Bereavement in haemodialysis units: a scoping review of the perspectives and experiences of patients and nursing staff and support strategies

Abstract

Objectives

Frequent haemodialysis creates close-knit communities within treatment units, where high patient mortality contributes to significant grief among patients and staff. Despite the emotional toll, support for grief and bereavement in these settings remains limited, and recent data are lacking. This scoping review aims to explore how patients and nursing staff within haemodialysis units experience and cope with bereavement, and to identify support strategies currently used or desired to inform future, culturally sensitive approaches, particularly in Australia.

Design

Scoping review conducted in accordance with the Joanna Briggs Institute methodology.

Data sources

A comprehensive search was conducted using the Clinical Information Access Portal, supplemented by grey literature and the Elicit AI Research Assistant tool.

Eligibility criteria

We included literature exploring patient and nurse perspectives on grief and bereavement in haemodialysis units. Studies outside the haemodialysis setting and non-English studies were excluded. There were no geographical or publication year limitations.

Data extraction and synthesis

Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by consensus. A data extraction table was used to collect study characteristics and key findings. Thematic analysis was applied to synthesise data across studies.

Results

17 publications from 1998 to 2021 were identified across five countries. Grief and bereavement following patient death profoundly shape haemodialysis unit dynamics. Patients form familial bonds and experience deep grief when peers die, while nurses face emotional stress and burnout. Reported support strategies include memorial services, peer and staff support, counselling and debriefing and spiritual care.

Conclusions

This study describes grief experiences, support strategies and cultural implications in haemodialysis units, which serve a culturally diverse group of people. By consolidating available knowledge, this review provides a critical platform for future empirical work and calls for culturally sensitive support and larger, diverse samples in future research.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Rigorous scoping methodology following the Johanna Briggs Institute (JBI) framework, ensuring systematic identification, selection and synthesis of relevant literature.

• A comprehensive and adaptable search strategy, including grey literature and AI tools like Elicit, broadened the scope and depth of included studies.

• Abstracts were screened by two reviewers to reduce bias and increase the likelihood of capturing all relevant studies.

• Key perspectives excluded, such as non-English studies and insights from clinicians, carers and allied health professionals.

• Outdated literature base, with published literature only up to 2021, highlighting the need for more current and culturally nuanced studies.

Introduction

Kidney failure is a life-limiting health condition in which a patient’s life is preserved by haemodialysis treatments undertaken over several hours a day, multiple times a week.¹ Reflecting this heavy treatment burden, recent international data estimate the global prevalence of treated kidney failure at around 823 cases per million people, equivalent to nearly one in every 1200 worldwide.² In-centre haemodialysis brings patients into frequent and prolonged contact with dialysis nurses and fellow patients, creating a unique community and relationships on the basis of shared experience and understanding.³ Discussions around mortality are inevitably faced in the context of kidney failure because of its life-limiting nature and high mortality rate.⁴ Despite the recognised need for supportive environments where patients and nurses can share coping strategies and receive emotional support, there remains a significant issue in openly acknowledging death and grief and implementing effective supportive strategies within the haemodialysis unit setting.

The nursing literature acknowledges that although forming relationships with patients is considered a rewarding aspect of a nursing career, these connections can also lead to emotional and psychological difficulties when a patient passes away.⁵ Nurses are often expected to attend to the ‘humanity needs of medicine,’ which include death and grief support.⁵ Despite this, interpersonal relationships and resulting bereavement are often unacknowledged, loss is viewed as part of the job and healthcare staff are often excluded from funerals and rituals because their grief is not appropriately recognised.⁶ This cultural issue is a core reason why hospital environments struggle to support their staff with adequate coping mechanisms.⁷ Death anxiety is well documented, and many nurses report their inability to provide grief counselling or express grief when a patient dies,⁸ with many of them seeing death as synonymous with failure.⁹ These beliefs lead to death-avoidant behaviours and unhealthy grief responses, such as avoiding end-of-life discussions or acknowledging death, fatigue, sleep disturbances, anxiety and difficulty concentrating after a patient’s death.⁵ This can result in significant consequences, including burnout, resignation, poor communication and a decline in personal health and quality of life for the staff affected by the death of a known patient.¹⁰ It was recommended that staff articulate their grief in a safe and supportive forum-based environment; however, nurses prefer to use informal networks with colleagues to discuss and debrief.⁷

