Feelings and Emotions of Nurses Related to Dying and Death of Patients - A Pilot Study

Death and dying in pharmacy learners: A critical review

PURPOSE

This review article is the first comprehensive evaluation of the available literature surrounding the education of death and dying in pharmacy schools. The purpose of this review was to describe the available literature and methods utilized regarding the emotional preparation for patient death in pharmacy education.

PROCEDURES

Searches were performed in three pharmacy databases to identify articles that contained descriptions of activities related to death and dying education in pharmacy curriculums.

FINDINGS

Eleven journal articles were reviewed, detailing activities in pharmacy education including simulations, didactic sessions, and an innovative "death over dessert" model. Evaluation methods varied, with surveys being most common, followed by reflection. Didactic courses demonstrated increased empathy and knowledge, while simulations compared to case-based activities improved skills, knowledge, and comfort levels with providing end-of-life care. Simulations often involved interprofessional groups, with third-year pharmacy students most evaluated.

CONCLUSION

Pharmacy students were mainly exposed to death and dying scenarios through didactic courses or simulations, with limited longitudinal exposure. Research suggests that students may lack preparation for handling death-related situations, leading to trauma and dysfunction. While existing studies focus on outward effects like empathy, internal factors such as coping methods receive less attention. Unlike nursing and medicine literature, pharmacy education lacks comprehensive coverage of coping and emotional support strategies for death and dying scenarios. Additional focus should be placed on intentional incorporation of these topics into pharmacy curriculums.

Modifiable work stress factors and psychological health risk among nurses working within 13 countries

INTRODUCTION

Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally.

DESIGN

A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy.

METHODS

Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk.

RESULTS

The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position.

CONCLUSIONS

Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention.

CLINICAL RELEVANCE

Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.

Self-Perceived Stress in Association with Emotional Experiences Following Patient Death and Coping Adequacy among Clinical Nurses in Lithuania: A Cross-Sectional Study

(1) Background: Stress is defined as a psychological sensation related to a change in both human physiology and behavior in response to a threat or challenge. As the prevalence of stress is increasing globally, nurses represent a risk group for exposure to stress-related psychological alterations. The aim of this study was to explore how clinical nurses in Lithuania cope with the perceived chronic stress in relation to additional emotional experiences following the death of a patient. (2) Methods: During a four-week period of October 2023, a total of 283 female nurses, aged between 20 and 70 years old, were enrolled in a single cross-sectional study. The PSS-10 (perceived stress scale) and the Brief-COPE (Coping Orientation to Problems Experienced) questionnaires were applied to assess the level of self-perceived stress and the use of coping styles along with the adequate strategies. Furthermore, the nurses' emotions, evoked following patient death, were classified depending on their valence. Both the multiple linear and logistic regression statistical analyses were conducted to examine the associations between dependent and independent variables. (3) Results: The study identified that more than half of the nurses experienced patient death several times a month. A moderate-to-high level of the symptoms of mental chronic stress were suffered by 76% of caregivers. The psychological arousal following the death of a patient may induce the occurrence of emotional complexity that refers to competitive feelings, namely, helplessness (adjusted odd ratio (AOR) 1.7, 95% confidence interval (95% CI) 1.1; 2.9), disappointment (AOR 1.9, 95% CI 1.1; 3.5), anxiety (AOR 1.9, 95% CI 1.2; 4.2), and guilt (ORadj 4.7, 95% CI 1.4; 5.7), and can serve as a potential trigger for chronic stress development in clinical nurses. In terms of emotion-focused stress control (β 0.1, 95% CI -0.1; -0.2, R2 = 0.12), Lithuanian nurses had low control of the perceived chronic stress. The use of problem-focused coping (β -0.2, 95% CI -0.3; -0.1, R2 = 0.09) was also not addressed to an appropriate extent. The use of the avoidance coping style was associated with moderate-high levels of chronic stress perceived by nurses (β 0.5, 95% CI 0.4; 0.7, R2 = 0.24). Furthermore, the avoidant coping strategy related to behavioral disengagement was significantly related to resilience to chronic stress in an adverse way. The cognitive process of self-blame was considered as a meaningful maladaptive behavior component for magnifying chronic stress in nurses. (4) Conclusions: The study highlights the need to implement the recommendations for boosting the nurses' mental health. Hospitals should contribute to psychological assistance along with providing necessary training on stress-coping strategies for clinical nurses. In order to promote the sustainability of mental health through additional social support interventions, it would be useful to upgrade the clinical nurses' daily routines with mindfulness-based trainings.

