A decision model for community nurses providing bereavement care

Nursing Interventions in Primary Care for the Management of Maladaptive Grief: A Scoping Review

Grief is a natural and self-limited adaptation process to a new reality that emerges after a significant loss (whether real or perceived), with a broad variety of manifestations that exert an impact on a grieving person's health. The study aim was to synthesize the evidence available about the interventions carried out by Primary Health Care nurses, by means of an individual approach to reduce maladaptive grief or maladaptive grief risk. A scoping review was conducted (November and December 2023) through searches in Medline, Cinahl, Web of Science, ProQuest and Scopus using MeSH terms combined with Booleans. Primary research of any design in adult people undergoing grief situations and receiving professional assistance by nurses in the primary, home and community care contexts published after 2009 in English, Spanish or Portuguese languages were included. Excluded publications were those conducted in in-hospital clinical settings and which did not correspond to research designs or the gray literature. The screening process was carried out by two reviewers using the appropriate JBI critical appraisal tools for each design and discrepancies were resolved by a third reviewer. A total of n = 10 studies were included (n = 4 qualitative, n = 2 RCTs, n = 1 quasi-experimental, n = 2 cross-sectional observational, and n = 2 mixed methods). The qualitative studies identified topics and subtopics of professionals' and families' experiences of grief. The observational studies analyzed symptoms and factors associated with the grieving process. Interventions consisted of cognitive-behavioral therapies delivered by psychological specialists who assessed the severity of grief in a range of cultural contexts using different instruments. The evidence retrieved from the studies that address the reduction in maladaptive grief or maladaptive grief risk is not conclusive. There is a need to increase both the number and the methodological quality of studies assessing the effectiveness of Nursing care in Primary Health Care for individuals experiencing maladaptive grief or maladaptive grief risk. Further research should focus on experimental studies, developing specific interventions conducted by nurses to address individual's grief and prevent maladaptive grief.

Home-based nursing care competencies: A scoping review

AIMS AND OBJECTIVES

To identify and consolidate the available evidence about nursing-related competencies for home-based care.

BACKGROUND

Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses.

DESIGN

A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles.

RESULTS

Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.

Supporting bereavement and complicated grief in primary care: a realist review

Background

Bereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.

Aim

To identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.

Design & setting

A review of evidence on the management of CG and bereavement in UK primary care settings.

Method

A realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.

Results

Forty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.

Conclusion

Bereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

Comparison of clinical effectiveness of nurse led care among Chinese patients with cancer: A prospective study evaluating effective patient care compared to consultant oncologist

OBJECTIVE

The NLC model in oncology setting was not well established in China, and there was no study evaluating the clinical effectiveness of NLC versus oncologist-led care (OLC) in Chinese patients with cancer. We therefore designed a pilot study to evaluate the clinical usefulness after NLC versus OLC in Chinese patients with cancer.

METHODS

This pilot, single center, prospective study was designed to evaluate clinical effectiveness of NLC versus oncologist-led care (OLC) in Chinese patients with cancer. Adult patients of either gender (aged between 20 and 65 years) who were diagnosed with any cancer at China were included. The patients' with stage IV cancer or who were not willing to give written consent to participate in this study were excluded during screening phase of our study. We assessed the symptoms from each enrolled patients, the most common symptoms associated with any cancer patients are pain, dyspnea and constipation. Also distress symptoms (caused by pain and dyspnea) and low quality of life are seen in patients with advanced stage of cancer.

RESULTS

A total of 220 patients who were visited in our hospital for consultation were enrolled and assigned to nurse led care and oncologist led care group (110 patients in each group). Pain intensity, dyspnea intensity and constipation intensity was recorded for patients of nurse led care and oncologist led care group. Pain intensity, dyspnea intensity and constipation intensity on numerical rating scale was numerically lesser in Nurse led care group as compared to oncologist led care group. However, the difference was not statistically significant (p>0.05). The mean QoL score of each key domain of QoL was higher in nurse led care group when compared to oncologist led care group. Overall, significant improvement in quality of life was observed in individuals underwent in nurse led care group than oncologist led care group.

CONCLUSION

The results of this preliminary study showed that NLC results in better clinical outcome in terms of improvement in pain intensity, dyspnea intensity, symptom distress, constipation score, and QOL in comparison to oncologist led care among Chinese cancer patients. This study results can aid as a base for steering outsized clinical study to form the model of NLC among Chinese cancer patients.

Bereavement care interventions and outcome criteria planned by community nurses in the Canary Islands

Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief.

OBJECTIVE

To identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands.

METHOD

Retrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009-2014.

RESULTS

NOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion.

CONCLUSION

Nurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended.

Role of district and community nurses in bereavement care: a qualitative study

BACKGROUND

The district nurse is one of the main providers of palliative care, which includes bereavement care. However, previous evidence shows a lack of education and training, as well as time management, as important factors in the delivery of bereavement care.

AIM

This qualitative study aimed to explore the provision of bereavement care from a district nurse's perspective.

METHOD

Data were collected from five participants using semi-structured interviews, and thematically analysed to produce the findings. The interviews were conducted within the author's and participants' working environments to maintain a professional stance between both parties.

FINDINGS

The results suggest an awareness of bereavement care, but a lack of training and education into the theoretical aspects of the care. Knowing the types and stages of bereavement would be beneficial, both in the delivery and the identification of the most effective time to refer on.

CONCLUSION

Bereavement care was understood to be part of the district nurse role, but the findings suggest that some nurses get too involved and no end date could be standardised, as each case is dependent on need. More experience of bereavement care and exposure increased awareness to its importance and improved confidence toward its delivery.

Bereavement life review improves spiritual well-being and ameliorates depression among American caregivers

OBJECTIVE

The aim of our study was to investigate the utility of bereavement life review (BLR) to elevate spiritual well-being and alleviate depression among Hawaiian-American caregivers, and to identify changes that occur when caring for their loved ones up to the time of death.

METHOD

Bereavement life review therapy was provided for 20 bereaved Hawaiian Americans. In the first session, subjects reviewed memories of the deceased with a therapist, who recorded their narratives and collected them into a personal history book. During the second session, subjects discussed the contents of this book. Caregivers completed the Functional Assessment Chronic Illness Therapy-Spiritual (FACIT-Sp) questionnaire and the Beck Depression Inventory, Second Edition (BDI-II) pre- and post-intervention. Subjects also described changes in their views that occurred during the caring process in response to questions.

RESULTS

FACIT-Sp scores significantly increased from 34.1 ± 9.63 to 36.3 ± 10.6 (t = -2.6, p < 0.05, and BDI scores significantly decreased from 11.7 ± 7.7 to 8.8 ± 7.0 (t = 2.27, p < 0.05). Five categories were chosen from the narratives on changes that had occurred during caregiving and due to the deceased death: "Learning from practical caring experience," "Positive understanding of patients," "Recognition of appreciation," "Self-change or growth," and "Obtaining a philosophy."

SIGNIFICANCE OF RESULTS

These findings show the applicability of bereavement life review therapy for Hawaiian families, including efficacy for spiritual well-being and depression. The comments of the caregivers also indicate the potential of the therapy for identifying the positive aspects of caring for terminally ill patients.