The preparation of graduate health professionals for working with bereaved clients: an Australian perspective

Death Anxiety: An Exploration of Professional Counselor Experiences

This quantitative research study guided by Terror Management Theory (TMT) provides a theoretical framework to understand death anxiety among practicing counselors while providing support for implementing death education into counseling graduate programs. The total sample comprised 97 total practicing counselors and current counseling students who were recruited from online platforms consisting of professional memberships, listservs, private practice, and Facebook groups. This study explored the level of death anxiety in counselors (measured by the Death Anxiety Scale-Extended (DAS-E; Templer et al., 2006) and examined the relationships between religious and/or spiritual affiliation, death education exposure, and years of practice (measured by a demographic questionnaire) through an online survey that measured counselor's religious and/or spiritual affiliation, death education exposure, years of practice in the field, and their self-reported levels of death anxiety. A Pearson correlation indicated that religious and/or spiritual affiliation and death education were significantly positively associated with years of practice in the counseling field. A regression analysis revealed that death education significantly predicted death anxiety levels. The results of the study indicated that the more death education an individual had received the less likely they were to experience death anxiety. The findings of this study affirm the need for support of a death education curriculum and to encourage CACREP counseling graduate programs to promote knowledge and awareness around death in order to better prepare counseling master's students to serve clients.

Occupations and occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore: A focus group study

INTRODUCTION

While Singapore is rapidly ageing and the need for palliative care services is projected to rise, there has been limited exploration of the occupations of Chinese older adults with life-limiting conditions. This study is the third in a series of three studies aimed to address this issue. This study also sought to discuss future directions for occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore.

METHOD

The study adopted a qualitative exploratory design using focus groups. Participants were recruited using convenience and snowball sampling. Inclusion criteria were occupational therapists who had attained full registration status with the Allied Health Professionals Council in Singapore, had two or more years of practice as an occupational therapist, and had a current or recent palliative care caseload.

FINDINGS

Three focus groups with 16 participants were conducted, and three themes were constructed from the data through reflexive thematic analysis. Reflections on culture and occupations is about the impact of a collectivist culture on occupations, such as tensions new caregivers experience between keeping clients safe and respecting clients' choices. It also highlights that there will always be individual differences within any cultural group. Challenges of occupational therapy practice in palliative care describe the need for therapists to be comfortable with rest and ethical tensions participants faced with billing for sessions that mainly involved time spent conversing with clients and when clients and caregivers' goals differed. Finally, Moving forward is about the importance of having mentors and the learning needs of occupational therapists in palliative care.

CONCLUSION

Occupational therapists experienced in providing services to palliative care clients in Singapore emphasised the collectivist nature of Singaporean Chinese families and contributed more information to its possible impact on occupations and occupational therapy practice and made suggestions for future practice.

Support needs of Australians bereaved during the COVID-19 pandemic: A cross-sectional survey study

BACKGROUND

COVID-19 disrupted access to bereavement support. The objective of this study was to identify the bereavement supports used by Australians during the COVID-19 pandemic, perceived helpfulness of supports used, prevalence and areas of unmet support need, and characteristics of those with unmet support needs.

METHODS

A convenience sample of bereaved adults completed an online questionnaire (April 2021-April 2022) about their bereavement experiences including support use and perceived helpfulness, unmet support needs and mental health. Multiple logistic regression was conducted to determine sociodemographic correlates of unmet needs. Open-ended responses were examined using content analysis to determine key themes.

RESULTS

1,878 bereaved Australians completed the questionnaire. Participants were mostly women (94.9%) living in major cities (68%) and reported the death of a parent (45%), with an average age of 55.1 years (SD = 12.2). The five most used supports were family and friends, self-help resources, general practitioners, psychologists, and internet/online community groups. Notably, each was nominated as most helpful and most unhelpful by participants. Two-thirds (66%) reported specific unmet support needs. Those with unmet needs scored lower on mental health measures. Correlates of unmet needs included being of younger age, being a spouse or parent to the deceased; reporting more impacts from public health measures, and not reporting family and friends as supports. The most frequent unmet need was for social support after the death and during lockdown.

