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Full Title Goes Here

Student Name

Benedictine University

Grief Experiences of Nurses in Ireland who have cared for Children with an Intellectual

Disability who have Died

This critique was primarily undertaken to provide an article critique. As a result, there

exist a couple of appraisal tools that are available for article critiques such as this one, and that

provide assistance in the analyzing and subsequent critique of research articles. The study design

therefore for this critique will be qualitative. This ought to be able to permit for the utilization of

a variety of standards and criteria. These standards that are available for a qualitative study

design would provide for the enabling of making a thorough evaluation and appraisal of the

research article, while providing for consistencies during the critique. Such consistencies would

arise within a qualitative design via the provision of an abundant description of participants or

informants, researcher, context, and appropriate methods for gathering of information and its

subsequent analysis (MacDermott & Keenan, 2014).

Research Issue

This article critique was undertaken to look into the exposure that nurses are emotionally

subjected to especially when dealing with the death of patients under their care who had had an

intellectual disability. Of note is that the patients in this case are children, exposing nurses

usually to higher levels of grief when such patients pass on. The grief that these nurses undergo

is something that has not been addressed to a conclusive state in practice settings albeit the fact

that this is a well-known phenomenon in terms of how it affects both the health and work

performance of the nurses (MacDermott & Keenan, 2014)

Purpose of Study

The purpose of the study was to investigate the personal grief experience of nurses who

have cared for children with an intellectual disability who have died. It is evident that not much

research has been done to comprehend what this usually means for the nurses in question, and

especially so in terms of how it personally affects them. With the continued expansion of

pediatric palliative care in Ireland and across Europe in general, it is likely that questions would

arise pertaining the type and nature of research that has been undertaken in the establishment of

priorities within this area (MacDermott & Keenan, 2014)

There have been numerous studies pertaining to the manner in which nurses respond to

both death and dying, but surprisingly limited literature on the personal grief that they experience

upon the demise of their clients. That there is not adequate information on the area of intellectual

disability provides for the fact that not much is therefore known pertaining to the personal grief

that nurses who experience the death of their patients undergo. This grief is especially more

announced when such deaths are related to the death of children, making many nurses have a feel

of triple failure to the point where they feel that they failed in being able to save the life of the

child, and ultimately having a sense of betrayal to the family that had put their hopes on the

nurse to aid in saving the childs life. It is this kind of failure that easily provides for an increase

in grief reactions, sadness and helplessness, proving for the need to have more studies into

pediatric palliative care.

Researcher Perspectives and Pre-understandings

The perspective of the researcher within the article primarily was based on the premise of

the emotional experiences of nurses who have cared for children with an intellectual disability

who had since died. The article was to present the personal perspective with which such nurses

experience without any form of after-loss follow up for the nurse. It is also within this set of

perspective that the researcher noted that this area of pediatric intellectual disability is one which

has for long not been give the kind of attention it deserves, requiring for more protracted

awareness of this area of palliative care, while enhancing the body of knowledge that would

better deem for the development of practice for the support and care within this area

(MacDermott & Keenan, 2014).

Literature Review

The historical grounding of nursing has usually been sound. However, there exist some

contemporary health care literature that questions aspects of spirituality, relevance and

spirituality which practitioners seem to shy away from. Part of the scope of this article critique

from a literature review perspective is one in which the findings of a research are highlighted,

especially so in terms of exploring the personal grief that nurses experience when especially

relating to the caring of children with an intellectual disability and who had since died. The value

and practice of spirituality when it relates to nursing practice is the crux within such studies. It is

as a result that such studies would find it most appropriate to utilize the use of a descriptive

research approach (MacDermott & Keenan, 2014)

Pediatric palliative care is a special area of nursing that especially exposes nurses to grief.

Such exposure provides for the rapid development of this area of nursing, necessitating for the

subsequent care of these professionals simultaneously with that that the children and the families

are also receiving. The Irish scope of nursing and midwifery practice framework provides that in

the holistic practice of the science and art of science, that there is need to ensure that there is a

solid comprehension of the emotional, cultural, social, psychological, physical and spiritual

experiences that patients undergo. All these are important dimensions, even though there fails

within nursing literature a unilateral definition for spirituality, with no specific evidence of

authoritative definition of the same. It is argued by certain scholars thus that even without the

inherent clarity of the spiritual aspect of nursing, that this is nonetheless a component that is

largely the prerogative of the individual during their respective search to create a meaning in life

(MacDermott & Keenan, 2014).

The secular age in which nursing is increasingly a part of is one where the nurses largely

opt to shy away from playing an active role in the identification of others spiritual needs. This

makes them truly unable to respond to emerging issues such as grief experiences, providing for

the possibility of ethical concerns emerging, such as that of omission.

