The perspective of community nurses
In the UK, a typical general practice with a patient list of 8000 will have around 80 patient deaths per year. Although an estimated 75 per cent of people die in an institution (i.e. hospital, hospice or nursing home), general practitioners (family doctors) and community nurses frequently care for patients with terminal illness in their homes and carry out bereavement visits to families of patients they have cared for. In a survey of community nurses in the UK, Hatcliffe et al. (1996) reported that 69 per cent had cared for between one and ten patients dying from cancer or AIDS in the past year. However, there is a paucity of published literature about the practice of community nurses in bereavement support. Most published literature is aimed at informing nurses about the theoretical aspects of bereavement, or provide descriptions about dealing with bereaved people. Other research has addressed bereavement issues from the hospital perspective (e.g. bereavement on the ward or within the accident and emergency department) or from specialist areas such as obstetrics or paediatric medicine.
In recent years, the professional role and responsibility of nursing has been expanded and the skill base extended. In the UK, the community nurse is one of the key providers of palliative care (Audit Commission 1999) and in a recent editorial Payne (2001) suggested that bereavement support had become a fundamental aspect of palliative care. At present in the UK, many community nurses carry out bereavement follow-up visits and some provide bereavement counselling or other bereavement services. Some have suggested that when community nurses have provided palliative care in the community they are ideally placed to offer bereavement care as they are multiskilled, in the right place (patient's home) and there at the right time (time of death) (Koodiaroff 1999). Furthermore, some suggest that they also have a key role in assessing the needs of the bereaved person, detecting any abnormal pathological grief, helping the individual with the pain of grief, and offering advice, support and information (Costello 1995; Monroe and Smith 1997). However, little is known about the extent of community nurses'