How do Professionals in Municipal Health and Welfare Relate to Bereaved Persons During the Acute Phase of a Drug-Related Death? A Qualitative Study

The experience of drug-related client loss for healthcare professionals who support people in addiction

INTRODUCTION

Addiction support and recovery is a multi-faceted support context in which practitioners work with clients who present with increased mortality risks. Drug-related deaths are understood to be a risk factor for complicated grief-reactions but, to date, research has neglected to explore the intricacies of drug-related client loss for practitioners who work with clients experiencing addiction. Due to wider expectations of professional endurance and the demanding nature of health care, grief-related reactions associated with the loss of a client may go unprocessed and, therefore, result in long-term health implications.

METHOD

Fifteen health care professionals took part in individual semi-structured interviews, which were analyzed using reflexive thematic analysis. Participants represented various disciplines in addiction support and recovery, including homelessness, inclusion health, addiction, and emergency medicine.

RESULTS

Three core themes emerged encapsulating the experience of drug-related bereavement for HCPs who support people experiencing addiction, as follows: (i) Grief Beneath the Surface, (ii) The Cost of Caring, and (iii) Finding Closure. The findings identified acute grief-related reactions in HCPs such as self-blame and shame, alongside fears of litigation and questions of clinical competency. Participants' accounts of drug-related client loss emphasized a deep professional connection with those that they work with, with grief-responses akin to the loss of peers, family members, and other close connections. The bereavement experience was complicated by unique compounding variables associated with drug-related deaths, but also by incongruity between their emotional responses to death and their professional responsibilities.

CONCLUSIONS

This article highlights the complex nature of drug-related client loss, and despite their social positioning as experts in their field, HCPs' reactions to client deaths were predominantly human responses to loss. The article identified a need for targeted postvention protocols that address complicated grief while also allowing staff to resume occupational functioning in a measured manner.

Innovation in Bereavement Care: Research Circles as a Framework for Translation of Research-Based Knowledge

This article aims to contribute to the research-practice gap in bereavement care by exploring Research Circles as a collaborative approach to implementation of research-based knowledge into bereavement care. Particularly the article discusses key dimensions for translating research concerning bereaved after drug-related deaths into practice-relevant knowledge, as a first step of implementation. This co-created knowledge translation took place in the first phase of a Research Circle including bereaved mothers, practitioners and researchers. Data were collected via semi-structured interviews with Research Circle participants and field notes. Data were analyzed using reflexive thematic analysis. Results showed two key dimensions with the Research Circle approach influencing the translation process: (1) multiple and long-lasting arenas for translation: (2) multiple stakeholders and perspectives. Research Circles appear to be a promising framework for translating research-based knowledge in bereavement care, but there are some barriers to fully realizing the democratic ideal that underlines the Research Circle framework.

Barriers and facilitative factors in the provision of first-responder services to persons bereaved following a drug-related death: A qualitative study

Aim: To broaden our knowledge from the perspective of municipality first-responder services of what prevents and what facilitates the provision of professional assistance to the bereaved after a drug-related death during the acute phase. Method: A reflexive thematic analysis was applied in six focus group interviews with 27 first-responder personnel in Norway. Results: The acute phase presented a challenging and complex support situation. We identified two main barriers: failure to initiate services and difficulties meeting with bereaved persons who use drugs. Facilitative factors were associated with competence and proactive cooperation. We discuss the findings in light of associated stigma, disenfranchised grief and an ecological approach to public services. Conclusion: First-responder professionals must understand drug-related death as a potentially traumatising event and initiate the procedures set out in the national guidelines. To achieve this, first-responder health and welfare services must become more knowledgeable about drug-related loss and bereavement, acute grief reactions and the need for psychosocial follow-up.

"How Do Municipal Managers Describe Improving the Services Provided to Drug Death-Bereaved Persons?" a Qualitative Study

Bereavement following drug-related losses is potentially traumatizing and may cause adverse health outcomes. These bereaved experiences are unacknowledged and omitted in municipal health and welfare service delivery. Reflexive thematic analysis was applied to six focus group interviews with 26 municipal managers. Knowledge about municipal managers' perspectives for improving psychosocial follow-up to drug-death-bereaved persons was perceived as vital for improving the quality of public services. The findings show how the services are perceived to be affected by macro-, meso, and micro-level processes. The participants suggested that service delivery should be based on an integrated organizational approach. Political, organizational, administrative, financial, and communicative processes are addressed and discussed in light of Osborne's theory of public service logic. The managers argue that a broad, contextual frame and infrastructure, enhancing managers' latitude of action regarding employees and facilitating collaborative service flexibility, would provide more sustainable, competent services.