Incorporating death education into nursing curricula and supporting nurses in their roles is important.⁸ One study noted that palliative care education reduced death anxiety in renal nurses, who reported that it was less difficult to talk about death and dying.¹¹ In addition, culturally appropriate education is needed to meet the needs of patients from diverse cultural backgrounds. In Australia, First Nations Australian people (referring to Aboriginal and Torres Strait Islander peoples of Australia and hereafter referred to as First Nations) experience kidney failure at 10 times higher than the national average,¹² the reasons for this being complex and not fully understood. Risk development is influenced by a combination of biological mechanisms and social determinants.¹³ As a result, it comes as no surprise that haemodialysis is one of the most common life-dependent treatments received by these individuals.¹⁴ Their unique cultural and spiritual perspectives on death make them an especially relevant population in the context of bereavement care. In New South Wales (NSW)-based programmes, little evidence has shown that hospital staff are supported through First Nations grief and loss education programmes.¹⁵ This was accompanied by the acknowledgement of the lack of grief theories or models regarding First Nations individuals.¹⁵ First Nations patients view Westernised health professionals as undereducated in their beliefs, resulting in their reluctance to discuss their spiritual and cultural needs out of fear of rejection or ridicule.¹⁶ Healthcare providers often acknowledge this gap in their cultural competency, stating that cultural training commonly lacks a clear definition and coordination and has poor staff attendance.¹⁷ As such, cultural education and training are needed in healthcare, particularly in haemodialysis settings where First Nations Australians are key stakeholders.

First Nations populations in rural and remote communities have even higher rates of kidney failure¹⁸ with deep geographical and intergenerational connections. The nursing staff at the Dubbo Base Hospital haemodialysis unit, in Western NSW, highlighted the challenges of caring for patients interconnected both within and outside the haemodialysis community, noting that many patients share close relationships through family ties, social circles and shared community experiences beyond the hospital setting. This interconnectedness complicates grief and bereavement. In haemodialysis units, where First Nations patients are disproportionately represented, it is crucial to address this and ensure that staff are providing bereavement support informed by this complexity. Dialysis units are in a unique position to provide this essential care to patients; however, there is a pronounced lack of research and care addressing the cultural needs of First Nations dialysis patients. Swan stated, “There is a need for people to adapt western models of grief and trauma therapy to meet the needs of their communities and culture and to be responsive to the individual experience of loss.”.¹⁹ First Nation individuals employ various grief practices, including crying, wailing, ceremonial singing and telling stories, with family and community playing an integral role.²⁰ This contrasts greatly with the ‘silent grief’ common in mainstream Australian culture,¹⁵ which presents a key obstacle to providing inclusive bereavement care, as conventional practices may not adequately address the communal and expressive nature of grief in First Nations communities.

Given the complex emotional issues resulting from the bereavement experienced when a haemodialysis unit patient dies, unique strategies are needed to support patients and nursing staff adequately. While there is a wealth of literature on the experiences of death and dying in other fields of medicine, there is a paucity of data surrounding grief and bereavement following the death of patients within a haemodialysis unit. Additionally, published First Nations perspectives were limited in this setting with no recent culturally inclusive research, signalling a critical gap in the literature. Addressing this gap is crucial, as the unique relationships built in haemodialysis units and the specific cultural and spiritual needs of patients within them necessitate tailored grief support strategies.

