Nurses' early and ongoing encounters with the dying and the dead: a scoping review of the international literature

Abstract

Background: End-of-life care is high on policy and political agendas in the UK and internationally. Nurses are at the forefront of this, caring for dying patients, ‘managing’ the dead body, and dealing with the corporeal, emotional and relational dimensions of death. Little is known about nurses' prior or early professional experiences of and reactions to death, dying and the corpse and how these might influence practice. Aims: To appraise the international literature on nurses' early experiences of death, dying and the dead body, to better understand how these might influence subsequent practice, and how this might inform our teaching of death, dying and last offices. Methods: A scoping review was undertaken of peer-reviewed publications between, 2000 and 2019, which included nurses working in hospital, care homes and the community. Medline, PubMed, PsychINFO and CINAHL databases were searched and 23 papers meeting the inclusion criteria were read. Arksey and O'Malley's (2005) five-stage approach was adopted to scope the relevant international literature, using where relevant the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Selected papers were independently reviewed and subjected to thematic analysis, leading to the generation of five overarching themes. Results: The five themes were: different philosophies of care; relationships; knowledge; impact of death; and giving care. The studies came from diverse geographical locations across different settings and were primarily qualitative in design. Conclusions: Students and registered nurses are impacted both positively and negatively by their early encounters with death and dying. Good communication with patients, families and between professionals, understanding of what constitutes a ‘good’ death, and high-quality mentorship and support were of particular importance.

A genealogy of what nurses know about ‘the good death’: A socio‐materialist perspective

“…For many nurses, ‘the dying body’ was percieved as an object in decline, damaged, nonfunctioning and deteriorating, oozing, malodourous, unclean, discoloured which needed to be actively managed as ‘it’ transmogrified toward death. The body as representation, was often the site of competing translations whether medical, cultural, religious or spiritual (Cipolletta & Oprandi, 2014; Jones & Draper, 2019). For example, Jones & Draper (2020), reported how the medical model endorsed curative, objectifying and mechanistic representations of the body, which was sometimes at odds with the nursing model of care, based on holism and person‐centred care.…”

“…The body as representation, was often the site of competing translations whether medical, cultural, religious or spiritual (Cipolletta & Oprandi, 2014; Jones & Draper, 2019). For example, Jones & Draper (2020), reported how the medical model endorsed curative, objectifying and mechanistic representations of the body, which was sometimes at odds with the nursing model of care, based on holism and person‐centred care. Nurses described challenging highly interventionist biomedical approaches during end‐of‐life care, especially where the proposed treatments and interventions prolonged life, when death was immanent, or came at the expense of the person's need for increased biopsychosocial and spiritual comfort (Borhani et al, 2014; Hov et al, 2007; Jones & Draper, 2020; de Silva et al, 2015).…”

“…For example, Jones & Draper (2020), reported how the medical model endorsed curative, objectifying and mechanistic representations of the body, which was sometimes at odds with the nursing model of care, based on holism and person‐centred care. Nurses described challenging highly interventionist biomedical approaches during end‐of‐life care, especially where the proposed treatments and interventions prolonged life, when death was immanent, or came at the expense of the person's need for increased biopsychosocial and spiritual comfort (Borhani et al, 2014; Hov et al, 2007; Jones & Draper, 2020; de Silva et al, 2015). For some nurses, the body as experience and the body as representation converged to comprise ‘the person’, before, and often after death, through the act of caring.…”

“…Irrespective of the cause of death, care of the dying has for many years, been very well narrated by nurses (Jones & Draper, 2020). Correspondingly, the nursing literature is replete with accounts of nurses' ‘lived experiences’ of caring for the dying person and death.…”

“…However, as Pereira et al (2018) noted, ‘there is no consensus’ and ‘no utilization of one unique theory’ (p. 233), despite ‘a growing need to affirm nursing in palliative care in theory, practice and research’ (p. 231). This is not entirely surprising given the complexities and practice challenges of providing end‐of‐life care across diverse contexts, either clinically or culturally (Jones & Draper, 2020). Calls for better theorisation in nursing generally, were echoed more recently by Hopia and Heikkilä (2020), following their scoping review of nursing research priorities.…”