The United States is on the precipice of a nursing crisis, fueled in part by a shortage of registered nurses, cuts in federal funding, and the gutting of diversity initiatives. The American health care system will collapse without a properly trained cadre of nursing professionals or the critical infrastructure needed to support nurse education and training programs. This is a call for the federal government to reauthorize the Nurse Training Act and restore critical funding for nurse education.

Background Because the death of a loved one is distressing for families, bereavement support is recommended for high-quality end-of-life care. Although health care professionals provide support during the death, many do not routinely follow up with bereaved families. Objectives To describe and compare how health care professionals view and provide bereavement support. Methods This prospective, cross-sectional study assessed registered nurses, physicians, social workers, respiratory therapists, and unlicensed assistive personnel working in the intensive care unit, step-down unit, and emergency department. Health care professionals completed a survey assessing their views, practices, and training in providing bereavement support to families. Descriptive statistics and the Kruskal-Wallis test were used to describe and compare the groups. Results Among 123 health care professionals, 67.5% were registered nurses and 78% were female. Most (64.2%) supported families at the time of death; however, only 6.5% followed up with bereaved families in the weeks after the death. Physicians, social workers, and registered nurses provided bereavement support more often than unlicensed assistive personnel and respiratory therapists did (P = .001). Only 29.3% were very comfortable providing support to bereaved families. Respiratory therapists were less comfortable than other health care professionals (P = .002). Most health care professionals (54.5%) wanted formal training on providing bereavement support. The main barriers to providing bereavement support included lack of training, time, and resources. Conclusions Understanding health care professionals’ views and practices on providing bereavement support may help inform the development of appropriate educational materials, interventions, and protocols around bereavement support.

When patients transition from curative to comfort-focused treatment, family-centered care at the end of life can improve outcomes for intensive care unit (ICU) families. Nurses make important contributions across 3 key phases: admission and the hope for recovery, realization of poor prognosis, and the active dying phases. Barriers such as conflicts and organizational constraints can be addressed through various strategies, including advocating for early palliative care, encouraging regular family meetings, involving spiritual care, and providing bereavement support. Finally, nurses must also attend to their own emotional well-being to sustain their work caring for patients and families during this challenging time.

Purpose of Study: This project explored the feasibility and perceived benefits of integrating mindfulness training, grounded in holistic nursing philosophy, into undergraduate and post-licensure BSN nursing curricula to support student well-being and resilience. Design of Study: Nursing faculty implemented an educational intervention using a pre-post design across two university nursing programs. Methods Used: Faculty embedded a semester-long mindfulness curriculum into existing nursing courses. Students received lectures, accessed curated mindfulness resources, and completed a reflective journal assignment. Pre- and post-intervention surveys assessed changes in students' knowledge, attitudes, and practices related to mindfulness. Findings: Among 103 students who completed both surveys, knowledge of mindfulness increased from 42% to 91%, and regular practice rose from 41% to 73%. Students reported improved stress and anxiety management, emotional awareness, and resilience. Nearly all participants (96%) indicated plans to continue mindfulness practices. Journal reflections revealed themes of improved mood, self-care prioritization, and enhanced coping strategies. Conclusions: Faculty successfully implemented mindfulness training, and students responded positively. The intervention supported stress reduction and resilience, aligning with national nursing education competencies and reflecting holistic nursing's emphasis on whole-person care. Findings suggest mindfulness integration may be a valuable, low-cost strategy to enhance nursing education and promote student well-being.

McAdam, Jennifer1; Gularte-Rinaldo, Jeneva1; Erikson, Alyssa2; Kim, Steven2 Author Information

BACKGROUND:Losing a loved one in the intensive care unit is associated with complicated grief and increased psychologic distress for families. Providing bereavement support may help families during this time. However, little is known about the bereavement experiences of families of patients in the cardiac intensive care unit.OBJECTIVE:To describe the bereavement experiences of families of patients in the cardiac intensive care unit.METHODS:In this secondary analysis, an exploratory, descriptive design was used to understand the families' bereavement experiences. Families from 1 cardiac intensive care unit in a tertiary medical center in the western United States participated. Audiotaped telephone interviews were conducted by using a semistructured interview guide 13 to 15 months after the patient's death. A qualitative, descriptive technique was used for data analysis. Two independent researchers coded the interview transcripts and identified themes.RESULTS:Twelve family members were interviewed. The majority were female (n = 8, 67%), spouses (n = 10, 83%), and White (n = 10, 83%); the mean age (SD) was 58.4 (16.7) years. Five main themes emerged: (1) families' bereavement work included both practical tasks and emotional processing; (2) families' bereavement experiences were individual; (3) these families were resilient and found their own resources and coping mechanisms; (4) the suddenness of a patient's death influenced families' bereavement experiences; and (5) families' experiences in the intensive care unit affected their bereavement.CONCLUSIONS:This study provided insight into the bereavement experiences of families of patients in the cardiac intensive care unit. These findings may be useful for professionals working with bereaved families and for cardiac intensive care units considering adding bereavement support.

