Thesis: Bereavement the Role of Acute Care Nursing

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Bereavement

The Role of Acute Care Nursing in Bereavement

Losing a loved one is one of the most difficult realities of the life cycle. All must experience at some juncture the death and departure of aged family members, sudden tragedies and protracted battles with illness. And all individuals will cope with loss differently. The process of bereavement is the umbrella phase during which individuals will contend with the loss in question. Inherently difficult and rife with variant emotional responses, bereavement is a natural part of the human experience, both culturally and medically. It is this latter context that is of particular concern to the account provided here. Particularly, the research here attempts to better understand the concept of bereavement from a nursing perspective. The medical realities of the end-of-life stages, as well as the human realities facing those left coping with a death are both of central importance to the nursing professional who will provide care in the acute setting.

The regular professional encounter with death and the relationship forged with both the patient and the patient's loved ones are important features in making the nurse a central and guiding figure during bereavement. It is also the case that the skills attributed to a successful nurse will be particularly well-suited to the needs of those who are bereaved. So is this reported in the article by Walsh (2008), which finds that "nurses have many transferable skills that are vital when helping bereaved people. These include:

the ability to establish and maintain relationships, which in some circumstances needs to be done very quickly; Interpersonal skills; Skills in communicating and giving information, and; The ability to give 'intuitive' support (Anstey and Lewis, 2001)." (Walsh, 33)

These abilities are of direct consequence in helping the bereaved to absorb and confront the immediate impact of one's passing. But these abilities must also be supplemented by a clear comprehension of the different aspects of the bereavement process. One point of use which is provided by the Worden (2001) text is that which helps us to define our terms. Namely, the discourse on coping with death is impacted by a number of terms which are used interchangeably but which in reality have their own particular nuances. This discussion will attempt to respect these nuances by defining and using in their proper place such terms. According to Worden, the text employs the term "grief to indicate the experience of one who has lost a loved one to death. Grief can be a term applied to other losses but this book primarily addresses losses due to death. Mourning is the term applied to the process that one goes through in adapting to the loss of the person. Bereavement defines the loss to which the person is trying to adapt." (Worden, 10) All of these terms emerge as relevant in a discussion on bereavement, but this specific point of focus is important as it characterizes in a broad sense the endeavor of confronting the realities of the passing of a loved one.

From the medical perspective which drives this account, the distinction is crucial. This is because the training of nursing professionals is neither in grief counseling or in proper support for the mourning process. These are aspects of the experience of losing a loved one for which individual will possess particular areas of training and expertise. The nursing professional, by contrast, will take a more important and direct role in aspects of bereavement, where the practical realities of death must be addressed. In spite of the emotional difficulty inherently present in these cases, it is the responsibility to the deceased of the loved ones to execute key aspects of the final stages of one's involvement with the healthcare system. Nursing professionals will take an important role in help to guide the bereaved through this extremely difficult part of the process.

The discussion here considers various aspects of that responsibility, considering bereavement in the broader cultural context of the United States and, subsequently, addressing the various dynamics between patients, loved ones and nursing professionals leading into and during the state of bereavement.

Bereavement and American Culture:

It is normal and healthy to experience grief with the loss of a loved one. But it is also normal and healthy to experience a range of other emotions that may be tied to the personal relationship with the deceased, the degree of emotional preparation availed to one leading up to the death and the living standards and quality of life for the deceased up until the time of death. Often in American culture, the experiences of aging and death are evaded in favor of less confrontational approaches to losing a loved one. The bereavement process requires individuals to dispatch with strategies of emotional avoidance in favor of more constructive coping strategies. Indeed, avoidance tends to reflect feelings of fear and guilt over the passing of a loved one and may be attributed to a difficulty in resolving certain conflicting emotions. Such emotions will include considerations relating to the experience of the loved one, the relationship held with the loved one leading up to the time of death and the relative perception of the suffering of the deceased. Here, Schulz et al. (2003) provide us with a recognition of this complex mix of emotions amongst family members functioning in a primary caregiver capacity. The article reports that "in follow-up surveys after the death, 63% of the caregivers stated the patient suffered frequent pain, 90% felt the death was a relief to the patient, and 72% felt personal relief at the death." (Schulz et al., 1936)

This feeling of relief can be especially difficult for the bereaved to understand and accept. This can be accompanied by feelings of guilt which may ultimately cause a compensatory tendency toward avoidance. A nursing staff which has had contact with the patient during these end-of-life stages should take an active interest in helping individuals to understand that these feelings are natural, offering comfort with verbal assurance. As will be discussed further at a later point in this account, there is a point at which the comfort that a nursing professional can or should provide must end and the attention must shift to those with more direct training in the areas of bereavement management and coping with grief. However, there is a significant cross-section for the nurse in the acute care setting between a sense of duty to the patient and a sense of duty to the bereaved upon said patient's passing. A study by Birtwistle et al. (2002) reports accordingly that among nurses consulted in an acute care setting, "sixty-nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow-up bereavement visiting." (Birtwistle et al., 467).

As will be considered hereafter, some of these qualifications are of particular value in the acute care setting, where nursing professionals will be especially demonstrated by education, training and professional experience in working effectively as transitional figures in the process of bereavement. As denoted in subsequent sections, the degree to which nurses are specifically outfitted with the skills to help families and individuals cope with bereavement will be significantly correlated to the positive reflection of said families on the experience of coping with approaching death and its aftermath.

Acute Care Settings and End Stage Care:

A tendency to appeal to acute care settings such as long-term care and hospice facilities for family members entering the end-stages of life is based on the perception for families that they may lack the time, resources or training to provide proper attention and care themselves. Issues concerning the high level of medical need for such patients, the requirement for the regular visitation of physicians for evaluation of vital signs and a more generalized fear of failure in the face of serious medical needs are just a few of the motives for placing loved ones in such settings.

The cost of in-home care can also levy a serious expense upon a family that it may not be readily prepared to shoulder. To this end, the article by Schulz et al. (2003) indicates that "the in-home care that family members provide for elderly patients with dementia is valued at billions of dollars each year. While these caregivers face a high degree of stress related to the intensity of the demands and the length of time that care is required, we know little about how they respond to and recover from the death of the patient." (Schulz et al., 1936) These uncertainties are based on a somewhat limited nationwide scope of understanding for the in-home caregiver, who functions independently from the broader healthcare system. The research encountered also provides indications that the acute care setting is likely to offer the patient and… [END OF PREVIEW]

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