Coping with death and bereavement : an exploration of older adults bereavement outcomes and community nurses’ perspectives

The inevitability of death as a part of existence means that it will affect everyone at some point during life. This thesis examines issues relating to death from the perspective of those who have been bereaved of a spouse in older age. It also explores the experiences of community nurses working with patients who have Chronic Obstructive Pulmonary Disease (COPD) – a palliative condition. Chapter One: The literature review aims to critically evaluate factors considered protective and/or contributory in depression in spousally bereaved older adults. Several factors were identified from the literature with high variability between findings, which prevent clear conclusions from being made. This variability was discussed in terms of conceptual and methodological limitations. The implications of this study suggest the importance of retaining the individual experience of loss at the centre of bereavement intervention for this clinical population. Chapter Two: The empirical paper aimed to explore how community nurses experience and manage working with people who have Chronic Obstructive Pulmonary Disease (COPD). A Grounded Theory approach generated a model representing how participants coped in their roles. The core category ‘Traversing the Unpredictable Terrain of COPD’ showed how working with the reality of COPD required nurses to engage in the constant process of pulling towards and pushing away from death. Clinical implications indicate that all nurses be offered appropriate time for reflection and the opportunity to develop advanced communication skills. Chapter three: This paper summarises a number of reflections made by the author throughout this research journey. These included prominent personal experiences that resonated with some of the emerging concepts and categories. Further reflections were made about the process of conducting qualitative research, specifically in relation to utilising Grounded Theory