CONCLUSIONS

This study demonstrates the complexity of bereavement support needs during a pandemic. Specialised grief therapy needs to be more readily available to the minority of grievers who would benefit from it. A clear recommendation for a bereavement support action plan is to bolster the ability of social networks to provide support in times of loss. The fostering of social support in the wake of bereavement is a major gap that needs to be addressed in practice, policy, and research.

Revising ruling discourses: The griefwork evidence-to-practice gap and the mental health workforce

Elisabeth Kübler-Ross' pioneering work focused on dying, yet some clinicians persist in prescribing it as a path through grief. We surveyed 964 mental health clinicians who completed a five-section mixed methods survey: two sections assessed knowledge with multiple choice questions and a case study to assess clinicians' knowledge-base and approach to grief/loss in practice. Analysis of four items related to Kübler-Ross' model and 66/962 case studies indicates ongoing use of "stages" and Kübler-Ross' model. Only 330 (34.2%) of the clinicians were deemed knowledgeable; 462 (47.9%) were questionable; and 172 (17.9%) were misinformed, continuing to use Kübler-Ross' stage theory for grief.

Development of an evidence-informed education package for occupational therapists for palliative and end of life care: promoting occupational justice

Abstract Introduction Death is inevitable, yet hospitals and health services continue to focus on life-sustaining practices despite clients presenting with clear decline related to life-limiting illness. Social and occupational injustice is common for clients receiving palliative or end-of-life care, as they experience increased occupational disengagement and disempowerment. A gap was identified in the Occupational Therapy department of a metropolitan Australian hospital regarding clinician skills, knowledge and confidence in working with these clients. Objective To describe the development of an evidence informed education package designed to support occupational therapists to provide the best possible quality of care and promote occupational justice for clients receiving palliative or end-of-life care. Method Consultation with key stakeholders and a review of existing resources including a skills audit, was conducted to identify current practice. A review of professional and grey literature was completed, and benchmarking with similar organisations provided a wider perspective on current Australian practice. Review of widely available educational resources were evaluated. Results Baseline data collection confirmed that promoting occupational and social justice for people requiring palliative or end-of-life care was under-recognised across the health service. Benchmarking identified significant variation in educational practices across similar Australian health services. The structure and content of a face-to-face clinical education session was formulated using evidence from the literature review and relevant available resources. There are plans to transfer this education package to an e-learning platform with evaluation built into the package to allow content to remain up to date. Conclusion Occupational Therapy clinicians are well placed to promote occupational and social justice for people requiring palliative or end-of-life care but require additional occupationally focused education to optimise their practice in this area.

"Doing" healthcare at end-of-life: Identity tensions, negotiations, and conflicts

Observing how healthcare providers deal with death and dying, in terms of "doing" identity, allows us to explore how they cope with patient end-of-life (EOL) and highlights how the professional identity breaks down while managing patient death and dying. We conducted a digital ethnography of a publicly-accessible online forum for healthcare professionals. Providers' personal experiences with patient death and dying were interpreted through internalized values associated with their professional identity, which when dealing with EOL are challenged and must be negotiated. Training and support are needed to better equip providers with the skills and tools needed at EOL.

Occupational therapy training on palliative and end-of-life care: Scoping review

Introduction

While occupational therapists promote quality of life enabling occupation, many receive little to no training on palliative and end-of-life care. This study synthesizes relevant literature to find out what is known about training for them on this matter.

Methods

A scoping review using Arksey and O’Malley’s five-stage framework exploring literature on palliative and end-of-life care training in occupational therapy (French or English; undergraduate or graduate). The first author screened the titles, abstracts, and keywords and selected literature to be read by the teams to extract and include relevant knowledge. Corroborated thematic analysis synthesized the findings.

Result

Out of the 384 publications initially identified, 25 were included in the review. To be trained in palliative and end-of-life care, occupational therapists have to (a) be exposed to knowledge on specific (b) topics required for competent practice using (c) educational strategies supporting learning about palliative and end-of-life care.

Conclusion

Whereas introductory-level knowledge of palliative and end-of-life care should be offered to all students, advanced training should allow occupational therapists to master the philosophy of this type of care, deepen the understanding of topics such as being confronted with death, and empower them to advocate for their unique contribution.

The impact of bereavement support on wellbeing: a comparative study between Australia and Ireland

Background:

There is a dearth of national and international data on the impact of social support on physical, mental, and financial outcomes following bereavement.

