With a rapidly aging population, the importance of promoting end-of-life care at home has been pointed out. Home-visit nurses play an important role as professionals in charge of home care, and pre- and post- bereavement care for bereaved families is included in home-visit nursing services . However, bereaved families are not always provided with care after bereavement as a previous study reported that 37.4% of home-visit nurses always provide post-bereavement care, and 46.2% provide this depending on the case .
Currently, Japan has no established system that covers the bereaved family after the death of a family member. Basically, medical service fees for the bereaved family are not covered by the national insurance program in Japan, and eligibility for medical insurance starts only after symptoms such as depression appear in the bereaved family and it is diagnosed as a disease. Because regular home-visit nursing is prioritized over bereavement care that is not covered by the medical insurance, and because of ambiguities in the role of home-visit nurses due to lack of knowledge of such care for bereaved families, basic efforts to address morbid grief sufficiently have not been made.
Among studies on grief and bereavement care published outside Japan, Stroebe, et al. reported that as situational factors related to grief, 42% of people with spousal loss suffer moderate or more serious depression 4 to 7 months after the death of the spouse . Futterman, et al. reported the importance of bereavement care, pointing out that other than depression, psychiatric illnesses due to increased antipsychotic drug intake and increased alcohol intake are related to higher death rates are related to higher death rates . In the United States, where grief support is substantial, there are a variety of services that meet the needs of bereaved families, making it simple to be provided with such support. The United States has addressed bereavement risks of bereaved families so that appropriate services are available for families after the death of a beloved family member by assessing the family acceptance levels of patient illnesses as death approaches for the patients .
These differences in bereaved family care between the United States and Japan show the need to establish details of bereavement care in Japan, including risk management based on skills gained through care experience and a clarification of reasons for evaluations in situations where support is particularly important. A previous study that conducted a questionnaire survey targeting bereaved families with beloved family members who died in hospice or palliative wards in Japan reported that about 40% of those affected experienced poor health conditions after the bereavement, and about 50% of people complaining of physical illness/symptoms assumed their symptom or progression of the symptoms to be due to the bereavement . As situational factors related to grief decrease one year after a bereavement , it is necessary to provide continued support after bereavements, in particular for the older people who show more physical reactions than younger people in the grief reactions .
Sakaguchi, et al. reported that many nurses experience feelings of sadness, fatigue, and helplessness after the death of patients . Nurses who have little experience in end-of-life care tend to feel “helplessness”, “responsibility”, and “anxiety”, suggesting the necessity to provide support for the mental reactions of nurses including educational support . In bereavement care for families of cancer patients provided by medical institutions in Japan, clinical nurses play the main role, particularly in medical facilities with palliative care units . As some nurses become confused as to how to respond to the families of the patients while performing daily tasks in the clinical setting, educational support for nurses in charge of bereavement care has been found needed . From these reasons, it is necessary to establish and identify factors related to the implementation of bereavement care to strengthen the support provided for home-visit nurses.
A bereavement care survey of home-visit nursing stations nationwide reported that about 80% of valid responses from 296 home-visit nursing stations provided bereavement care, and 90% visited homes . This study also reported that the support was mainly for the mental aspects and instrumental and informational support accounted for less than 50% . However, as described above, in Japan, it is necessary for nurses in charge of bereavement care to perform risk assessments of symptom appearance also before bereavement and to provide interventions depending on individual needs. Although there are some studies investigating the items addressed in the care before and after bereavement, no studies have systematically focused on home-visit nurses and managers nationwide. This present study aims to investigate the relationship between the provision rates of pre- and post-bereavement care for the patient family and the demographics of home-visit nurses through a survey of home-visit nurses, and to clarify the details of post-bereavement care and the reasons why the care is employed, exploratorily through a survey of the managers of home-visit nursing stations.
Definition of terms
Bereavement care: defined as pre- and post-bereavement care. Pre-bereavement care means sharing information on evaluations and decision making as support for expected family grief at the early stage and mourning, and post-bereavement care involves assisting with a new life, including dealing with the fatigue and health of the family.