Objective

The objective of this scoping review is to assess the current extent of literature relating to grief and bereavement in haemodialysis units, with the dual purpose of informing improvements in local service delivery and establishing a foundation for future research. By consolidating existing knowledge and identifying key gaps, particularly the lack of recent, culturally inclusive data, this review highlights areas for further investigation and supports the development of updated studies to advance the field. A scoping review was selected as the most appropriate methodology to map diverse evidence in a largely underreported area, generate a comprehensive overview and illuminate areas requiring greater attention.²¹ By better understanding and addressing these needs, healthcare providers can have opportunities to improve the well-being of both patients and staff, thereby enhancing the overall quality of care in haemodialysis units.

Research question

What are the experiences of grief and bereavement among patients and nursing staff following the death of a patient within their haemodialysis unit, and what strategies are currently employed to support these experiences? Sub-questions were used to delineate further concepts and populations outlined in table 1.

Table 1. Guiding subquestion for review on bereavement in haemodialysis units.

Subquestion	Population	Question
The emotional and psychological impact of bereavement	Haemodialysis Patients	How do patients in haemodialysis units experience and cope with the bereavement of fellow patients?
The emotional and psychological impact of bereavement	Haemodialysis Nursing staff	How do nursing staff in haemodialysis units experience and cope with the bereavement of patients, and how does it affect their professional practice?
Cultural and spiritual needs in grief and bereavement	Haemodialysis Patients and nursing staff	What are the cultural and spiritual needs of patients and nursing staff and how are they addressed in the context of grief and bereavement in haemodialysis units?
Support strategies and interventions	Haemodialysis Patients and nursing staff	What strategies and interventions are currently employed in haemodialysis units to support patients and nursing staff in managing grief and bereavement?

Methods

This review methodology closely follows the Johanna Briggs Institute (JBI) protocol for scoping reviews²¹ (See online supplemental file 1). The process included identifying the research question, conducting a comprehensive search for relevant literature, selecting studies based on predefined criteria, extracting data and summarising and reporting the results. Deviations from the protocol included incorporating AI tools such as the Elicit Research Assistant²² to supplement our search. Additionally, we involved First Nations contacts who provided advice on the cultural sensitivity and safety of the information reported. They reviewed drafts, recommended culturally appropriate terminology and sources and ensured respectful representation of First Nations perspectives. An ethical review was not needed, as the data used in this study are publicly available. This process was conducted from 13 May–16 August 2024 in line with the academic timeframe of this project.

Inclusion and exclusion criteria

Participants

Data regarding dialysis patients and nursing staff were sought. No exclusion criteria based on sex, age or ethnicity were applied. Physicians and external caregivers were excluded, as the review focused on stakeholders directly involved in dialysis unit care and the relationships built within the unit on a frequent basis.

Concept

Grief and bereavement experiences and perspectives following the death of other haemodialysis patients within a unit were explored, with a focus on the support structures utilised or desired.

Context

Only in-centre haemodialysis settings were included, excluding home-based therapies, peritoneal dialysis and non-dialysis medical wards/fields. Only studies published in English were considered, with no restrictions on publication year or geographical location. This approach is justified by the limited overall literature, especially within Australia, with significant studies dating back to 1998.

Sources

This scoping review encompassed a range of qualitative study designs, including descriptive observational studies such as surveys, questionnaires and in-depth interviews. It also incorporates qualitative studies focusing on designs such as phenomenology, grounded theory and qualitative description. Additionally, grey literature, such as blogs, was considered and included.

Search strategy

The search strategy aimed to identify both published and unpublished studies. A multistep approach was employed, beginning with an initial limited search of the Clinical Information Access Portal and associated databases (Embase, Lowitja Institute, Medline, ProQuest and PubMed) to identify relevant articles. The text words in the titles and abstracts of these articles, along with the keywords and subject heading terms used to describe them, were utilised to develop a comprehensive search strategy in a PICO (Population, Intervention, Comparison, Outcome) format (table 2). Although PCC (Population, Concept, Context) is often recommended in scoping reviews, we adopted PICO as our question was intervention-focused, and this framework provided a clearer structure for eligibility and synthesis. This search strategy was then adapted for each included database and information source (See online supplemental file 2). The process was further enhanced by the Elicit AI Research Assistant tool,²² which identified additional studies. Additionally, reference lists from all sources were screened for further studies. Grey literature was assessed using the same criteria as peer-reviewed sources to maintain consistency. A second reviewer analysed the articles, ensuring their quality before selection and data extraction. After initial lines of search did not yield any First Nations dialysis patient or staff perspectives, a further line of inquiry searching for this data was utilised.

