Research Objectives
Background
One of the major issues experienced by nurses is grief. This grief is experienced as nurses start caring for the patients and it is more when the patient dies. The extent to which the nurses experience this grief depends upon their bonding with the patients. Grief is one of the major problems affecting the lives of nurses and ultimately the quality of healthcare. Unfortunately, healthcare professionals and hospitals do not provide the nurses with the necessary support system to cope with the losses. This has a negative impact on the social life of the nurses. Also the quality of the work is negatively affected. All these can indirectly have a negative impact on the treatment of the patients.
Goals of the Study
This research aims to study the impact of grief on the personal life and practice of the nurses and also to determine the proportion of nurses encountering grief in their practice.
Purpose
Human participation is vital for this study to understand grief in nursing and to identify different factors like lack of skills and training on the grief process, lack of support systems and individualized interventions that help to overcome grief. Further, the project examines different symptoms reported by nurses depending on the exposure to patient’s death. This study will help to improve the personal and social life of nurses. Overall nurses will be able to provide quality care to patients.
A total of 60 nurses in the assisted living centers will be interviewed and 10 nurses will be used as participants in the research. These participants will be male or female, between 25 and 55 years of age. Younger nurses who have less experiences in the field would have less coping skills than nurses who have been in nursing longer. This will avoid focusing on a specific age group providing a comprehensive data collection. The nurses will have atleast 5 years of experience. Nurses will be with different ethnic background as people’s culture influences how they respond to grief and loss. Also the nurses will have different education levels - Baccalaureate degree in nursing, Master’s Degree in nursing or PhD to determine whether educational level impact’s nurses ability to cope with patients’ death.
A random sampling technique will be used to recruit nurses to eliminate bias. This random technique will be based on participants’ responses to questions that reflect the loss of their affectionate ones/people in the recent past, their emotional feelings, their capability to rate and review their losses in the past and every aspect of their present life situation.
Research Methods
The mixed method that requires both qualitative and quantitative data will be used to collect the data. A combination of both methods (qualitative and quantitative) would help to explore in-depth how much grief affects nurses. Mixed method will help in overcoming the bias that is encountered when a single method is used. Thus, a series of data collection methods will be used to achieve the best results.
These methods of collecting the data will include the questionnaires. These questionnaires have been submitted and approved. The questionnaire contains 8 quantitative questions and 2 qualitative questions at the end. The quantitative questions are closed ended questions i.e., the responders has the option to select an answer from a set of limited choices. This questionnaire has been designed to be very specific to the cause of this research as the participants will be able to choose and focus on only one of their patients who have passed away. Thus the data will be most precise. The 2 qualitative questions at the end will allow the nurse participants to provide individual details that are pertinent to the question asked. The data is also collected using Brief Grief Questionnaire. In this method, the participants will be mentioning the same patient while answering the questions with multiple choice answers. This method helps to assess symptoms of grief across different cultures. Lastly, Marwit Meuser caregiver grief inventory (MM-CGI) will be used to assess pre-death grief in caregivers. This data will add value to the research.
Research Procedure
Initially pre-interviews will be carried out to determine the participants suitable to provide grief information. Data collection instruments include questionnaires and interviews. These questionnaires and interviews ensure that the data collected is valid and reliable. To get information about grief symptoms, a brief questionnaire consisting of 5 questions for self reporting grief symptoms across diverse cultures will be used. Three tools will be used to measure the nurses’ grief.
First is the MM-CGI tool that contains 50 statements used to gather data in three categories. The three categories are Personal Sacrifice and Burden which contains 18 items, Heartfelt Sadness and Longing which contains15 items, and Worry and Felt Isolation which contains 17 items. These item responses range from 1 = strongly disagree to 5 = strongly agree. The total grief score on each participant would indicate if the nurse is at risk for more serious symptoms or complications (if score is more than one below or above the mean), or indicate a positive or normal response to the loss (if score is one higher or one below the mean).
Second tool is the brief grief questionnaire to determine the symptoms of complicated grief. It is used to assess participants, who score at risk, from the MM-CGI tool. This instrument contains 5 questions about difficulty accepting the death, grief interference in current life, troubling thoughts related to the death, avoidance of reminders of the loss, and feeling distant from others. Each item is scored from 0 to 2 (0 = not at all, 1 = somewhat, 2 = a lot).
