Dr Wendy Walker

Approximately 500,000 people die in England each year. The majority of deaths take place in hospital [58%] and this figure is predicted to rise to around 65% by 2030 (Leadbeater and Garber 2010). Deaths in hospital may be sudden and unexpected, resulting from disease or trauma (Frost et al. 2010). Sudden death can be challenging for the experiencing family (Worden 2009). Their grief may be more pronounced (Deranieri et al. 2002), prolonged (Kent and McDowell 2004) and complicated (Parkes 1998). The NICE Quality Standards for End of Life Care for Adults (statements 7 and 14) emphasise the importance of timely support appropriate to the needs and preferences of those closely affected by death (NICE 2011). Nurses are in a unique position to meet the needs of the suddenly bereaved and skilled interventions can provide a foundation for healthy adaptation (Walker 2010). Person-centred practices at the end of life also have the potential to enhance the care experiences of the dying and bereaved (Ball et al. 2013). Despite a recognised need for service improvements in end of life care (DH 2008) and enhanced personalisation (DH 2010a), research to support the caring practices of hospital staff who encounter sudden death and bereavement is scarce. A comprehensive synthesis of literature relating to bereavement care in the UK revealed a dearth of research in acute care settings (Department of Health 2010).

 

To explore nursing interventions for person-centred bereavement care in adult acute and critical care settings.

Study objectives

1. To provide insight into nurses’ perceptions of care for the suddenly bereaved.

2. To examine the provision of person-centred bereavement care.

3. To inform the development of person-centredness in practice.

 

This was a small-scale study, using a descriptive qualitative approach. The research setting was an inner-city Acute NHS Trust. Purposive sampling gave preference to nurses working in environments where sudden death was known to occur, i.e. emergency, cardiac and critical care. Participants comprised nine registered nurses and one health care assistant. Focused, face-to-face interview was the method of data collection. Interviews were transcribed verbatim and data subjected to directed content analysis (Hsieh and Shannon 2005). The provision of person-centred care was examined by applying a validated Person-Centred Nursing Framework (McCormack and McCance 2006, 2010).

 

Salient issues were grouped to form 13 sub-themes and five main themes (see Table 1). Each theme contained descriptions of bereavement care activities and the presence of person-centeredness. Caring for suddenly bereaved families was important to nurses, but also a source of tension and unrest. Contextual, attitudinal and professional factors influenced the degree to which person-centred care operated. An important consideration for person-centred practice is movement away from sudden bereavement as a ‘here and now’ event, toward a pathway of supportive care that envisions the longer-term.

 

Table 1: Thematic representation of the study findings

Main themes	Sub-themes
The context of care	The meaning of sudden death A challenging situation
Perceived needs	Information Comfort measures
Care provision	Planned contact Essential tasks Participation and choice
Influencing factors	Professional Attitudinal Contextual
Beyond the event	Supporting staff Supporting bereaved families Obtaining feedback

 

Ball P. Monks N. Torkington A. Meyerhoff T. Sanderson H. (2013) Progress for Providers End of Life: Checking your progress in delivering personalised support at end of life. Cheshire: HSA Press.

 

Department of Health (2008) End of life care strategy: Promoting high quality care for all adults at the end of life. London: DH.

 

Department of Health (2010a) Personalisation through Person-Centred Planning. London: DH.

 

Department of Health (2010b) Bereavement care services: a synthesis of the literature. Final report of review commissioned by DH to support implementation of the End of Life Care Strategy. Available at: https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/ 215799/dh_123810.pdf

 

Deranieri JT. Clements PT. Henry GC. (2002) When catastrophe happens. Assessment and intervention after sudden traumatic death. Journal of Psychosocial Nursing and mental Health Services 40(4), 30-37.

 

Frost PJ. Leadbeatter S. Wise MP. (2010) Managing sudden death in hospital. British Medical Journal 340:c962.

 

Hsieh H-F. Shannon SE. (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9): 1277-1288.

 

Kent H. McDowell J. (2004) Sudden bereavement in acute care settings. Nursing Standard 19(6), 38-42.

 

Leadbeater C. Garber J. (2010) Dying for Change. London: Demos.

 

McCormack B. McCance TV. (2006) Development of a framework for person-centred nursing. Journal of Advanced Nursing 56(4), 472-479.

 

McCormack B. McCance T. (2010) Person-Centred Nursing: Theory and Practice. Oxford: Wiley.

 

National Institute for Health and Care Excellence (2011) Quality standard for end of life care for adults. Available at: http://www.nice.org.uk/guidance/qualitystandards/endoflife/home. jsp?domedia=1&mid=1& mid=E9C7F83619B9E0B5D4B49B5A7149F081

 

Parkes CM. (1998) Bereavement in adult life. British Medical Journal 316: 856-859.

 

Walker WM. (2010) Sudden cardiac death in adults: causes, incidence and interventions. Nursing Standard 24(38), 50-56.

 

Worden, JW (2009) Grief Counselling and Grief TherapyA Handbook for the Mental Health Practitioner. (4th Ed). New York: Springer Publishing Company

 

Constructs of person-centred care and research to develop an evidence-base for practice were studied during a study tour in the UK (University of Ulster Person-centred Practice Research Centre) and Europe (University of Gothenburg Centre for Person-centred Care). Click on the web link below for find out more.

 

http://www.gpcc.gu.se/english/news+and+events/news/newsdetail//visiting-british-researcher-reports.cid1239404

 

Re Article: Walker W. Deacon K. (2016) Nurses' experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: A qualitative study

Originating from a study funded by ERAS, the above paper is published in Intensive and Critical Care Nursing journal in the current Special Issue: ‘Innovations and insights into end-of-life in critical care.’ The Special Issue comprises ‘eight important international articles that offer both theoretical and practical insights based on research.’ The paper is also discussed in the editorial, with reference to the study findings.

The link http://authors.elsevier.com/a/1Sek93RG-M9yjK provides free access to the article, and is valid for 50 days, until April 22, 2016. No sign up or registration is needed - just click and read!