the moment of death: Lived experiences, practices, and rituals of internal medicine residents

Given the limited information on physicians' practices at the time of pronouncing a patient's death, this study aimed to learn about the prevalence and purpose of internal medicine residents' practices, the obstacles to performing them and how they can be overcome. Responses to a questionnaire were analyzed using logistic regression, to compare respondents who did and did not have a ritual. Twenty-one interview transcripts were thematically analyzed. A total of 151 physicians responded to the questionnaire; 35 (22.3%) reported performing a private ritual at the time of patient death. Religious participants were 2.97 times more likely {CI: 1.18-7.41} to perform a ritual following a patient's death. Three main themes were found, indicating residents' need to pause and perform a practice to honor the patient, express their humanity, and cope with the overflow of emotions. Senior staff should support opportunities for residents to honor the moment of death.

An Integrative Review of "The Pause" After Patient Death

Background: Healthcare providers are engrossed in high-stakes, high-stress situations during their daily work with patient death being a potential negative outcome of work-related stress. Many interventions exist to combat work-related stress among nurses. The Pause, an intervention to offer a moment of silence for the healthcare team after a patient death, is one example. Objective: An integrative review of The Pause was conducted to investigate its use and how it impacts healthcare providers and their work environments. Methods: The integrative review methodology by Whittemore and Knafl was used to guide this study. Steps included were problem identification, literature search, data evaluation, data analysis, and presentation. Content analysis was used to identify themes. Results: Seven databases were searched in 2022 and seven studies were identified for inclusion in this review. Two themes were identified: personal benefits and professional benefits. Findings reveal benefits from self-care and grief processing to a better work environment. Conclusions: The Pause is a low-cost, low-risk intervention that can be implemented at an organizational level to help reduce burnout, unresolved grief, increase resilience, increase retention, and improve patient outcomes. Future research should include an examination of how The Pause may affect patient outcomes and workplace culture.

Composing a Life that Works with a Life that Counts for Nurses

The life of a nurse since the Covid-19 pandemic is characterized by high rates of anxiety, depression, and burnout, leading national organizations to declare the nursing shortage a national emergency. Solutions cite work-life balance, but this term has no clear guiding definition. Experts in the organizational psychology and personal development literature suggest other ways to reconsider this dilemma, that of integration. In this paper the concept of integration is proposed to focus on relationships with family and friends, work, and oneself. The American Association of Critical-Care Nurses 'standards for a healthy work environment are used to frame the benefits of an integrated life. Strategies to achieve an integrated life, one with meaning and purpose, are described to create more happiness and joy and to begin to mitigate the nursing shortage.

Posttraumatic Growth as a Model to Measure and Guide Implementation of COVID-19 Recovery and Resiliency

The COVID-19 pandemic has forced leaders to reconsider the various factors that attribute to work-life balance, a healthy work environment, and resilience among nurses. Posttraumatic growth (PTG) provides a lens through which clinicians and leaders can measure, articulate, and espouse resilient recovery through unprecedented times. This article suggests the use of PTG as a framework, measured by the Posttraumatic Growth Inventory to guide leaders as they implement job-specific resiliency interventions for professional nurses. This article also suggests 3 science-based interventions intended to increase PTG. Published data support the efficacy of these interventions: resilience retreats, resilience rounds, and "The Pause," while longitudinal impacts of PTG following these interventions remain currently unknown.

Factors associated with critical care nurses' acute stress disorder after patient death

BACKGROUND

In intensive care units, patient death can have a negative psychological influence on the patient's nurse. However, how the frequency of events and factors contributed to acute stress among nurses remains unknown.

OBJECTIVE

The objective of this study was to explore the prevalence of and the factors affecting acute stress disorder among intensive care unit nurses after their patient death.

METHODS

Nurses from five adult intensive care units whose patient had died during the nurses' working shift were recruited from July 2018 to April 2019. Bryant's Acute Stress Disorder Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory-II were used to measure acute stress, depression, and anxiety. Descriptive statistics, chi-square tests, independent sample t-tests, and stepwise logistic regression were used for data analysis.