Methods:

We draw from two large, population-based studies of bereaved people in Australia and Ireland to compare bereaved people’s experience of support. The Australian study used a postal survey targeting clients of six funeral providers and the Irish study used telephone interviews with a random sample of the population.

Results:

Across both studies, the vast majority of bereaved people reported relying on informal supporters, particularly family and friends. While sources of professional help were the least used, they had the highest proportions of perceived unhelpfulness. A substantial proportion, 20% to 30% of bereaved people, reported worsening of their physical and mental health and about 30% did not feel their needs were met. Those who did not receive enough support reported the highest deterioration in wellbeing.

Discussion:

The compassionate communities approach, which harnesses the informal resources inherent in communities, needs to be strengthened by identifying a range of useful practice models that will address the support gaps. Ireland has taken the lead in developing a policy framework providing guidance on level of service provision, associated staff competencies, and training needs.

The value of implementation science in bridging the evidence gap in bereavement care

There is a gap in the use of evidence in bereavement care. Implementation science is a field focused on moving evidence into practice and therefore may help close the gap. Implementation science advances the design, relevance, and dissemination of research and the adoption, implementation, and maintenance of evidence-based practices. We provide an overview of implementation science, describe five implementation frameworks (Knowledge to Action; Behavior Change Wheel; Exploration Preparation Implementation Sustainment; Interactive Systems Framework; and Reach, Adoption, Implementation, Maintenance), and illustrate their application in bereavement care. These advancements will promote high-quality bereavement care that improves the lives of bereaved people.

Complicated grief knowledge, attitudes, skills, and training among mental health professionals: A qualitative exploration

The knowledge, attitudes, skills, and training of professionals regarding complicated grief influence their practice. We conducted 30 semi-structured interviews with psychiatrists, psychologists, and counselor/psychotherapists; the preliminary findings were contextualized via interviews with three experts in complicated grief research/practice. Findings suggest that professionals did not substantially rely on research evidence, favoring instead personal and professional knowledge. They expressed concern regarding the possible pathologization of normal grief that might arise from having a diagnosis of complicated grief. Deficits in professional training were evident. A need for an improved culture of collaboration between researchers and practitioners was identified.

Matching response to need: What makes social networks fit for providing bereavement support?

The objectives of this study were to explore the goodness of fit between the bereaved peoples’ needs and the support offered by their social networks; to ascertain whether this support was experienced as helpful or unhelpful by bereaved people; and to explore both the types of social networks that offer effective support and the characteristics of the communities that encourage and nurture such networks. This study was based on qualitative interviews from twenty bereaved people, in Western Australia, interviewed in 2013. A framework analysis of these interviews was undertaken using a deductive approach based on the goodness of fit framework. Much of this support is provided informally in community settings by a range of people already involved in the everyday lives of those recently bereaved; and that support can be helpful or unhelpful depending on its amount, timing, function and structure. Improving the fit between the bereaved person’s needs and the support offered may thus involve identifying and enhancing the caring capacity of existing networks. An important strategy for achieving this is to train community members in mapping and developing these naturally occurring networks. Some such networks will include relationships of long standing, others may be circles of care formed during a period of caring. Peer support bereavement networks develop from these existing networks and may also recruit new members who were not part of the caring circle. The findings endorse social models of bereavement care that fit within a public health approach rather than relying solely on professional care. As exemplified by Compassionate Communities policies and practices, establishing collaboration between community networks and professional services is vital for effective and sustainable bereavement care.

A model for occupation-based palliative care

This article presents a scoping review of 74 papers from the peer reviewed literature dealing with occupational therapy in palliative care. Five themes emerged regarding the parameters of occupational therapy in palliative care. The themes include: the importance of valued occupations even at the end of life, an exploration of how occupations change over the trajectory of a terminal illness, the balance between affirming life and preparing for death, valued occupations might be doing, being, becoming, or belonging occupations and the emphasis of a safe and supportive environment as an essential dimension for effective palliative care. These five themes are combined to form a model to guide occupational therapy in palliative care. The model offers structure and direction for occupational therapists in order to offer an opportunity for clients in palliative care to flourish toward the end of their lives.

