Absence of grief care: Japanese medical professionals have no place to grieve
Aki Morita
Grief and Bereavement Institute, Japan
Background: Medical professionals (MPs) in Japan have no educational or continuing professional training to deal with issues related to grief. The default coping mentality is to stay put ("ganbaru;" enduring the tough times) which prevents MPs from actively grieving. Grief Circle is a time-limited, semi-structured support group specially designed for MPs. Its goals include grief education, coping skills exercises, community building as well as empowering MPs to be grief educators at their own workplace.
Objectives: To examine the impact of Grief Circle program in 2023.
Design: Participants were mainly recruited through two mailing lists. Grief Circle met regularly over the topics including understanding grief, coping helping others and meaning making. This presenter facilitated all meetings.
Methods: Clinical observation, Grief Intensity Scale, questionnaire and self-report
Results: Among 24 participants who completed the program, 23 responded to the post-assessment and questionnaire. 96% of participants answered the program was extremely helpful and 100% answered the workbook was extremely helpful. While 4 participants reported that grief is impairing their daily routines on pre-assessment, one remained to be so after the program. 18 people reported to be comfortable with a group setting and 5 were moderately satisfied. All expressed the importance of grief support at their workplace and desire to commit to improve the grief support on multiple levels including personal and organizational.
Conclusion: The concept of grief is poorly recognized and grief care program is not even available for MPs in Japan. In addition, Japanese culture inhibits public expression of emotional needs such as grief. Despite these obstacles, Grief Circle was the first, innovative attempt to highlight the significance of grief awareness among MPs. And those who participated reported the high rating of understanding of grief, coping and self-awareness. These findings suggest that grief education as well as grief care need to be provided more widely in the Japanese medical community. This would enhance greater self-awareness and provide coping tools. In the world's fastest aging society, Grief Circle program will help develop a community of more compassionate caregivers.
We are all mortals – Undergraduate nursing students’ reflections following a seminar focused on proactive end-of-life communication
Malin Eneslätt1,2, Ingela Jobe3, Catharina Melander1
1Luleå University of Technology; 2Karolinska Institutet; 3University of Stavanger
Background
Prior research show that nursing students may experience dying as frightening, and feel uncertain and unprepared to communicate with patients nearing death and their families. An interactive learning activity was therefore created, including preparatory self-reflection on end-of-life preferences using the Swedish adaptation of the GoWish cards – the DöBra cards – followed by a seminar with group discussions.
Objectives
To explore nursing students’ reflections after a learning activity focusing on proactive end-of-life communication.
Design
Inductive, qualitative study.
Methods
Following the seminar, students had an optional written assignment to answer three reflective questions about their learning, experiences, and main takeaways. Free-text answers from 160 consenting students of three course iterations were analyzed using Interpretive Description.
Results
While feeling unfamiliar at first, the task of reflecting on their own death and themselves as mortals was rewarding and valuable to students. They especially appreciated the opportunity to reflect on how their end-of-life values and preferences may change over their life-course. Group discussions facilitated students’ acknowledgement of the importance of proactive end-of-life conversations to understand others’ preferences, thus increasing the likelihood of providing person-centered end-of-life care. The most prevalent ‘takeaway’ mentioned was gaining the courage to talk about death and dying in the future. Students emphasized that the seminar helped them obtain knowledge and skills in engaging in end-of-life conversations that they would make use of both as professionals and in their private lives.
Conclusion In this first study to report the use of DöBra/Go Wish cards in nursing education, we argue in favor of using a ‘first-person perspective’ when engaging students in learning about proactive end-of-life communication. Designing activities where students are encouraged to ‘do knowledge’ by actively engaging with the subject rather than simply ‘gain knowledge’ should be further considered in education on end-of-life communication. For this, faculty need to carefully consider how to create safe learning environments. Various forms of individual and group reflection lowered the threshold for students to engage in future end-of-life communication, both as professional nurses and private persons – thus recognizing the fact that we are all mortals.
Increasing access to primary palliative care through undergraduate education: New Zealand medical and nursing graduates’ preparation, self-efficacy and attitudes towards providing palliative and end-of-life care.
Elisabeth Ellen Heath1, Richard Egan1, Ella Iosua1, Robert Walker1, Jean Ross2, Rod MacLeod3
1University of Otago, New Zealand; 2Otago Polytechnic; 3University of Auckland
Background: Advances in the management of life-limiting diseases coupled with an aging population mean there is an increasing prevalence of people with palliative and end-of-life care (PEOLC) needs in most healthcare settings around the world. Junior doctors and nurses are at the frontline of patient care, so it is essential they have the knowledge, skills and attitudes required to provide safe, effective, and compassionate care for people who are nearing the end of life. However, PEOLC has traditionally been under-represented in undergraduate medical and nursing education, which fails to prepare graduates for a core component of clinical practice and restricts access to primary palliative care for those who need it.
Objectives: This study aimed to investigate how medical and nursing students in New Zealand learn about PEOLC, their self-efficacy and attitudes towards caring for those with PEOLC needs and the factors that influence this process.
Design: Mixed methods doctoral research
Methods: Three-phase project with two national online surveys of education providers and graduates plus semi-structured interviews.