RESULTS

In total, 119 nurses were enrolled. Nearly one in three nurses (29.4%) had suffered from acute stress disorder after their patient had died. Nurses experienced a higher risk of acute stress disorder when their patients underwent cardiopulmonary resuscitation before death (odds ratio [OR] = 13.75, 95% confidence interval [CI]: 2.59-72.95), when their patients died unexpectedly (OR = 4.88, 95% CI: 1.16-20.56), and when they experienced verbal abuse from the patient family at the patient death (OR = 4.61, 95% CI: 1.18-18.05) compared with their counterparts.

CONCLUSION

Intensive care unit nurses often experience acute stress disorder after their patient death. The nurses of patients who underwent cardiopulmonary resuscitation before death and/or who died unexpectedly and/or nurses who were subjected to verbal abuse by the patient's family were at higher risk of acute stress disorder. A comprehensive program aimed at improving the knowledge, skills, and resilience of nurses is needed.

Jewish Values in Medical Decision-making for Unrepresented Patients: A Ritualized Approach

Determining appropriate care for patients who cannot speak for themselves is one of the most challenging issues in contemporary healthcare and medical decision-making. While there has been much discussion relating to patients who left some sort of instructions, such as an advance directive, or have someone to speak on their behalf, less has been written on caring for patients who have nobody at all available to speak for them. It is thus crucial to develop clear and rigorous guidelines to properly care for these patients. The Jewish tradition offers an important perspective on caring for unrepresented patients and determining approaches to guide care providers. This article develops an understanding of fundamental Jewish principles that can provide clear guidance in navigating this challenge. It applies those values to a specific set of suggested behaviors, one of which adds a novel ritualized component to what has been recommended by bioethicists in the past.

Actions, style and practices: how leaders ensure compassionate care delivery

Demands for more patient-centred care necessitate that leadership creates the conditions for more compassionate care that is sustainable even in periods of acute crisis. We draw on a growing body of empirical research in health services, management and medicine to highlight how the combination of interpersonal acts, leadership style and organisational structures underpins leading with compassion. We further detail how this benefits care provider well-being and patient outcomes through fostering integrative thinking and prosocial motivation. We conclude with implications for practice.

Qualitative analysis of European and Middle East intensive care unit nursing death rituals

BACKGROUND

Grieving and death rituals vary widely across cultures and are often influenced by geographical regions, religions, and local norms. Nursing rituals reflect the forms of cultural behaviour that assist in communicating traditional knowledge and practices. They help nurses maintain social order through cohesion and interaction.

AIM AND OBJECTIVES

Exploration of European and Middle Eastern intensive care nursing ceremonies and rituals surrounding care provided to patients after death has been carried out. The key question researchers asked was "Can you describe your practice of caring for a patient who has died?"

DESIGN

Prospective qualitative thematic analysis.

METHODS

This study used a prospective qualitative thematic analysis investigating nursing practice and rituals when caring for patients who have died in intensive care. The interviews were conducted face-to-face with nurses consenting to be interviewed for research purposes. During the interviews, researchers noted sentences and topics, which they later classified into categories and subcategories. The interview settings were international and national conferences, workshops, meetings, and seminars over a 2-year period. Thematic analysis was performed. This analysis allowed the researchers to understand and make sense of collective meanings and experiences of participants.

RESULTS

A total of 23 interviews with critical care nurses from 16 countries in Europe and Middle East were conducted. Through reflective and meaningful analytical interpretation, two main themes (with subthemes) emerged: sacredness and dignity. More similarities than differences among the nurses' experiences were found. Rituals included, opening a window, lighting a candle, blessing the deceased, and bereaving with the family.

CONCLUSIONS

Post-death ritual reflects local guidelines regulating the handling of the deceased body, culturally approved expressions of mourning, and acts to perform at specific times following death. Nursing rituals expressed here demonstrated the dignity, wherein nurses show towards the deceased and relationships between deceased and bereaved.

RELEVANCE TO CLINICAL PRACTICE

The investigators perceived nursing culture, beliefs, ceremonies, and rituals surrounding caring for patients who have died to be creative, spiritual, meaningful, and relevant for nurses.