Bereavement support is recommended as part of family-centered care in critical care settings. This literature review describes the impact on a family after the death of a loved one in the intensive care unit (ICU) and how bereavement services could help. Potential components of a bereavement program are explored, including tangible contents (eg, bereavement brochure, sympathy card, memory making), family preferences, and optimal timing. A bereavement risk assessment tool is also described to more optimally meet families' needs. Finally, the goal of this review is to guide ICUs in planning and developing of a successful and sustainable bereavement program.

BACKGROUNDCritical care consensus groups recommend providing bereavement support; however, little is known about what cardiac intensive care patients' families would find useful and beneficial in their grieving process.AIM AND OBJECTIVESTo describe cardiac intensive care unit (ICU) patients' families' opinions on six common components of a bereavement programme.DESIGNQualitative, exploratory and descriptive.METHODSFamilies were recruited from a cardiac ICU 13-15 months after their loved one's death. Families were interviewed using a semi-structured questionnaire. The research team analysed interview transcripts to assess and categorize families' opinions on six bereavement components.RESULTSTwelve family members were interviewed. Most were female (n = 8, 67%), spouses (n = 10, 83%) and white (n = 10, 83%), with a mean age (SD) of 58.4 years (16.7). Families' overall opinions of the bereavement brochure were positive, stating it was helpful in providing information about the grieving process. Families described the sympathy card as "meaningful" and "touching," although they rated it neutral in providing comfort. Most participants felt that a follow-up telephone call was unnecessary except to answer lingering questions they had. Many participants favoured the unit offering counselling services because they found therapy helpful in their grieving process. Participants had mixed feelings about a memory box; they believed it was an individual preference and should be handled in a sensitive manner. Most would not have attended a memorial service if offered because of traffic, distance, concerns about stressful feelings on returning to the hospital or because they already honoured their loved ones through a personalized memorial service.CONCLUSIONSParticipants varied in their opinions about what bereavement services may be useful; however, this study provides insight about services that cardiac critical care units may consider when adding bereavement support.RELEVANCE TO CLINICAL PRACTICEFamily perspectives about bereavement needs can help structure services offered by critical care units.

Purpose: To explore how nurses manage personal and professional boundaries in caring for seriously ill children and their families.Design and methods: Using a constructivist grounded theory approach, a convenience sample of 18 registered nurses from four practice sites was interviewed using a semi-structured interview guide.Results: Nurses across the sites engaged in a process of maintaining integrity whereby they integrated two competing, yet essential, aspects of their nursing role - behaving professionally and connecting personally. When skill-ful in both aspects, nurses were satisfied that they provided high-quality, family-centered care to children and families within a clearly defined therapeutic relationship. At times, tension existed between these two aspects and nurses attempted to mitigate the tension. Unsuccessful mitigation attempts led to compromised integrity characterized by specific behavioral and emotional indicators. Successfully mitigating the tension with strategies that prioritized their own needs and healing, nurses eventually restored integrity. Maintaining integrity involved a continuous effort to preserve completeness of both oneself and one's nursing practice.Conclusions: Study findings provide a theoretical conceptualization to describe the process nurses use in navigating boundaries and contribute to an understanding for how this specialized area of care impacts health care providers.Practice Implications: Work environments can better address the challenges of navigating boundaries through offering resources and support for nurses' emotional responses to caring for seriously ill children. Future research can further refine and expand the theoretical conceptualization of maintaining integrity presented in this paper and its potential applicability to other nursing specialties. (C) 2017 Elsevier Inc. All rights reserved.

BACKGROUNDLosing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs.OBJECTIVETo describe current bereavement follow-up services in adult ICUs.METHODA cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of Critical-Care Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression.RESULTSA total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care.CONCLUSIONSThe study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.

Erica Brown, Head of Research and Development at Acorns Children's Hospice in Birmingham, England, wrote with A. Mercer, “The Mercer Model of Paediatric Palliative Care,” which appeared in European...