Table 2. Keywords and subject heading term combinations in PICO format used in search strategy.

	Population	Intervention	Comparison	Outcome
Keywords	Dialysis OR Renal dialysis OR End Stage Kidney Disease OR Kidney Failure Patient OR Nurse First Nations OR Indigenous Australians	End-of-Life Care OR Palliative Care Grief support OR Bereavement Support	Not applicable	Perspectives OR Experiences OR Attitudes Coping mechanisms OR Well-being OR Quality of Life Support Needs OR Response
Subject heading	Dialysis OR Renal Insufficiency OR End Stage Renal Disease OR Kidney Failure Patients OR Nurses Indigenous Population OR First Nation OR Aboriginal	Bereavement support Memorials Palliative care OR End-of-life Care Grief counselling	Not applicable	Perspective OR Experience OR Attitudes Coping Mechanisms OR Well-being OR Quality of Life Psychological Bereavement Process Communication Satisfaction

PICO, Population, Intervention, Comparison, Outcome.

Study selection

Following the search, all identified citations were collated and uploaded into Endnote 21, and duplicates were removed. Titles and abstracts were screened by two reviewers for assessment against the inclusion criteria. Any disagreements that arose at each stage of the selection process were discussed and resolved by consensus. The reasons for exclusion were recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (figure 1).

Figure 1. PRISMA flow diagram for study selection in the scoping review on bereavement perspectives and support in haemodialysis units.⁴¹ CKD, chronic kidney disease; ESRD, End-Stage Renal Disease; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

The remaining studies were retrieved in full and assessed in detail by two reviewers. Data were extracted following a comprehensive assessment via a data extraction table, which identified the study demographics, origin, methods, aims, participants and sample characteristics. We then analysed how each study contributed to answering the research subquestions relevant to the review question (table 1). Both reviewers conducted thematic coding of each article to identify key ideas, phrases and patterns, helping to identify prevalent perspectives, support strategies, associated outcomes and research gaps within the literature.

Results

Selection of sources of evidence

A total of 67 records were identified through database searching and supplementary sources. After removing duplicates (4), 63 records were screened, of which 21 were excluded due to no mention of renal, dialysis, end-stage renal disease or chronic kidney disease. Following retrieval and full text review for eligibility of the remaining 42 studies, 17 were included in the final synthesis. This process is illustrated in the PRISMA flow diagram (figure 1).

Characteristics of sources of evidence

This review encompasses 17 studies from the USA (9), the UK (4), Australia (2), Canada (1) and Sweden (1), published between 1998 and 2021. The included studies were selected based on predefined criteria and primarily utilised qualitative methods such as interviews and phenomenological approaches (12), along with literature reviews (2), descriptive manuals (1) and grey literature, including a blog (1). Participants included haemodialysis patients and nurses across various age groups and genders, representing diverse cultural and religious backgrounds. Study demographics, characteristics, aims and key findings are detailed in Table 3 (online supplemental file 3).

Critical appraisal within sources of evidence

Methodological quality was assessed using the appropriate JBI Critical Appraisal Checklists, with scores ranging from 3/6 to 9/10. Ten studies were rated high quality, five moderate and two lower quality. A common issue was small, single-centre qualitative samples, often involving fewer than 20 participants, which restricts the transferability of findings. While qualitative approaches were appropriate for exploring experiences of grief and bereavement, many reports provided limited detail in methodology, raising concerns about transparency in data collection and analysis. A number of studies focused narrowly on specific groups, such as female patients, or were drawn from homogenous cultural contexts, limiting cultural applicability. In addition, several sources were descriptive service evaluations, conceptual papers or grey literature (including a blog and programme manuals), which contributed valuable contextual insights but lacked systematic methodology or an objective outcome measurement. Despite these limitations, all studies were retained because they addressed an under-researched area and offered unique perspectives on bereavement experiences and support in haemodialysis units.

