Evidence-based protocol. Family bereavement support before and after the death of a nursing home resident

Relationships among actions, antecedents, and outcomes of grief care for bereaved caregivers: surveying visiting nurses throughout Japan

AIM

This research identified and analyzed relationships of grief care by visiting nurses using antecedent factors and grief care outcomes.

METHODS

A mailed, original, researcher-developed, self-administered questionnaire for visiting nurses employed at home-visit nursing care stations throughout Japan provided data which was then analyzed using multiple regression analyses. Grief care provided by nurses is divided into three scales: (i) grief care from beginning of home care to the terminal period (GCBT); (ii) grief care at deathbed (GCDB); and (iii) grief care after the patient's death (GCAD).

RESULTS

Valid responses were provided by 332 (90.7%) administrators and 1442 (76.1%) staff nurses. The data revealed that it was "years of experience as a visiting nurse" and "experience of learning grief care after the patient's death" that were significant to GCBT. Also, nurses' outcomes "learning opportunity" and "confidence in visiting nursing" were significant to GCBT and GCAD.

CONCLUSION

Simply being told how to provide care to the patient during the terminal phase is inadequate. The care during this period seemed to require years of experience as a visiting nurse. Nurses should consider more effective educational methods to nurture this skill rather than wait for it to be acquired through experience. Implementation of grief care is an opportunity for receiving feedback on the care nurses provided. Grief care provides motivation for nursing and maintains mental health.

Bereavement care for older people in healthcare settings: qualitative study of experiences

AIM

This study aimed to explore the experiences of healthcare staff of caring for bereaved older people, and older people's experiences of bereavement care.

BACKGROUND

Loss through death of close family members, partners and friends inhibits the physical, emotional and social well being of older people. The rising population of older people and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence.

DESIGN

A qualitative design drawing on phenomenological methodology was used to understand interactions between healthcare staff and bereaved older people. The study was set in hospital wards, general practice and community nursing teams, and care homes. Healthcare staff and a sample of recently bereaved older people participated.

METHODS

Purposive sampling took place to recruit staff with a range of roles, and older people who were 65 years of age or more, and bereaved of a family member or friend for between 6 months and 5 years. Participants took part in in-depth interviews, and data were analysed systematically.

RESULTS

Thirty-nine participants were recruited, and three key themes arose from the data: (i) Bereavement care depends on an established relationship between healthcare staff and the patient's relatives; (ii) Preparation for the relative's death may not equate to being prepared for bereavement; (iii) The 'Open Door' to bereavement care is only slightly ajar.

CONCLUSIONS

The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions.

IMPLICATIONS FOR PRACTICE

(i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow-up post-bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration.

Evidence-based protocol. Family bereavement support before and after the death of a nursing home resident

Front-line caregivers in nursing homes frequently provide bereavement support to family members before and after the death of a nursing home resident. Use of the evidence-based guideline "Family Bereavement Support Before and After the Death of a Nursing Home Resident" (Davidson, 2002) can reduce uncertainty and increase the confidence of staff providing before and after death care to families, and can ensure all families receive consistent bereavement support.