Nurse assistants’ experiences of encountering patients in grief due to the death of a loved one - a qualitative study in municipal health and social care

Figures & data

Table I. Overview of participants (n = 28) in the focus groups.

Focus group	FG 1	FG 2	FG 3	FG 4	FG 5	FG 6
Municipal Care Context	A HCT/STC	B RCFC	C RCF	C RCFC	D HCS/RCF	E HCS
Participants	3	5	4	5	7	4
Age, median (range)	49 (43–52)	49 (35–60)	44 (32–51)	53 (47–63)	54 (45–61)	48 (39–58)
Participants education addressed grief	2	0	2	2	2	0
Years in the profession, median (range)	20 (10–26)	23 (10–40)	21 (15–28)	31 (22–46)	25 (14–37)	22 (9–37)

FG = Focus group, HCS = Home Care Service, HCT = Home Care Team, RCF = Residential Care Facilities, RCFC = Residential Care Facilities for persons with Cognitive impairment, STC = Short-Term Care.

Table II. Overview of the theme, sub-categories and categories and examples of meaning units and codes.

Theme: Having to be attentive to signs of grief after patients´ loss of loved ones, sensing the right time to approach and comfort, while having to cope with emotional challenges
Meaning units	Codes	Sub-categories	Categories
(NA A) … In the morning, he [the patient] just lay there. […] At night he felt that his wife was there. Physically, that is, even though she wasn’t there. And therefore, he had had a restless night./…/. (FG 1)	In the morning just lay there, had a restless night	Seeing changes in mood and behaviour	Noticing changes in the patient: The NAs described how they experienced that patients changed when affected by grief. They described how some patients changed both in mood and behaviour. These changes could vary from one moment to another. NAs also heard how the patients expressed their suffering verbally and noticed they had an increased need for help with daily life due to the loss of the loved one.
(NA A) The patient said, I feel a bit down; today would have been his [son’s] birthday or I have been to the grave today/ … /. (FG 6)	Told that they feel down. They had visited the grave of their son’s birthday	Hearing verbally expressed suffering
(NA A) … If you lose one [the partner], you lose half of yourself. It is noticeable daily. It must be a great sorrow, and then you [the patient] may not be able to live at home anymore, when you [the patient] have lived with your husband for 60 years and everything is falling apart. (FG 1)	Life is falling apart when losing a partner and they may need to move	Noticing a changed and increased need for help
(NA A) Sometimes you [NA] feel that it’s very difficult to explain but you can get the feeling that I should stay, or no, I should leave. Without them [the patient] having said anything. (FG 2)	Feeling to stay or leave, without the patient having said anything	Sensing when and how to approach	Using different strategies to create a dialogue with the patient: The NAs described that they used different strategies when encountering patients suffering from grief. They tried to sense when and how to approach the grieving patient depending on their needs at the time, and also tried to create a dialogue with them. Another strategy was to try to confirm the patients and establish trust in order to provide comfort.
(NA A) Trying to talk and explain, like, if it is a lady who is 94 years old/ … /so you can make them understand/ … /but you have to wrap it up [that her loved one is dead], you cannot throw it straight up, sit and talk with them. (FG 4)	Trying to talk and explain, make them understand, sit and talk with them	Trying to start a dialogue
(NA A) Sometimes when I had time, the patient’s husband’s bed was still there so I lay down on it and we talked a bit and I read a newspaper to her [the patient], so I showed that I cared a bit. (FG 5)	I lay down next to the patient and read the newspaper to her, I showed that I cared.	Striving to confirm and establish trust
(NA A) The most difficult [to encounter] are the ones [the patients] who get angry, if there is someone who gets really angry because yes. (FG 5)	It is difficult to encounter when patients get angry	Dealing with patient´s emotions	Experiencing challenges when encountering patients in grief: The NAs described a variety of situations that made it challenging for them to encounter patients who were grieving. Other challenging situations were dealing with their own emotions, which affected their response to patients in grief.
(NA A) … I can´t see any [patients] cry; then it starts right away. Yes, it [I start crying] starts straight away, you think to yourself about your loss as if it is still there./ … /. (FG 3)	Can not see anyone cry, thinking about own loss	Dealing with own emotions