Themes emerging from evidence

Across the included studies, four themes were consistently identified: patient experiences of bereavement, the emotional and professional impact on nurses, the importance of cultural and spiritual dimensions and the role of formal support strategies such as memorial services and palliative care.

Patient perspectives

The results indicate that haemodialysis patients experience a spectrum of emotions ranging from profound sadness, anxiety²³ and fear, as well as acceptance in coping with the bereavement of fellow patients. Their coping mechanisms include seeking social support, open communication and spiritual practices, although social isolation remains a significant challenge.323,27 Patients expressed their desire for open discussions and acknowledgement of death, wanting to be notified when another patient passed,³ as the sudden absence of a fellow patient can leave survivors feeling isolated and anxious.³

Nurse perspectives

Haemodialysis nurses endure significant emotional tolls due to frequent patient deaths, often leading to burnout and compassion fatigue. They describe stress from providing complex care, witnessing patient deterioration and struggling to balance close patient relationships with professional boundaries.^{27 28} This can result in complicated grief characterised by feelings of helplessness, frustration and guilt when patients pass away.²⁶ Effective support for nurses includes debriefing sessions, peer support and professional counselling, yet many nurses still report feeling ill-equipped to manage bereavement in their practice.26,30

Spiritual and cultural needs

The cultural and spiritual needs of both patients and nursing staff are closely intertwined with their experiences of loss and grief in haemodialysis units. Inclusive practices such as empathy, active listening and spiritual dialogue can help integrate spiritual care into routine activities, enhancing coping and overall quality of life.2831,33 Nurses are in a position where they can provide spiritual care, which may assist patients in finding meaning and balance in the setting of an ultimately terminal condition.³² Patients appreciate when nurses display genuine caring, build relationships, initiate spiritual dialogue and mobilise spiritual resources such as prayer and scripture reading.²⁶ Patients felt that these actions not only supported their spiritual needs but also enhanced their overall care experience.³¹ For nurses, providing spiritual care can bring a sense of responsibility and fulfilment but also emotional exhaustion, given the recurrent, nonlinear progression of grief in kidney failure patients, triggered by new losses or health setbacks.^{26 28} While many nurses rely on their own spiritual beliefs to cope with grief,^{28 29} they lack adequate resources and formal training to extend such care to their patients.²⁸

Support strategies

A range of support strategies were identified across the literature, varying in formality and impact. Strategies include memorial services, counselling and comprehensive palliative care, which provides emotional closure and strengthens community bonds.33,37 The introduction of renal memorial services has been particularly beneficial in several units. Evaluations indicate that these services provide relatives and friends an opportunity to connect with and thank the staff who care for their loved ones, aiding in their grieving process.33,35 Other specific strategies provided by unit staff include prayer, obituaries, placing flowers in memory of the deceased and lighting candles.^{30 33} Despite these interventions, the findings suggest that these interventions alone may be insufficient and that a coordinated multifaceted approach is needed.

Discussion

The exploration of grief and bereavement experiences among patients and nursing staff within haemodialysis units sheds light on a critical yet underexamined aspect of care. The lack of literature describing the experience in rural and regional settings of Australia such as Dubbo is even more profound. The findings underscore the extensive emotional impact of patient deaths within these units, emphasising the need for tailored grief support strategies that account for the unique social dynamics and local characteristics of rural haemodialysis units. This study builds on the limited literature that explores these experiences, emphasising the importance of addressing both patient and staff needs to prevent maladaptive grief responses and support overall unit well-being.