R425 first year student nurses 'experience of encounters with death of a patient during clinical placement

BACKGROUND

In the course of caring, nurses often experience the death of patients, and this experience has an effect on the nurse. Every nurse responds to this experience in a different way, and it can be either a negative emotional response, or a positive emotional response. As part of their curriculum, R425 first-year student nurses are placed in clinical facilities to acquire competency in nursing skills, and here they may be exposed to patients dying. R425 is a South African Nursing Council regulation relating to the approval of and the minimum requirements for the education and training of a nurse (General, Psychiatric, and Community) and Midwife, leading to registration. End-of-life care can be rewarding, yet emotionally and psychologically challenging. Little is known about R425 first-year student nurses' experiences of patients dying while being cared for by nurses on clinical placement. The study, therefore, explored and describes R425 first-year student nurses' experiences of the death of a patient during clinical placement.

METHOD

A qualitative exploratory descriptive and contextual research design was adopted, and a purposive, nonprobability sampling approach applied. Data were collected through unstructured individual interviews with 15 R425 first-year student nurses. Data were analysed using content analysis.

RESULTS

Four themes emerged, namely, knowledge, psychological trauma, low self-esteem, and nutritional disorders, and subthemes were identified. Results reveal both negative and positive responses to encountering the death of patients, with more negative responses, and fewer positive responses.

CONCLUSION

Results show that first-year student nurses struggle to cope with the death of a patient, mainly because they lack knowledge and the skills required to provide end-of-life nursing. It is the requirement for student nurses to be competent in a skill, 'last office', which involves laying out of a dead person. Such skill can be deferred in the first year of study, and can only be introduced at a later stage, either in third year or fourth year of study, when students are better equipped with knowledge and skills relating to dealing with death. There is a need to review the curriculum of R425 first-year student nurses, so that outcomes such as death and dying can be introduced in the third or fourth year of study.

Core components of end-of-life care in nursing education programs: a scoping review

BACKGROUND

So far, there have been many studies on end-of-life nursing care education around the world, and in many cases, according to the cultural, social, and spiritual contexts of each country, the results have been different. The present study intends to gain general insight into the main components of end-of-life care in nursing education programs by reviewing scientific texts and the results of investigations.

METHODS

This study was a scoping review conducted with the Arksey and O'Malley methodology updated by Peters et al. First, a search was made in Wos, ProQuest, Scopus, PubMed, Science Direct, Research Gate, and Google Scholar databases to find studies about end-of-life care education programs. Then, the screening of the found studies was done in four stages, and the final articles were selected based on the inclusion and exclusion criteria of the studies. Due to the nature of the research, editorials, letters, and commentaries were excluded. The screening steps are shown in the PRISMA-ScR diagram.

RESULTS

23 articles related to end-of-life care education programs were reviewed. The studies included eleven descriptive and cross-sectional studies, two qualitative studies, eight interventional studies, one concept analysis article, and one longitudinal study. By summarizing the data from the studies, six themes were obtained as the main components of end-of-life care education: principles of end-of-life care, communication skills, physical considerations, psychosocial and spiritual considerations, ethical considerations, and after-death care.

CONCLUSION

End-of-life care is one of the most challenging nursing care in the world. Since many nurses are not prepared to provide such care, the information obtained from this review can help nursing education and treatment managers develop more comprehensive training programs to improve the quality of end-of-life care.

A Qualitative Exploration of Nurse Faculty Experiences Related to the Sudden Unanticipated Death of a Nursing Student

BACKGROUND

Nurse faculty serve as teachers, role models, and mentors to nursing students. This unique relationship results in a myriad of feelings when a student dies. Limited research exists in examining faculty grief related to the sudden unanticipated death of a nursing student.

PURPOSE

To explore the experiences of nurse faculty following the sudden unanticipated death of a nursing student.

