Background NICE guidance and the National Service Framework for children recommend healthcare professionals consider the whole family's needs prior to a parent's death. Despite evidence that in the terminal phase of a parent's illness children experience elevated levels of stress and demonstrate distress at their parents impending death, there is little work focusing on how their needs are identified.
Aims To explore how hospice nurses identify children's bereavement needs (aged 18 years or younger) when they have a terminally ill parent, and their experiences of supporting children.
Methods Individual semi-structured interviews were conducted with ten hospice nurses recruited from a single inpatient unit to explore their practice of identifying the bereavement needs of children of terminally ill patients, and their experience of providing support to these children. Transcripts were analysed verbatim and coded thematically.
Results Participants identified multiple factors impacting upon children's bereavement, but felt their knowledge was limited. The following key themes emerged:
Perception of need – indicated by distress in the well parent, changes in a child's behaviour, or when safeguarding concerns arose.
Communication – nurses expressed concern talking directly to children may cause distress.
Barriers to provision of support – these included parents blocking discussions, variable supportiveness of colleagues, lack of time and nurses not feeling ‘child-orientated’.
Personal experiences of illness and bereavement – nurses related to their own experiences when considering children's needs.
Impact on nurses – caring for patients with children was associated with negative emotions. Many felt unprepared, and some expressed concern about letting children down.
Education – nurses wanted further training and easily accessible resources.
Conclusions Nurses identified professional and personal challenges in recognising and addressing children's bereavement needs and their requirements for support. Further work is needed to develop strategies to overcome these challenges, and address the requirement for additional training.
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