Patient Perspectives

While dialysis units are described as unique social environments, where patients spend considerable time together, in a rural setting, units may include staff and patients who are either relatives or known to one another in the community by other means. The interconnected relationships likely further amplify the sense of loss when a peer passes away. This suggests a need for support systems that extend beyond the unit to involve families and the wider community affected by the grieving process, especially in the First Nations context, where this is most prevalent. The physical absence of a deceased patient, described as ‘an empty chair’, in the unit serves as a powerful visual cue of mortality, further intensifying the emotional impact on the remaining patients.³ As a result, patients feel a sense of isolation and vulnerability, which requires attention²⁵ to prevent withdrawal from the unit community as a means of self-preservation against the emotional impact of the loss.²⁶

Coping strategies among patients are often informal and revolve around shared understanding and solidarity within the haemodialysis community.^{24 27} Such informal mechanisms include conversing with other patients, family members and staff or engaging in personal rituals.²³ Moreover, the role of the physical environment in shaping how patients process their grief is important.²⁷ The presence of memorials or dedicated reflection spaces within haemodialysis units provides a tangible way for patients to honour the memory of their deceased peers and cope with their loss.²⁷ Within a rural setting with a high prevalence of First Nations patients, grieving and memorial rituals should be tailored with cultural oversight by First Nations leaders and stakeholders to ensure they align with patient’s wishes.

Patients desire open acknowledgement of death within the units, which could facilitate better coping mechanisms and foster a sense of closure and community support.^{24 26 27} Lack of end-of-life planning and palliative care education for patients also limits the ability for bereavement support to be customised for haemodialysis patients within the unit.³⁸ Discussions about death and dying are widely considered taboo within the culture of the dialysis centre. Exploring the perceptions of patients within the unit about their wishes for support around end-of-life may assist patients in coping with death and improve the quality of the care they receive.

Nurse perspectives

It is clear in the literature that haemodialysis nursing staff do not feel equipped to provide grief care to patients and there is an urgency to develop training and competencies for staff, to mitigate risk of burn out and attrition.³⁹ Additionally, targeted interventions and comprehensive support systems including debriefing and counselling need to be developed to sustain nurse well-being in haemodialysis units.^{26 27 30}

This desire is often in conflict with the stringent guidelines that healthcare providers must follow regarding patient confidentiality. Confidentiality constraints not only impact patients but also place a significant emotional burden on nurses, who must navigate the complex terrain of providing care while withholding information that could comfort both themselves and other patients.²⁹ In the Dubbo haemodialysis unit, in regional Australia, proactive steps are being taken towards this. Nurses would like to implement a consent process for incoming dialysis patients, permitting them to release certain information to other patients in the unit. This approach aims to respect patient privacy while also addressing the emotional needs of the remaining patients. While this is not yet a standardised protocol, it represents a significant step toward balancing the need for confidentiality with the provision of effective care—a challenge that many haemodialysis units face.²⁹ This approach could serve as a model for other rural units, fostering an environment where confidentiality is respected, but the emotional well-being of both patients and nurses is prioritised.

Spiritual and cultural needs

In rural settings, where cultural and spiritual practices may differ significantly from those in urban areas, the need for culturally sensitive care becomes even more relevant. This is particularly true for First Nations patients, whose spiritual and cultural practices are often integral to their grieving processes.¹⁵ However, as identified in this study, the perspectives and needs of First Nations people are notably absent in much of the literature on grief and bereavement in haemodialysis units. Engaging with First Nations communities and incorporating their cultural and spiritual practices into support strategies are essential for providing holistic and inclusive care. This study highlights the urgent need for further research focused on understanding the specific bereavement needs of First Nations patients in rural haemodialysis units to allow for the development of culturally appropriate interventions that respect and integrate their traditional practices.

