Grieving quietly whilst navigating the journey: The impact of managing end-of-life conversations on nurses working in adult general wards

Background The management of end-of-life conversations in hospital settings has been discussed and debated for more than a decade, with commentary being raised by the government, national bodies, and regulators (DoH 2008, 2009, 2017; PHSO, 2015; CQC, 2016). Many studies have evidenced the way in which this can be improved in specialist settings; however, there is a dearth of empirical evidence in general wards where most hospitalised patients die (ONS, 2021). Aim The aim of this study was to explore the impact managing end-of-life conversations has on nurses working in adult acute general (non-specialist) inpatient wards. Method A constructivist grounded theory approach was used (Charmaz, 2014), with data collection occurring in four district general hospitals in the East of England. Purposeful and theoretical sampling recruited a total of eleven registered nurses. Data were collected using semi-structured interviews, which were audio recorded, transcribed verbatim and were analysed using the constant comparison method on the NVivo QSR system. Findings Five theoretical categories were co-constructed from the data to explain the processes of managing end-of-life conversations and their subsequent impacts. The categories of walking the path with the dying, walking the path with the grieving, battling time, becoming lost and finding the way form the substantive theory of Navigating the Journey (Grieving Quietly), which evidences the cyclical and complex paths nurses take during each patient or familial interaction. Positive or negative impacts were predicated by the accessibility or lack of internal and external resources and time. Conclusion The proposed substantive theory of Navigating the Journey (Grieving Quietly) offers an insight into multiple microprocesses that occur when nurses enter conversations with the dying and the grieving. Further work is required to ensure that nurses have ready access to practical resources, meaningful education and supervision that will enable them to best succeed such journeys.