Grace MacConnell1, Megan Aston, Pat Randel, Nick Zwaagstra. 1. Pediatric Palliative Care Service, IWK Health Centre, Halifax, Nova Scotia and Adjunct Professor, Dalhousie University, Halifax, Nova Scotia, Canada. grace.macconnell@iwk.nshealth.ca
Abstract
AIMS AND OBJECTIVES: To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. BACKGROUND: Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. DESIGN: Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. METHODS: Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. RESULTS: The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. CONCLUSIONS: Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work.
AIMS AND OBJECTIVES: To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. BACKGROUND: Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. DESIGN: Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. METHODS: Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. RESULTS: The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. CONCLUSIONS: Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work.