Living bereavement : an exploration of health care workers' responses to loss and grief in an NHS continuing care ward for older people

摘要

The continuing care for older people is an important but often overlooked area of health care.T his thesis is concerned with how care staff work with residents and their relatives in an NHS continuing care ward. It focuses on the care staff's perceptions and responses to the losses experience by the residents and their families in their care.T he research is rooted in a work based education project and the theme of loss was chosen by the participating care staff who felt it was central to their work. They coined the phrase "living bereavement" meaning the complex responses and grief reactions of those experiencing and bearing witness to the multiple losses endured in continuing care environments. The literature review suggested that the body of knowledge related to loss in continuing care is fragmented and the research aimed to explore the relationship between some of the fragmented issues. For example, by blending social and psychological methods it was possible to research the interaction between' the cultural and emotional aspects of loss in continuing care. Psychoanalytical formed data collection and analysis strategies w re built into the methods so that formulations could be made about the role of emotions and psychological defenses in shaping the customs and practices on the ward. A key message from the thesis is that there is an intense emotional demand in care work related to loss and grief in continuing care environments. This demand consists of the care staffs own feelings as well as their experience of other people's emotional responses. I propose that care staff used psychological defenses to avoid or gloss over aspects of the emotional demand that stirred up unbearable emotions and feelings that are usually considered unacceptable, particularly for people in care work. Social systems in the organisation of work supported the psychological defenses and prevented any changes in working with emotions becoming custom and practice in the everyday work. The study makes its unique contribution by articulating the nature of the emotional demand, psychological defenses and social systems that are related to having close contact with very dependent older people living and dying in continuing care environments.I Me thesis concludes by making specific recommendations about integrating the emotion work related to living bereavement for the participants in the study. Broader considerations are also suggested or similar continuing care environments such as care homes.