ABSTRACT
BackgroundFamilies and support networks are key to managing bereavement. During COVID-19 these were disrupted because mitigation measures inhibited families’ and communities’ ability to participate in social rituals marking death (Harrop, Farnell, Longo, et al., 2020;Harrop & Selman, 2022. Bereavement. 1). Families were unable to be with those dying or honour the dead which resulted in social disconnection (Smith, Wild, & Ehlers, 2020. Clin Psychol Sci. 8: 464), feelings of guilt (Bear, Simpson, Angland, et al., 2020), difficulty in making sense of the death and the important adjustment of reconstructing relationships in the period following the death.We discuss how the development of a theoretically informed, co-constructed web-resource to facilitate meaning-making, which situates bereavement in the context of family and friends, offers an opportunity to manage grief collectively.MethodsA literature review and online survey via questionnaire were conducted to identify key elements for family bereavement and the impact of the pandemic. Findings informed the co-production of the web-resource through a virtual workshop with bereaved people and bereavement professionals.ResultsRespondents to the online survey reported the pandemic had negative effects on bereavement (guilt, isolation, inability to bear witness). However, it presented a chance to celebrate the deceased and support the bereaved differently (new funeral rituals, technology, remote contact, social acknowledgement of grief). Sense-making and managing bereavement were helped through information-giving, support networks, and relocating the person within the family context. A web-resource to facilitate collective grief was viewed positively and key content agreed by participants at an online workshop.ConclusionWhile COVID-19 has exacerbated challenges to bereavement, it has enabled grief to be managed collectively. An online web-resource that encourages consideration of bereavement in the context of close social networks, promotes communication, and sense-making has been developed and is available at www.familiesinbereavement.org.uk It enables grief to be understood and managed within a shared experience and evaluation is in progress via in-depth interviews with users of the web-resource.
ABSTRACT
PURPOSE: The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings. DESIGN/METHODOLOGY/APPROACH: A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis. FINDINGS: While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process. PRACTICAL IMPLICATIONS: The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them. ORIGINALITY/VALUE: The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.