Bereavement of professional caregivers after patient deaths : conceptualization, measurements, and predictive factors

Abstract

Patient deaths are inevitable and significant events for professional caregivers. However, professional caregivers’ bereavement after patient deaths is under- researched. A clear, comprehensive, and generalizable conceptualization of professional bereavement that is cleanly distinguished from familial bereavement is missing, no satisfactory specific measurement or consistent findings on predictive factors exists, and no explorations have ever been conducted in Mainland China. This thesis aims to fill these gaps and promote a more in-depth understanding of professional bereavement. Based on a proposed integrated, multidimensional, and process-oriented conceptual framework of professional bereavement informed by previous literature, this thesis aims to: 1) Understand the lived experience of professional bereavement in Mainland China; 2) Modify the conceptual framework with input from Mainland China; 3) Validate the construct models and develop specific measurement tools for key elements in the core process of professional bereavement; and 4) Identify predictive factors for short-term bereavement reactions. The sequential exploratory mixed method research comprises three parts. In the qualitative phase, 24 physicians and nurses from hospitals in Nanjing, China were interviewed, and interpretative phenomenological analysis identified five themes: the nature of professional bereavement experience, the meaning of patient deaths, short-term reactions, long-term changes, and coping strategies. Based on these findings, the conceptual framework was modified, and the key feature of professional bereavement that distinguishes it from familial bereavement was identified as involving a professional dimension in addition to a personal dimension. In the quantitative phase, data were collected from 563 physicians and nurses across Mainland China through an online survey. In the first part, Substudy I validated with partial least square structural equation modelling that both personal meaning and professional meaning contribute significantly and uninterchangeably to the meaning of patient death. Substudy II and III developed and evaluated two subscales of the Professional Bereavement Scale (PBS): the 17-item Short-term Bereavement Reactions Subscale and the 15-item Long-term Changes Subscale. Four factors, namely, frustration and trauma, guilt, grief, and being moved were involved in the former subscale, while five were involved in the latter, which were new insights, more acceptance of limitations, more death-related anxiety, less influenced by patient deaths, and better coping with patient deaths. On such a basis, the second part of the quantitative phase identified predictive factors for professional caregivers’ short-term bereavement reactions after their most recent patient death. Multivariate regressions show that experiencing the first patient death in one’s career, experiencing the death of a minor, perceiving the patient to suffer from more severe pain before death, stronger uncomfortable feelings caused by the death scene, and more suspicion and blame expressed by the bereaved family are risk factors for more intense reactions, while the professional caregiver being older serves as a protective factor against frustration and trauma. This thesis has proposed a clear, comprehensive, and generalizable conceptualization of professional bereavement and supported it with quantitative evidence. It has developed a theory-based, strictly developed, and specific measurement of professional bereavement, and on such a basis, identified predictive factors for short-term bereavement reactions. Contributions, implications, limitations, and future directions are discussed.