Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis.

BACKGROUND: Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death. METHODS: MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child. RESULTS: Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals. CONCLUSION: Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.

Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey.

BACKGROUND: Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population. AIM: To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close. DESIGN: The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on. SETTING: Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. RESULTS: A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'. CONCLUSION: These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.

Registered nurse verification of expected adult death: new guidance provides direction.

Despite UK national guidance on care after death, it is clear that the bereaved family can experience distress while waiting for the patient's death to be verified. This distress can escalate if there is a delay in verification. Anecdotally, such delays particularly occur out of hours and in community settings. Verification of death is a clinical task and an act of care whereby the identity of the person and death is confirmed. In addition, the subsequent providers of care to the deceased, such as families, mortuary teams, funeral directors and cremation services, have their health and safety protected by the provision of pertinent patient-specific information, for instance, infection risk and implantable devices, within the bounds of confidentiality. During this time, the bereaved family may also receive emotional support and information from the skilled clinician. Registered Nurse Verification of Expected Adult Death (RNVoEAD) guidance and associated competencies have recently been developed to ensure that the registered nurses involved in the patient's care can feel confident about their responsibilities and competent in the process of verifying death. It is hoped that this guidance will help to avoid delays that may cause additional distress to grieving families. This article sets out the rationale for the guidance, as well as discussing outstanding concerns and proposals for future considerations.

Places of Farewell: A Scoping Review Exploring Factors Influencing the Choice of Place of Death for Children when Death is Expected.

Progression of ill health and death trajectories is different for children with a non-oncology diagnosis. As previous research has focused primarily on children with cancer diagnoses, this scoping review explored what factors influence the parent and/or child's choice of place of death for a child with a non-oncological complex care condition, when death is expected. Eighteen papers were identified considering the preferred place of death. The findings were themed into 1. Diagnostic Factors; 2. Home Factors; 3. Socio-economic Factors; 4. Parent Factors. In conclusion, informed discussions with families that recognize the reason for, and the impact of their choices, are necessary not only for the preferred place of death but also end of life care.

SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study.

BACKGROUND: The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (situation, background, assessment, recommendation) on the incidence of serious adverse events (SAE's) in hospital wards. METHOD: In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48 h before a SAE. A questionnaire was used to measure nurse-physician communication and collaboration. RESULTS: During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p<0.001), total score on the questionnaire increased in nurses (from 58 (range 31-97) to 64 (range 25-97); p<0.001), the number of unplanned intensive care unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; relative risk ratio (RRR)=50%; 95% CI 30-64; p=0.001) and unexpected deaths decreased (from 0.99/1000 to 0.34/1000 admissions; RRR=-227%; 95% CI -793 to -20; NNT 1656; p<0.001). There was no difference in the number of cardiac arrest team calls. CONCLUSION: After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths.

Influence of age, gender, and prodromal symptoms on sudden death in a tertiary care hospital, eastern Saudi Arabia.

BACKGROUND: Sudden death (SD) remains an important worldwide public health problem. The incidence of SD and causes vary in different societies, and these differences are influenced also by demographic and clinical factors such as age, gender and prodromal symptoms and signs. This six-year study describes the influence of these factors on SD. MATERIALS AND METHODS: This is a retrospective study of SD in all age groups undertaken in King Fahd Hospital of the University (KFHU), Eastern Saudi Arabia. All cases of death (1273 total, 1050 expected death and 223 cases of sudden unexpected death) that occurred between January 1, 2000 and December 31, 2005 were investigated and subsequently analyzed on demographic and clinical parameters of the deceased patients. The statistical analysis was performed as appropriate to illustrate any possible association between different demographic variables and SD. RESULTS: There were 223 cases of SD (17.5%) out of 1273 total deaths in KFHU in the 6-year study period. There was a definite influence of age on the incidence of sudden death (SD) as it increased clearly at the two ends of the age spectrum, 32.2% of the cases were infants (from birth to 12 months), and 31.4% were elderly (> 60 year-old). However, among infantile age group, the highest frequency of SD (22.2% of the cases) was among the neonates. There was also a significant trend of gender influence on the incidence of SD which was higher in men than women (56% vs. 42%). The influence of prodromal symptoms and signs on SD was variable. Dyspnea and cough as major symptoms of cardiovascular and respiratory disease were the most frequent presenting symptoms in 32.3% of the cases, followed by fever as a sign of infections in 11.7%, premature infants in 10.8%, circulatory collapse in 9.4%, and angina in 7.6% of the cases. CONCLUSION: The current study indicated a definite influence of age, gender and prodromal symptoms on the incidence of SD. The highest incidence occurred in the two extremes of age scale as compared to other age groups. Incidence was also higher in men than women. Meanwhile, the major prodromal symptoms and signs were dyspnea and cough, fever, premature birth, circulatory collapse, and angina pectoris..