Results: PEOLC is under-represented in nursing education. Medical education offers more extensive learning opportunities and is guided by a national undergraduate PEOLC curriculum. There are shared concerns around gaps in content, minimal formal assessment, and limited contact with specialist palliative care providers. Lack of teaching staff and pressure on curriculum time are barriers to development. Participants showed modest self-efficacy and positive attitudes towards caring for those with PEOLC needs. Self-efficacy improved with education and frequency of exposure to PEOLC, whereas attitudes were more influenced by personal values, beliefs, attributes, and experiences.
Conclusion: Further curriculum development is needed to improve workforce capacity to increase access to primary palliative care. These results may be used to influence undergraduate education to ensure graduates are prepared to meet the palliative care needs of the population into the future.
Conflict of interest: none
Developing an appropriate model of palliative care for mainland China: exploring the application of alternative medicine in the Shanghai model
Chenyang Guo1, Xinyan Cheng2
1Xi’an Jiaotong-Liverpool University, China, People's Republic of; 2Fudan University, China, People's Republic of
Background:The Shanghai model of palliative care is a pilot project aims to build a national palliative care model, which caters to the requirements of the new medical reform: ‘government-led, people-centred healthcare and healthcare as a public good’ and the blueprint of the Healthy China Initiative 2030: ‘to cover all people, particularly older people in need’. The central government is the policy maker of the Shanghai model, while Shanghai’s municipal government is the primary organiser and leader of the Shanghai model. The Shanghai model aims to build a community-based model. Community health service centres play the most important role in the Shanghai model. GPs and other health care workers provide and innovate palliative care services in the Shanghai model. This study focuses on exploring the Shanghai model of palliative care, which aims to build a community-based model and adopt Traditional Chinese Medicine (TCM) to cover all people in need.
Objectives:1.to explore the features and evaluation of the Shanghai model from GPs’ perspectives. 2.to explore the process of GPs’ choice and use of alternative medicine in Shanghai model. 3.to study the feasibility of using alternative medicine in palliative care.
Design:This study chose grounded theory methodology with an analysis approach combining the grounded theory methodology and ethnography methodology.
Methods:The paper adopts the methods of in-depth qualitative interviews with 24 participants. Ethnographic content analysis was used in data analysis. Reliable reports analysed by XC and observation memos conducted by CG were selected.
Results:From this study, the ideal model depicted by GPs should satisfy clear requirements for palliative care in the context of mainland China, including rationalisation, professionalisation, and institutionalisation. The Shanghai model has not yet reached all standards. TCM, as another low-cost treatment widely accepted by end-of-life patients and as a readily available ‘spare tire’. In short, there is a lack of durability in the Shanghai model.
Conclusion:If TCM is fully utilised, especially in spiritual care, the application of TCM can help to establish a needs-based palliative care model in Shanghai. The choice of TCM by service-users is not restricted by economic conditions, although affordability is an important strength of TCM in the Shanghai model. TCM can be an important tool to achieve social justice and equality in palliative care in mainland China.
"If death was told to me": Youth literature as a creative means to discussing death
Deborah Ummel, Émilie Lauzière, Rassy Jessica
Univeresité de Sherbrooke, Canada
Background: Throughout their development, children will experience various losses, such as the death of a pet or of a grandparent. However, the acquisition of the concept of death, in its five dimensions of universality, irreversibility, cessation, inevitability and causality (Slaughter et Griffiths, 2007), varies according to factors such as developmental stage, experiences of death in the family and upbringing, and family, school, religious and cultural influences (MIller, 2018; Whalen et al., 2015). Even if between the ages of 9 and 11, the concept of death is generally really understood and integrated (D'Antonio, 2011), many parents and caregivers of children aged between 5 and 12 do not know how to appropriately approach this potentially delicate subject with them.
Objectives: This paper will present the results of the first step of pilot a study aiming at obtaining expert consensus on the content and form of the French story "Grandpa Mario's Death" (La mort de grand-papa Mario), written by Anne-Marie Lebrun, psychoeducator, to address death with children aged 5 to 12.
Design: Inspired by the Delphi method, the study consisted of the following three phases: 1) literature review, 2) adaptation of the story and 3) validation using the Delphi method (Keeney et al., 2011).
Methods: After having conducted the first phase (literature reivew), we concluded that dimensions of universality, irreversibility, cessation, inevitability and causality should be included in the story. To adapt the story (second phase), wo research assistant independdly read the story, completed an interjusdge agreement regarding aspects that should be revised and/or submitted to the consensus of experts. For the third and last phase, two rounds of Delphi have been conducted with three categories of experts: 1) parents of children aged 5 to 12, 2) child development specialists and 3) psychosocial workers having experience with this age group as to obtain consensus onthe content and the form of the story.
Results: The final story as validated by the various experts will be presented, with a particular emphasis on the elements where consensus was easily and challenging to obtain.
Conclusion: Apprehending the death with schoolage children is often reported as challenging. Using a story validated by experts such as "Grandpa Mario's Death" is therefore an innovative and inspiring initiative which future implications will be discussed.
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