Loss and grief in aged care facilities: Understanding nurses' experience of the daily reality

Providers of Residential Aged Care have undergone major structural and philosophical change in the past fifteen years with vastly improved outcomes in service delivery. The improvements covered all aspects of daily living and have been coupled with greater demands for financial accountability. Introduction of the changes has been difficult, and many aged care workers have experienced characteristics of rapid, frequent change in the workplace, such as anxiety, tension and conflict. This is particularly applicable to registered nurses responsible for supervision of personal care, and who are largely responsible for the management of issues surrounding loss, grief and bereavement. It is an aspect of aged care at risk of neglect, because of competing pressures to meet complex needs of residents within a highly structured legislative environment.This study is an exploration of nurses' experiences in coping with the daily realities of grief reactions. Reference to the literature provided information on previous research, and guidance for development of a pilot study which would further investigate the phenomenon. The aim was learn to 'what it is like' for nurses dealing with the complex reactions and relationships which occur among residents, families, friends and other staff. A small group of nurses participated in semi -structured interviews, responding to questions which addressed loss and grief among residents, relationships between staff, residents, families and management, and adequacy of available support. Participants indicated feeling frustration with time constraints of their work environment which impacts on their ability to provide adequate counseling. Support of colleagues, either positive or negative, was identified as having a major impact on daily experience. Management support was seen to be adequate in some aspects, however there were also expressions of dissatisfaction with the value placed on nurses by management.These findings support further research to compare experience in alternative cultural environments, and explore themes of time availability, the ability of nurses to support each other, as well as being valued and supported by management.