Theoretical Framework

The theoretical framework upon which this article critique is built upon is largely hedged

upon the articles aim which is an exploratory inquest into the kind of individual grief that nurses

have, especially for those who have had the primary responsibility of caring for a child who had

had an intellectual disability and had since died. This form of theoretical framework was crucial

due its intent on providing an increase towards the professional knowledge of such experiences

and with an aim of improving nursing practice. Subsequently, the objectives providing for the

support of the theoretical framework goes into the ascertainment of what nurses comprehend

grief as encompassing, while gaining a better understanding of their personal grief experiences

with the intent of establishing better support systems for nurses so that they can better manager

personal grief while better evaluating their effectiveness (MacDermott & Keenan, 2014).

Research Design

This study explored the qualitative descriptive approach as its research design. In so

doing, semi-structured interviews were conducted with a sample size of eight female nurses who

had at some point or the other cared for a child who had had an intellectual disability and passed

on. A qualitative research design as may be inferred from the success of this study enabled the

researcher to provide specific answered to such questions as what, who, where, how, and when

as associated with the studys particular research problem. While from the research it may not be

one that is able to conclusively answer all questions as the why, by it can nonetheless, provide

for information pertaining the current status of the phenomena in question, and be used to

describe the current existing components as related to the conditions or variables in the situation

at hand (MacDermott & Keenan, 2014).


The methodology used for this article was exploratory with a purpose of providing

highlights into the findings of a study. To be able to do this, the study had the personal grief that

nurses get when dealing with pediatric palliative care as the dependent variable.


This study was open to all categories of nursing practitioners. These include those in

general, psychiatric, disability, as well as midwives, for as long as they were in active

membership with the nursing board. In the recruiting of participants, purposive sampling was

used, to especially get participants from an intellectual disability organization. Out of the

purposive sampling, eight registered nurses were finally selected for participation in the study.

Each of the participants had previously worked over the last seven years with at least a child who

had had an intellectual disability and who had since died. This was a mandatory requirement to

be considered for purposes of the study (MacDermott & Keenan, 2014).

Protection of Human Research Participants

In the protection of human research participants, the study focused first and foremost on

the themes of the study so as to remove focus on the participants. The themes were focused on in

detail, yet again four of the more crucial of the themes amongst the eight.

Data Collection and Generation Methods


In the collection of data, the research used semi-structured interviews and which were

also conducted by use of an interview schedules as informed from the studys aims and literature

review. This form of data collection and generation method permitted the research to be able to

collect the pertinent data, while enabling the nurse participants the freedom to have full

disclosure of whatever they deemed both comfortable and necessary. The interviews each lasted

for about an hour, with the raw data from the same recorded via use of a sound-recording device,

and which was then transcribed verbatim for the studys results (MacDermott & Keenan, 2014).

Credibility of Results

For purposes of ensuring that the results were credible, a pragmatic approach was applied

to the qualitative data analysis. The researcher would carefully go through the transcripts

garnered during the interviews, and would note down any general themes that were emerging

from the data. While there were themes such as relationship with the child and grief that were

anticipated, others also emerged in the process, such as the sub-themes of religion and prayer.

Spirituality had not been anticipated by the researcher, but it is such variability that provide for

the protracted credibility of results. Code headings were created and which covered every

component of the data from each of the transcripts.

Data Analysis

Data was analyzed by use of the Newell and Burnard rational approach to qualitative

data. With both main and sub-themes, the analysis of data was also more focused on the positive

elements of the responses in line with the studys aims and objectives.

Research Findings

Discussion of Findings

From the article critique, the findings were that nurses did employ a decent amount of

spirituality within the framework of professional support. Discussions also brought about the

component that a good number of nurses employed one form or another of a religious source so

as to provide an enabling framework which they could rely upon when grieving the loss of their

patients. The correlation of the use of a religious resource for the reduction of stress levels was a

crucial component of the studys discussions. There was subsequently a lot of mention pertaining

to God for most of the nurses (MacDermott & Keenan, 2014).


Just as in any other study, this study had its share of limitations such as the sole use of

qualitative analysis that may not adequately answer the why questions, which is what can be

seen as probably having been a major question when nurses lost their patients to death. Also,

given the number of the sample population, this was a small-scale study whose findings may not

be the best to provide a generalized conclusion (MacDermott & Keenan, 2014).

Conclusion and Implications

The conclusions of this study its special suggestion that any nurse who may have cared

for children possessing an intellectual disability and then died, had the possibility of

experiencing disenfranchised grief. Subsequently, nurses were deemed to have been having

sporadic support from a couple of sources with organizational support deemed as important for

nurses who may have experienced loss of their patients.


The recommendations of the study is the importance to have structured support systems

for nurses who may have undergone various degrees of grief experiences as a result of caring for

children with an intellectual disability and then who had since died. Continued research into this

matter is also inferred within the study.

Research Utilization in Practice

Looking at protracted use of research utilization in practice, there is the increased need to

provide for the synthesizing, dissemination and utilization of research generated information if

impact or change is to be attained in current nursing practice. This will continue to aid in

addressing inherent challenges when utilizing research outcomes in practice.



MacDermott, C., & Keenan, P. M. (2014). Grief experiences of nurses in Ireland who have cared

for children with an intellectual disability who have died. International Journal of

Palliative Nursing, 20(12), 584-590.