Exploring Spanish emergency nurses' lived experience of the care provided for suddenly bereaved families

Cultural aspects of death notification following cardiopulmonary resuscitation

AIMS

To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context.

BACKGROUND

Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation.

DESIGN

A phenomenological study.

METHOD

Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran.

FINDINGS

There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation.

CONCLUSIONS

Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.

Improving the support of the suddenly bereaved

PURPOSE OF REVIEW

It is recognized that death is inevitable but rarely are we prepared for the death of significant persons in our lives. Sudden death is by its nature unexpected and thus shocking for family members and friends of the decedent. Sudden deaths have customarily been divided into four categories based on the cause of death, including natural, accidental, suicidal, or homicidal (NASH) deaths. Supporting the suddenly bereaved can be stressful, for both novice and experienced professionals; this review provides information important to healthcare professionals (HCP) who are often in a position to support family members after a sudden death.

RECENT FINDINGS

Evidence suggests that supportive actions for those suddenly bereaved include HCPs conveying empathy, answering questions about the cause of death, allowing family members an opportunity to say goodbye, and providing follow-up over time. Bereaved individuals appreciate ongoing connections with healthcare professionals after the death, and HCPs need to recognize that the bereaved are at increased risk of illness in the months after a sudden death.

SUMMARY

Supporting those bereaved after a sudden unexpected death is not easy, even for experienced professionals. This review identifies supportive strategies to use with individuals and family members who are suddenly bereaved. The suggestions in this review can be used in emergency departments and other settings involved with death notifications. Also provided is information that HCPs can use to support bereaved family members.

The impact of a 'Critical Moments' workshop on undergraduate nursing students' attitudes to caring for patients at the end of life: an evaluation

AIMS AND OBJECTIVES

To evaluate the impact of an educational workshop on nursing students' attitudes to caring for dying patients.

BACKGROUND

The quality of end-of-life care education provided in preregistration nursing programmes has been criticised. The lack of attention to the emotional content results in nursing students feeling ill-prepared to care for the dying and bereaved. This article reports the findings of a study conducted to evaluate the impact of an educational workshop on undergraduate nursing students' attitudes to caring for patients at the end of life.

DESIGN

A pre- and postintervention survey was used to determine nursing students' attitudes and feelings concerning end-of-life care prior to and following their involvement in an educational workshop.

METHODS

Third-year undergraduate nursing students completed two questionnaires incorporating the Frommelt Attitude Toward Care of the Dying Scale, before and after attending a 'Critical Moments' workshop.

RESULTS

The data revealed a statistically significant increase in positive attitudes to end-of-life care amongst the respondents. Free text responses confirmed the development of positive attitudes and indicated that the workshop was regarded as a valuable learning opportunity.

CONCLUSIONS

Workshops that use case studies based on 'real-life' episodes of end-of-life care can provide an effective learning opportunity that significantly improves the attitudes of nursing students to caring for the dying.

RELEVANCE TO CLINICAL PRACTICE

Identifying emotional labour is an important stage in the development of emotionally intelligent nurses. It may reduce the risk of occupational stress, burnout and potential withdrawal from nursing practice in the longer term. Timing, expert facilitation and peer support are important considerations for an educational workshop that aims to enable nurses to remain healthy whilst delivering high-quality care to patients and their relatives near the end of life.

Ethical challenges in pain management post-surgery

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice.

Contacting bereaved relatives: the views and practices of palliative care and oncology health care professionals