Support strategies

The implementation of support strategies in haemodialysis units is vital in managing grief and bereavement among patients and nurses. This requires a sophisticated strategy, as the dialysis environment is unique and not able to be reliably replicated or generalised to other areas. Complicated grief, characterised by prolonged and intense mourning, necessitates a comprehensive multidisciplinary approach that includes psychological, social, spiritual and existential support tailored to the diverse aspects of grief experienced by individuals.^{26 32 40} This need is particularly true for rural haemodialysis units, where the impact of death reverberates beyond the immediate unit and into the broader community, especially among First Nations people. In rural settings, support strategies must be sensitive to the wider social and cultural context and should involve community leaders, including those from First Nations communities, in both the design and implementation of these interventions. Furthermore, ongoing support is essential, extending beyond the immediate aftermath of a patient’s death. Regular follow-ups, home visits, condolence cards and personal letters from staff, as well as the involvement of social workers, can help maintain a connection between the unit and the wider community, ensuring continuous support for those grieving, particularly in culturally diverse populations.^{36 40}

Implications for clinical practice

We make the following recommendations for future practice:

• The development of culturally sensitive grief communication protocols for staff to be able to support patients in coping with grief and loss in the dialysis setting.

• Death education in undergraduate and postgraduate nursing curricula.

• Structured debriefing sessions for staff, with additional access to counselling services

Limitations and recommendations

Despite these insights, it is important to acknowledge the limitations of the studies included in this review. Small and homogeneous sample sizes of the included studies may not fully represent the diverse experiences of all haemodialysis patients. Our search revealed a significant gap in the understanding of the specific grief and bereavement needs of First Nations patients in dialysis settings. Engaging with our First Nations Advisory Contacts highlighted real-world challenges, including a lack of awareness about intergenerational grief and the constraints that haemodialysis imposes on attending crucial mourning practices and funerals. Their input underscores the urgent need for culturally sensitive support, education and resources. To address this, further qualitative research involving key stakeholders within and outside haemodialysis units is needed. This approach should consider the unique, intricate connections within rural communities, enabling haemodialysis units to better support their patients and staff in the face of death.

With respect to our study, we sought findings from a global context to broadly describe the practices of a diverse group of patients; however, we found minimal literature specific to Australia and, in particular, rural communities. This lack of data prevents a more accurate and representative picture of the unique challenges faced in these settings. Additionally, owing to this project’s limited timeline, we excluded non-English studies and certain groups, such as nephrologist clinicians, allied health professionals and carers. Including these perspectives might have offered valuable insights, enhancing the comprehensiveness and applicability of our findings.

Importantly, this review reflects literature published up to 2021. While this can be perceived as a limitation, the outdated nature of the available research reinforces the urgency and value of this work. A scoping review is a crucial tool for mapping what exists, even if limited or dated, so that future, more targeted and culturally nuanced studies can be designed. The aim was not to offer conclusive answers, but to illuminate the path for further inquiry.

Additionally, while AI tools such as ‘Elicit’ were used during the initial search and screening phases to support evidence identification, it is important to acknowledge the potential limitations of AI-assisted methods. These tools, though efficient, may have overlooked relevant studies due to algorithmic constraints, particularly in niche or cross-disciplinary areas. Human oversight was maintained throughout, but the reliance on AI introduces a risk of incomplete retrieval that should be considered when interpreting the comprehensiveness of the review.

The findings from this study aim to lay a foundation for our local unit to implement strategies or initiate conversations about the grief and bereavement needs of patients. Future research should include larger, more diverse populations to better represent the heterogeneous groups encountered in haemodialysis units. Specifically, understanding the unique needs within the Dubbo unit is crucial given its First Nations groups and rural community intricacies to design a more tailored support service.

Conclusion

This study delves into the grief and bereavement experiences within haemodialysis units, highlighting the profound emotional impact on both patients and nursing staff. The findings emphasise the urgent need for comprehensive, tailored and culturally informed support systems that address the psychological, social and spiritual needs of both groups, while identifying a critical gap in understanding the specific grief and bereavement needs of First Nations and rural communities.

Transparency declaration

The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects have been omitted and that any discrepancies from the planned study have been explained.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.