• Melanie Shorter and Louise Caroline Stayt.
• St. George's Healthcare NHS Trust, London, UK.
• J Adv Nurs. 2010 Jan 1;66(1):159-67.

AimThis paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies.BackgroundThe goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief.MethodThis study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework.FindingsParticipants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients.ConclusionThere are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.

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