Abstract
Summary of Work
Previous research reports the barriers to nurses asking family members about dependent children and assisting them in supporting children through parental death. Little is known about enhancing nurses' confidence and competence to do this.
Aim
To explain what is needed to enhance nurses' confidence and competence to connect and engage with families to help them support dependent children through the death of a parent.
Method
Scoping the background literature and conducting a qualitative review led to a two-phased explanatory mixed methods research study. Phase one consisted of three rounds of a classic-Delphi survey which sought and measured topic experts' (n=43) consensus on the issues and priorities for nurses in connecting with families concerning their dependent children. Topic experts participating in the Delphi survey were comprised of registered (senior) health and social care professionals (HSCPs) (n=28). These HSCPs included palliative care social workers (n=7), palliative care, and oncology nurses (n=9), medical doctors (n=4) with expertise in palliative and end-of-life care; play, drama, and occupational therapists with specialist expertise (n=4); and specialist bereavement counsellors, and psychologists (n=4). The survey also included academics with topic-specific expertise (n=3) and key stakeholders working in independent and charitable sectors (n=3). Additionally, topic experts were parents (n=6) who experienced the death of a partner whilst parenting dependent children (hereafter referred to in this research as surviving parents) and bereaved young adults (n=3).
Phase two, a focus group inquiry, consisted of four focus groups (two in acute hospital trusts and two in the hospice sector). I sought oncology (n= 14) and palliative care nurses' (n=11) opinions on and experiences concerning the issues and priorities identified in the Delphi survey. I then integrated findings from the two datasets determining whether they supported or expanded upon each other.
Main findings
Contrasting with previous findings, integrated findings from the Delphi survey and focus group inquiry demonstrated that professional and life experience facilitated nurses to connect and engage with families to help them support dependent children.
Conducting a patient-centred assessment supported nurses to know when and whether to ask patients and their family members about dependent children. Connecting and engaging with families concerning children involves emotional work. Oncology nurse specialists in acute hospitals and nurses in hospice in-patient units valued peer support. Palliative care nurse specialists working in isolation in the community said they took an emotional load home.
What this study adds
Positive workforce cultures facilitate nurses to connect and engage with families concerning dependent children.
There is a need to strengthen how the presence of dependent children is documented and communicated when patients transition from curative to palliative care and between care settings.
Lone workers need support to manage the emotional work.
Junior nurses would benefit from formalised supervision and communication training to help them manage the emotional work. Experienced nurses could act as role models for junior nurses.