“Wrapped in Their Arms”: How Nursing Staff Support Family Presence At the Moment of Death (759)

Abstract

1.The attendee will describe the significance of family presence at the time of death.2.The attendee will identify nursing interventions that facilitate and shapes family presence at the end of life.3.The attendee will identify key nursing competencies that positively impact patients and their families during the final days/hours of life. Family presence is recognized as a marker of a good death. In this analysis, we explore how nursing staff facilitate family presence at time of death in hospital settings. In 2005–2010, we conducted interviews with 78 next-of-kin of deceased veterans in 6 VA Medical Centers in the Southeast U.S. We used content analysis to explore respondents’ accounts of being present at the patient’s bedside at the moment of death and to examine factors related to the role of nursing staff in enabling and shaping the process. 78% of respondents were female (78%) and 60% were white. 40% percent were surviving spouses, 31% adult children, and 17% siblings of the deceased. Locations of death included: ICU/SICU (43.6%), medical floor (33.3%), and palliative care or long-term care bed/unit within VA Medical Centers (23.1%). 42.3% of respondents were present at the time of death. Exemplary quotes illustrate how nursing staff facilitate and shape family presence through the following processes: notifying next-of-kin of changes in patient status, particularly patients’ transitions to the actively-dying phase; arranging private space for families to be with patients during the dying process; encouraging families of imminently dying patients to gather around the patient, say their last goodbyes, and sustain an around-the-clock presence; and providing resources to meet families’ needs for physical comfort, emotional support, and spiritual reassurance during the final days/hours of life. Family presence at the time of death is a process of end-of-life care, requiring coordinated effort and thoughtful attention to family needs. This research provides an in-depth characterization of family presence, sensitizing us to the critical role of VA nursing staff.