METHODS

Researchers conducted a phenomenological qualitative study. The source of qualitative data included a demographic questionnaire and in-depth interviews with 13 participants throughout the geographical regions of the United States.

RESULTS

Six following themes emerged: (1) leadership response, (2) grief experience, (3) role uncertainty, (4) grief triggers, (5) cannot help but think what if, and (6) acknowledging a life unfulfilled.

CONCLUSION

This study yields a rich understanding of the unique grief experiences of nurse faculty, warranting the need for further dialogue, faculty education, policy development, and supportive interventions for faculty and administrative leaders.

Research on the death psychology among Chinese during and after the COVID-19 pandemic

Under the threat of the novel coronavirus, people are compelled to contemplate some ultimate existential questions, such as life and death. This study collected texts related to the death psychology from Sina Weibo, and after data cleaning, a total of 3868 Weibo texts were included. Study 1 employed grounded theory from qualitative research to explore the core categories and evolutionary mechanisms of people's psychology when facing death threats in the context of the pandemic. Study 2 utilized big data mining techniques such as topic mining and semantic network analysis to validate the effectiveness of the death psychology theory developed in qualitative research. The findings demonstrate that within the "Emotion-Cognition-Behavior-Value" framework, the implications of death threats manifest in four aspects: death anxiety, death cognition, coping efficacy, and sense of meaning. As time progresses, the study of death psychology can be segmented into four distinct phases: the tranquil phase prior to lifting pandemic restrictions, the threat phase at lifting pandemic restrictions onset, the coping phase mid-lifting pandemic restrictions, and the reformative phase post-lifting pandemic restrictions. The calculated outcomes of topic mining and semantic network analysis corroborate the coding results and theories derived from the grounded theory. This reaffirms that data mining technology can be a potent tool for validating grounded theory.

Attitudes and experiences related to the deaths of COVID-19 patients among nursing staff: A qualitative evidence synthesis

AIM

To identify and synthesize the experiences and attitudes of nursing staff regarding the deaths of COVID-19 patients.

REVIEW METHODS

A qualitative evidence synthesis was carried out, using Noblit and Hare's meta-ethnographic approach. The review protocol was listed in PROSPERO (CRD42022330928). Studies published from January 2020 to January 2022 that met the criteria were searched in PubMed, Web of Science, Scopus, CINAHL, CUIDEN and PsycInfo. A total of 12 articles were included.

RESULTS

Thirty-three metaphors emerged, which were grouped into three main themes: Determining factors of care, Feelings about death and Strategies for coping with death. Nurses reported the high emotional toll, the absence of family and the lack of staff, protocol and training as determining factors. Furthermore, staff had doubts about the quality of care that COVID-19 patients received. As coping strategies, nurses developed avoidance behaviours towards COVID-19 patients, selective memories, resilience, and/or leaving the profession.

CONCLUSIONS

The difficulty in providing adequate nursing care and the high number of deaths has increased anxiety and stress among nurses. These factors, alongside their lived experiences of seeing patients suffering, many dying alone without family members, have had psychological repercussions on nursing staff.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results demonstrate a high emotional toll and doubts surrounding their caregiving role caused by the lack of professional training needed to face a pandemic. This research shows what has been learned for future pandemics and highlights basic components that could provide a foundation for coping interventions for healthcare professionals.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: The challenges posed by COVID-19 patient deaths for nursing staff around the world and also by the pandemic circumstances in which those deaths occurred. WHAT WERE THE MAIN FINDINGS?: The high number of deceased patients who were isolated from family members, communication with family members and doubts surrounding care given during the pandemic have created feelings of fear, stress and anxiety, as well as obsessive thoughts that have changed nursing staff's perception of death due to COVID-19. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Results will be useful for preparing for future pandemics, and for policymakers and health staff in supporting healthcare professionals by creating programmes to help them cope with the emotional toll they have felt after dealing with death in such unprecedented circumstances.

REPORTING METHOD

The authors have adhered to the PRISMA guidelines and the eMERGe Reporting Guidance.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review

CONTEXT

Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown.

OBJECTIVE

To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being.

METHODS

We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity.

RESULTS

We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being.

CONCLUSION

This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.

