title: Nurses' views of the coping and support mechanisms experienced in managing terminal haemorrhage.
abstract: BACKGROUND
  Although palliative care is a rewarding specialty, it presents emotive personal challenges for the health professionals working within it. Terminal haemorrhage is arguably the most feared and distressing event in the palliative care setting, both for the patient and for the health professionals looking after them. The aim of this study was to explore and reflect on the coping and support mechanisms that have helped nurses to manage these events.
  
  
  METHODS
  Purposive sampling was used to recruit nurses from palliative care and oncology who had personal experience of managing terminal haemorrhage. Semi-structured interviews were used to collect qualitative data that were then analysed using interpretative phenomenological analysis. Saturation of data was reached after 11 participants had been interviewed.
  
  
  RESULTS
  The participants had a combined experience of managing 37 patients with a terminal haemorrhage. The key themes that emerged were the role of the 'autopilot', having a plan, education and training, the value of debriefing and peer support, and the importance of supporting the whole team. Education and training specifically about terminal haemorrhage and structured debriefing after such events were both identified by the participants as currently unmet needs.
  
  
  CONCLUSIONS
  Professionals working in areas in which patients are at particular risk of terminal haemorrhage require adequate training and education prior to these events and a structure for formal debriefing and peer support afterwards.
authors.affiliation: Prince Charles Hospital, Merthyr Tydfil, Wales. dgharris@doctors.org.uk
authors.forename: Dylan G
authors.initials: DG
authors.lastname: Harris
authors.forename: Sarah
authors.initials: S
authors.lastname: Flowers
authors.forename: Simon I R
authors.initials: SI
authors.lastname: Noble
mesh_terms: D000223:Adaptation, Psychological; D004506:Education, Nursing; D006470:Hemorrhage / Q000451:nursing*; D006801:Humans; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care; D010348:Patient Care Team; D010379:Peer Group