Ambiguous presence: Grief and care among healthcare assistants in permanent vegetative state

Patients in a permanent vegetative state present unique emotional, ethical and relational challenges for those who care for them, whose physical presence yet psychological absence may expose staff to ambiguous loss, vicarious grief and disenfranchized grief. This qualitative study used reflexive thematic analysis to explore the lived experiences of 13 healthcare assistants working in a vegetative-state unit in north-east Italy, drawing on semi-structured interviews about caregiving, emotional burden, grief and anticipatory treatment declarations. Five themes were developed, describing care as emotionally complex and requiring continuous negotiation between attachment and protective detachment, alongside ethical distress over prolonged treatment and profound shifts in views on life and death. Caring for these patients involves complex, often unrecognized grief; psychological support, reflective spaces, death education and training on ambiguous loss may help staff process emotional burden and sustain humanized care.