There are few data on the interactions of health care professionals with bereaved relatives. The objective of this study was to explore the current practice of health care professionals in oncology and palliative care in contacting bereaved relatives, and to elicit their views regarding the purpose, the optimal means, the format, timing, and content of these contacts. We conducted 28 in-depth, semi-structured interviews with health care professionals in Australia working in palliative care and oncology. The interviews were audiotaped and transcribed. Further interviews were conducted until no additional themes were raised. The narratives were analyzed using qualitative methodology. Most participants were in favor of contacting bereaved relatives after the death of a patient they had cared for. Some barriers to implementing these contacts were identified, including time constraints, institutional factors, and personal barriers. Contacts ranged from a personal phone call to a standardized letter. Timing of contacts varied from immediately after the death of the patient to several weeks later. Participants used words and phrases in these contacts that ranged from personal and individualized messages to standard phrases. Health care professionals emphasized the importance of contacting bereaved relatives after the death of a patient for whom they had cared. The format and content of current contacts vary widely, and there does not seem to be a gold standard approach. This area has been relatively unexplored and lacks adequate models for health care professionals. This study provides some insight into current practice and hopes to facilitate further discussion of this topic.

Close relatives in intensive care from the perspective of critical care nurses

AIM

The aim was to describe critical care nurses' experiences of close relatives within intensive care.

BACKGROUND

There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives.

DESIGN AND METHOD

The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis.

RESULTS

The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given.

RELEVANCE TO CLINICAL PRACTICE

This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.

Nursing is different than medicine: ethical difficulties in the process of care in surgical units

AIM

This paper describes a study of the kinds of ethical difficulties nurses face in the process of care in surgical units.

BACKGROUND

Nurses face ethically difficult situations in trying to find the most appropriate actions to take for patients. Differences of opinion with doctors about the treatment and care of patients and conflicts between nurses' value systems and those in the organization where they are employed are described as sources of ethical difficulty. Nurses experience moral distress when institutional constraints restrict them from carrying out appropriate moral actions.

METHODS

Ten female nurses working in surgical units at one university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and doctors about being in ethically difficult situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The study was conducted during 2004.

FINDINGS

The main ethically difficult care situations described by the nurses concerned being open and honest, trusting patients' complaints, and creating limits to their involvement. Differences in opinion with doctors about the treatments, the absence of doctors in the unit and limited interest in holistic treatment and care resulted in nurses not receiving the medical orders they needed. A heavy workload, lack of time and staffing problems resulted in difficult ethical prioritizations and reduced standards of care. Shared rooms and beds in the corridors made it difficult to preserve patients' rights to privacy and confidentiality.

CONCLUSION

Interventions and investments are needed to improve the work environment of nurses, especially modifying the job constraints of the work environment. The moral responsibility for upholding the quality of care in surgical services and hospital performance should be more equally distributed between nurses, doctors and hospital managers. Discussions and collaboration between and within healthcare disciplines and managers should be initiated to establish shared moral understanding of the standards of care in hospitals.

Phenomenology as rhetoric

The literature on 'nursing phenomenology' is driven by a range of ontological and epistemological considerations, intended to distance it from conventionally scientific approaches. However, this paper examines a series of discrepancies between phenomenological rhetoric and phenomenological practice. The rhetoric celebrates perceptions and experience; but the concluding moment of a research report almost always makes implicit claims about reality. The rhetoric insists on uniquely personal meanings; but the practice offers blank, anonymous abstractions. The rhetoric invites us to believe that knowing is subjective and involved, but at the same time it recommends a technique (bracketing) which can only represent a crude, and entirely misconceived, gesture towards objectivity. Finally, the rhetoric claims that generalisation is beside the point; but the majority of researchers generalise anyway. In quietly ignoring their own rhetoric, 'phenomenologists' appropriate scientific prerogatives illegitimately. For their methods do not entitle them to lay claim to anything resembling 'objectivity', or generalisability, or 'reality', or theoretical abstraction. Like other researchers, they want to talk in generalisable terms about reality; they want to be objective, they want to do theory. But they are saddled with a philosophy that is disabling, because it says they can only talk about perceptions, and meanings, and uniqueness.

Family member presence during resuscitation in the emergency department: An Australian perspective

OBJECTIVE

The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice.

METHODS

A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations.

RESULTS

The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements.

CONCLUSION

Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.

Families' needs in emergency departments: instrument development

BACKGROUND

Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined.

AIM

The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs.

METHOD

Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires.

RESULTS

The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate.

CONCLUSIONS

This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.