The third tool is a 10 item questionnaire. It is also used on nurses, who score at risk, from the MMCGI tool, for symptoms of complicated grief. The first 6 questions are used to assess the effect and depth of grief on participants. The last 4 questions will be used to collect a combination of quantitative and qualitative data. This data will be used to assess the training and the resources that have been available for the nurses dealing with grief and which resources nurses would like to be provided to them.
Data Analysis
The first method of collecting the data is by providing the nurses with both open ended and close ended questionnaires to get their responses regarding grief and their routine practices. Since most of the questions are quantitative, the data can be only interpreted the way the participants expressed it, therefore giving the researcher more confidence in the results of this research and avoiding bias. The other two questionnaires are the Marwit- Meuser Caregiver Grief Inventory (MM-CGI) and the Brief Grief Questionnaire that contain only quantitative questions.
For quantitative data, SPSS will be used for the analysis. The data is entered into columns and each column is used as a different defined variable for each question. This data is made easily readable and understandable by manipulating it using the program tools. These outputs can be depicted using graphs or tables in SPSS.
Informed consent
Informed consent will be obtained from the participants and their consent will be documented with a signed consent form. This consent form will inform the participants about the nature of the study in lay terms. The informed consent will include a statement that the subject participation is voluntary and the subject can withdraw anytime with no penalty and without affecting his/her employment status, grades, or access to medical care. The records of the subjects will be kept confidential. The participant will be informed about the risks of the study which can be the psychological stress faced by the subject because of the questions and also about the benefit of knowing the impact and the extent of grief on the nurses.
Protection of confidentiality
The data will be coded using numbers and will be free of any names or any identifiers. The data will be stored in a locked file cabinet. Only the researcher will have access to the data.
Potential Risks
The questions being asked could result in negative or uncomfortable emotions, sadness or anxiety. The participants will be provided with a potential mental health resource or counseling.
Benefits
The study will give the nurses an idea whether they suffer from grief and if yes, the extent to which they suffer. They can have a better understanding of the different symptoms of the grief and can help them to better equip themselves to cope up with a patient’ death. This project will also enhance the knowledge of this study area. This research will make the healthcare organizations aware of this neglected situation, thus providing the nurses with the necessary help in the future.
Appendix 1
Questionnaire
Hospital name.. Age..
Current position..
Primary area of specialization
Ethnic background
Gender.(M) (F)
Initials of patient expired.
The following questions are meant to assess the effect of patient loss on yourself as well as your colleagues. You may think of a patient you lost which had a challenging effect on you.
Brief Grief Questionnaire
1. Are you having trouble accepting the death of ______________?
Not at all 0
Somewhat 1
A lot 2
2. How much does your grief still interfere with your life?
Not at all 0
Somewhat 1
A lot2
3. How much are you having images or thoughts of _____________ when s/he died or other thoughts about the death that really bother you?
Not at all 0
Somewhat 1
A lot2
4. Are there things you used to do when ______ was alive that you don’t feel comfortable doing anymore, that you avoid? Like going somewhere you went with him/her, or doing things you used to enjoy together? Or avoiding looking at pictures or talking about _________? How much are you avoiding these things?
Not at all 0
Somewhat 1
A lot2
5. How much are you feeling cut off or distant from other people since _________
died, even people you used to be close to like family or friends?
Not at all 0
Somewhat 1
A lot2
Appendix 2
Letter of Permission
The Superintendent,
Bergen Regional Medical Center,
Paramus,
New Jersey.
RE: Request to conduct a research project
I hereby request to conduct a research project at your hospital. The topic for the research is “Grief and Nursing Personnel”.
The target population of this study is the nurses with different educational and ethical backgrounds. The aim of the project is to study the impact of grief on the personal life and practice of the nurses and also to determine the proportion of nurses encountering grief in their practice.
This study will involve the use of a series of questionnaires that are well structured and which have been submitted and approved. Your approval to conduct this study will be greatly appreciated. Kindly receive the attached questionnaires which will be used to get the information from the nurses.
Thanking you
.
