Date of Award

2007

Degree Type

Dissertation

First Advisor

Ginette Ferszt

Abstract

It is estimated that, in this country, over 2.5 million people die each year with an average of five individuals who are left grieving. Nurse practitioners (NPs) have provided care to clients in primary care settings for over forty years. Although NP practice standards have identified grief as a health concern that needs to be addressed, little is known about the practice of nurse practitioners with this population. The aim of this study was to better understand how nurse practitioners assessed, developed a plan of care, and evaluated health care outcomes of their clients who were grieving. An inductive, descriptive, exploratory design was used and included semi-structured audiotaped interviews with nine nurse practitioners known for their comprehensiveness in providing primary care to clients. The data was analyzed utilizing qualitative content analysis. The nurse practitioners' descriptions of their clinical practice yielded information about their assessment, intervention and evaluation of grieving clients. Descriptions of assessments by nurse practitioners provided data that was categorized as physical complaints, overall functioning (self care, relationships and work roles), and the clients' emotional well being/coping. Descriptions of interventions included validation of clients' grief, prescriptions and teaching/referral. Descriptions of outcomes included relief of physical complaints and stabilized chronic illness, improvements in overall functioning (self-care, relationships and work roles), and improvements in clients' emotional well being/coping. Implications and recommendations for nursing practice, education and research are addressed. Single case designs and longitudinal studies closer to the actual nurse practitioner - client encounter are recommended. Formal education regarding theoretical and clinical models of grief need to be included in graduate nurse practitioner curriculum. Ongoing continuing education for nurse practitioners is also advised given the results of the study. Implications for health policy that recognize and reimburse the role of nurse practitioners in providing comprehensive care to clients who are suffering the loss of a loved one are highlighted.

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