Behind the Caring Veil: Unveiling Vicarious Grief, Ambiguous Grief, and Reflective Function among Nurses and Healthcare Assistants in Prolonged Care for Vegetative State Patients

The Permanent Vegetative State (PVS) was first introduced by Bryan Jennett and Fred Plum in 1972. It describes patients who exhibit no clinical discernible behavioral signs of self-awareness or environmental awareness. Despite this, they remain in a state of wakefulness, retaining basic functions to stay clinically alive with intensive supportive care (von Wild et al., 2012). The diagnosis of PVS presents health professionals with intricate ethical and practical challenges. Following diagnosis, individuals with SVP are commonly transferred to long-term care facilities (Lavrijsen et al., 2005). This transition involves a network of caregivers and family units, requiring a complex and prolonged care trajectory. The whole team of healthcare assistants, and particularly the nurses, play a central role in the long-term care and rehabilitation of patients with SVP. The nature of the condition requires a deep understanding and continuous adaptability on the part of nurses, who are called upon not only to preserve physical well-being but also to contribute significantly to the emotional and communicative dimensions of care. The emotional impact of daily activities, carried out by nurses in the management of patients in a vegetative state, is evident. The continuous engagement in such tasks can lead to distress, burnout, and discomfort. Thus, this thesis proposes an investigation into the psychological and emotional dynamics of professional caregivers of patients in PVS at the I.S.A.A.C. nursing home. Through the use of semi-structured interviews, the aim is to investigate the experiences of vicarious grief and ambiguous loss among the participants and to explore how the reflective function, i.e., the inferences they make about the mental state of the patients, affects their approach to end-of-life matters. The project aims to provide useful results for the design of interventions aimed at improving emotional and psychological support for professionals involved in the long-term care of patients in PVS.