Social support following bereavement: The role of beliefs, expectations, and support intentions

Social support is one of the strongest determinants of bereavement outcomes, yet little is understood about the community's recognition of grief and intentions to provide social support to grieving persons. A total of 476 adults responded to an online vignette and questionnaire measuring grief norms and supportive intentions. Respondent gender, age, and bereavement status all had some association with expectations of grief, intentions to support, perceived helpfulness of support attempts, and opinions toward the diagnostic classification of grief. Given that most bereavement support is informal, this study informs the development of community capacity to provide constructive, timely bereavement support.

What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach

AIMS

To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care.

DESIGN

A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis.

SETTING AND PARTICIPANTS

Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013-2014).

RESULTS

In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance.

CONCLUSION

A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.

Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives

AIMS

To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death.

BACKGROUND

The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice.

DESIGN

A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation.

METHODS

Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires.

RESULTS

Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p < .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p < .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p < .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p < .000, partial eta squared = 0.458] in relation to providing bereavement support were also found.

CONCLUSION

Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.

Invitation to grief in the family context

Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches.

O ESTUDO DE CASO COMO MÉTODO DE PESQUISA EM ENFERMAGEM: UMA REVISÃO INTEGRATIVA

RESUMO Objetivo: analisar a aplicação do estudo de caso como método de pesquisa pela enfermagem nas publicações científicas nacionais e internacionais. Método: revisão integrativa de literatura realizada nas bases bibliográficas eletrônicas PubMed, CINAHL, LILACS e SciELO, utilizando os descritores estudo de caso, pesquisa e enfermagem. Foram incluídos artigos originais disponíveis na íntegra no formato on-line, nos idiomas português, inglês ou espanhol, no recorte temporal de 2010 a 2015. Resultados: foram encontrados 624 estudos, dos quais 50 atenderam ao objetivo. Os autores Yin e Stake foram os pesquisadores cujos referenciais metodológicos de estudo de caso se destacaram no contexto da pesquisa na área da enfermagem. A aplicação do método abrangeu os diferentes campos de atuação da profissão: educação, assistência/cuidado e gestão/administração. Conclusão: o estudo de caso como método de pesquisa mostrou-se uma importante metodologia que pode ser amplamente utilizada pela enfermagem nos seus diversos campos de atuação ao buscar compreender fenômenos relacionados a indivíduos, grupos ou organizações.

Simulation in Occupational Therapy Curricula: A literature review

BACKGROUND/AIM

Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students.

METHODS

A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula.

RESULTS/FINDINGS

Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were student's perceptions of the value of simulation.

CONCLUSION

Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice.

The suffering in silence of older parents whose child died of cancer: A qualitative study

As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.

General Practitioners' experiences of bereavement care and their educational support needs: a qualitative study

BACKGROUND

General Practitioners (GPs) are well-positioned to provide grief support to patients. Most GPs view the provision of bereavement care as an important aspect of their role and the GP is the health professional that many people turn to when they need support. We aimed to explore GPs' understandings of bereavement care and their education and professional development needs in relation to bereavement care.

METHODS

An in-depth qualitative design was adopted using a social constructionist approach as our aims were exploratory and applied. Nineteen GPs (12 women and 7 men) living in Western Australia were interviewed; 14 were based in metropolitan Perth and 5 in rural areas. GPs were invited, via a letter, to participate in a semi-structured interview. The interviews occurred within each GP's workplace or, for the rural GPs, via telephone, and all interviews were digitally audio-recorded and transcribed.

RESULTS

Analysis was based upon constant comparison and began as soon as possible after each interview. The data revealed four tensions or opposing views concerning bereavement and bereavement care. These were (1) whether grief is a standardised versus an individual process, (2) the role of the GP in intervening versus promoting resilience, (3) the GP as a broker of services versus a service provider, and (4) the need for formal education and professional development versus 'on-the-job' experiential learning.

CONCLUSIONS

GPs have a critical role in exploring distress, including grief. However, changes need to be made to ensure GPs have up-to-date knowledge of contemporary theories and approaches. GPs urgently need education both at the undergraduate and postgraduate degree levels, and in continuing professional development. Otherwise GPs will rely on out-dated theories and constructions of grief, which may be detrimental to patient care.