Influence of basic attributes and attitudes of nurses toward death on nurse turnover: A prospective study

BACKGROUND

Facing patient death is an unavoidable aspect of work for nurses working in healthcare settings. The attitudes of nurses toward death, however, can exert a negative psychological impact on themselves that can even cause them to quit this occupation.

AIM

The objective of this study was to explore the attitudes of nurses toward death, the factors influencing said attitudes, and whether nurses basic attributes and attitudes toward death were associated with their future turnover behavior.

METHOD

A prospective study design was adopted. The recruitment period ran from October 2017 to March 2018. A total of 323 nurses completed a basic attributes survey as well as the Death Attitude Profile-Revised questionnaire and were followed until May 30, 2021. The factors influencing turnover were then analyzed using the Cox proportional hazard model. The STROBE checklist was used for reporting in this study.

RESULTS

Age was found to be significantly associated with fear of death and death avoidance. Compared with nurses with no religion, nurses who were Buddhists/Taoists were more inclined toward neutral acceptance in their attitude toward death, whereas those who were Christians/Catholics were more inclined toward escape acceptance. Nurses with less than three years of work experience were more likely to resign earlier than those with more than 3 years of work experience. Fear of death and approach acceptance could be used to predict turnover.

CONCLUSIONS

Younger nurses were more likely to exhibit fear of death and escape behavior, and those with less work experience or a greater fear of death were more likely to resign. Nurses with religious beliefs could accept patient death more positively, whereas those who faced death with positive approach acceptance displayed reductions in turnover.

IMPLICATION FOR NURSING AND HEALTH POLICY

Younger nurses should receive more education regarding death early in their training. Hospitals should also offer more education from a religious aspect in order to reduce turnover.

Psychological Intervention on Reducing Stress of Nurses Caring for Terminally Ill Cancer Patients: A Quasi-Experimental Study

Objective

The aim of the study was to explore the effect and feasibility of psychological intervention on reducing stress in nurses caring for terminally ill patients in the Department of Oncology.

Methods

This quasi-experimental study enrolled oncology nurses at Sir Run Run Shaw Hospital, affiliated to Zhejiang University School of Medicine, between April 2021 and February 2022. Interventions included Soul Moisturizing Hall, Balint group, one-on-one interviews, and routine debriefing sessions. Psychological interventions for the nurses were carried out by a team of psychiatrists and senior clinical nurse specialists. The Work Stressors Questionnaire of Nurses in the Department of Oncology (WSQNDO) was used to measure the stress in nurses before and after intervention.

Results

A total of 27 female nurses were enrolled, with the majority of them aged <30 years. Following intervention, the scores in each of the WSQNDO dimensions were all significantly lower (P < .001) than prior to intervention (social factors and career prospect: 15.18 ± 3.67 vs. 11.11 ± 2.42; working environment and working nature: 20.22 ± 5.03 vs. 17.29 ± 4.87; professional skills: 19.11 ± 3.93 vs. 16.51 ± 3.27; stress from the patient and their family: 11.85 ± 3.07 vs. 10.37 ± 2.45; interpersonal relationship: 9.77 ± 2.54 vs. 8.62 ± 1.62; the problem of oncology specialist nursing: 41.03 ± 8.46 vs. 38.51 ± 6.30). Moreover, the nurses reported alleviation of negative emotions after the psychological intervention.

Conclusion

Psychological interventions can reduce the stress experienced by nurses while caring for terminally ill cancer patients.

Nurses' bereavement experiences of a deceased colleague due to COVID-19: A phenomenological study

AIM

Healthcare workers have little time to mourn due to the intensification of the COVID-19 pandemic. Although grief is a normal part of life and death, the circumstances surrounding the death can affect the grieving process. So far, the nurses' experience in mourn for a deceased colleague in the COVID-19 pandemic has not been determined. Identifying these experiences can provide opportunities to formulate appropriate strategies to functionally adapt to death and promote mental health and well-being during this crisis. This study aimed to understand the nurses' experiences in mourning for a deceased colleague due to COVID-19.

DESIGN

This was an interpretive phenomenological study.

METHOD

Participants included 10 nurses with the bereavement experience following the death of a colleague due to COVID-19, who were selected through purposive sampling, and the data were collected through in-depth and semi-structured interviews and analysed using Diekelmann et al.'s (1989) approach.

RESULTS

The nurses' bereavement experiences were in the form of eight themes: disbelief and amazement, acceptance with grief, lasting sadness, unsung laments, bringing back memories, impulse to leave the service, a professional myth and holy death. For nurses, mourning for the death of a colleague due to COVID-19 is like a lasting sadness that begins with disbelief and amazement and changes to acceptance with sadness. From the fellow nurses' point of view, this type of death was perceived as a holy death, which along with countless unsung laments and memories brought to us the association of a professional legend, and that such a fate would be inevitable for us as well, it was a push to leave the service.

PUBLIC CONTRIBUTION

Crisis managers and policymakers need to add protocols and training programs for resilience skills and healthy mourning.

Exploring the challenges and roles of nurses in delivering palliative care for cancer patients and co-morbidities in Ghana

BACKGROUND

Patients suffering from chronic and life-threatening diseases receive inadequate palliative care in low-income countries, eventually leading to poor quality of life for these patients. Little is known about the experience of delivering palliative care in a low-resource country such as Ghana in comparison to higher-income countries. This study, therefore, aimed to assess the roles and challenges of nurses providing palliative care services for patients with cancer and life-limiting conditions at tertiary Hospitals in Ghana.

METHODS

Thirty oncology nurses at a tertiary Hospital in Ghana participated. All nurses were providing end-of-life care to patients with cancer. A qualitative exploratory-descriptive design and a semi-structured interview guide developed by the researchers were used. Interviews lasted on average forty minutes to 1 h were audio-recorded, and transcribed verbatim. Content analysis was carried out to generate themes and sub-themes.

FINDINGS

Participants were between the ages of 25 and 40 years. A higher percentage of females (n = 17, 57%) participated in the study than males (n = 13, 43%). Two main themes were generated which were the delivery of palliative care and the provision of home care services. The current roles of nurses were centered around pain management, home care services, spiritual needs, and psychological care. Challenges that hindered the implementation of palliative care included distress over expected and unexpected patient mortality, difficulty delivering bad news to patients and families, and frustration with health system resource shortages that negatively impacted patient care.

CONCLUSION

Palliative care is one of the essential services provided for patients with life-limiting conditions, and nurses play an active role in the provision of this care. Further research is needed to determine the most effective ways to deliver this care, particularly in developing nations like Ghana.

"Suddenly Feeling Dark": A Qualitative Study on the Experiences of Nurses Facing Coworker Death During the COVID-19 Pandemic

BACKGROUND

The coworkers of nurses who died because of COVID-19 infection generally experience a highly emotional grieving process. Nurses grieving the loss of a coworker during the COVID-19 pandemic experience higher psychological stress because of their high workload and the grueling shifts required to manage health emergencies during the pandemic and cope with long-standing staffing shortages. The limited number of studies discussing this issue has resulted in insufficient evidence necessary to develop effective counseling strategies and psychological support for nurses in Indonesia dealing with the massive waves of COVID-19 cases.

PURPOSE

This study was designed to elucidate the experiences of nurses across four provinces in Indonesia who had experienced the loss of a colleague during the COVID-19 pandemic.

METHODS

A qualitative research design and phenomenological approach were used in this study. Sampling was done in Jakarta, Bali, East Java, and East Nusa Tenggara using purposive sampling for the first eight participants and snowball sampling for the subsequent 34 participants. Semistructured, in-depth interviews were used to collect data from 30 participants using appropriate ethical principles. Data saturation was achieved after interviewing 23 participants, and their data were analyzed using thematic analysis.

RESULTS

Three main themes related to nurses' responses to the death of a colleague, distinguished into several stages, were identified. Stages in the first theme were as follows: (a) shocked to hear of colleague's death, (b) self-blame for failing to save a life, and (c) afraid to experience the same situation. Stages in the second theme were as follows: (a) make efforts to avoid the same thing from happening again, (b) develop strategies to avoid thoughts of loss, and (c) expect to have a psychological support system. Stages in the third theme were as follows: (a) seek new reasons, goals, directions, and meanings in life and (b) improve the physical and social health of individuals.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The range of responses from nurses to the death of a colleague during the COVID-19 pandemic identified in this study may be referenced by service providers to better provide psychological assistance and support to nursing staff. In addition, the coping strategies described by the participants provide detailed information that healthcare providers may use to deal with nurses facing death more comprehensively. This study emphasizes the importance of developing strategies to help nurses cope positively with their grief from a holistic perspective, which may be expected to impact positively the performance of nurses.

The effectiveness of the training program on accepting and expressing emotions on the psychological resilience and depression levels of nurses: A two-year follow-up study

PURPOSE

This study aimed to examine the effectiveness of the training program which was based on cognitive behavioral theory on accepting and expressing emotions in terms of nurses' psychological resilience and depression levels.

DESIGN AND METHODS

The study is an intervention study with a control group conducted with pretest, posttest, and two-year follow-up test design in line with Consolidated Standards of Reporting Trials (CONSORT). The participants in the intervention group attended an eight-week accepting and expressing emotions training program, while those in the control group did not. The Psychological Resilience Scale for Adults (RSA) and Beck's Depression Inventory (BDI) were applied to both groups as pre-test, post-test and 6-month follow-up (T2), 12-month follow-up (T3) and 24-month follow-up (T4).

RESULTS

It was determined that there was a significant change in RSA scale scores of the intervention group, and that the effect of group ∗ time interaction for all scores was significant. An increase in the total score was found for all follow-up periods with respect to T1. A significant decrease was determined in BDI scores of the intervention group, and the effect of group-time interaction for all scores was found to be significant. It was found that there was a decrease in the scores of the intervention group in all follow-up periods with respect to T1.

CONCLUSIONS

The results obtained from the study showed that the training program conducted with groups on accepting and expressing emotions was effective on the nurses' psychological resilience and depression scores.

PRACTICE IMPLICATIONS

Training programs that develop the skills of accepting and expression emotions can help nurses find their thoughts underlying their emotions. Thus, depression levels of nurses can decrease, and their psychological resilience can improve. This situation can help in terms of reducing workplace stress of nurses and can cause their working life to be more effective.

Barriers and Facilitators of Working with Dying Patients among Novice Nurses in Saudi Arabia

Novice nurses face immense challenges while they transition from being students to becoming professional nurses. Dealing with dying patients has been documented to be an immense task among professional nurses, especially for new nurses. This study aimed to explore the barriers and facilitators of working with dying patients, experienced by novice nurses in Saudi Arabia. This study employed a phenomenological qualitative research methodology among the nurses who participated in this study, which were twelve participants, of various ages, genders, religions, and nationalities, who took part in semi-structured focus group discussions. The identified barriers included a lack of experience with dying patients; a language barrier with patients and medical staff; inadequate staffing; and patients’ responses or cooperation. Furthermore, the facilitators were categorized into three themes: caring/compassion, teamwork/collaboration, and mentors/experienced colleagues. Based on the findings of this study, an action plan must be developed to improve the experience of novice nurses in Saudi Arabia, and to minimize the impact of the barriers on the new nurses when working with such patients.

Moving and Handling Children After Death: An Inductive Thematic Analysis of the Factors That Influence Decision Making by Children's Hospice Staff

Hospices for children and adolescents in the United Kingdom provide care to the bodies of deceased children in specially designed chilled bedrooms called "cool rooms." In an effort to develop resources to support hospice practitioners to provide this specialist area of care, this study aimed to identify the factors that influence decision making when moving and handling children's bodies after death in a hospice cool bedroom. An internet-based survey was sent to all practitioners employed by 1 children's hospice. A total of 94.9% of eligible staff responded (n = 56). An inductive approach to thematic analysis was undertaken, using a 6-phase methodological framework. Three core themes were identified that inform practitioners' perception of the appropriateness of moving and handling decisions: care of the body, stages of care, and method of handling. The complexity of decision making and variation in practice was identified. Practitioners relied on both analytical and initiative decision making, with more experienced practitioners using an intuitive approach. Evidence-based policy and training influence the perception of appropriateness and the decisions and behavior of practitioners. The development of a policy and education framework would support practitioners in caring for children's bodies after death, standardizing expectations and measures of competence in relation to moving and handling tasks.