Bereavement Follow-up Services Research Articles

The impact of COVID-19 on the provision of bereavement support in Australian intensive care units: A national survey

BackgroundBereavement support is a vital part of caring for families when a patient dies in the intensive care unit (ICU). Previous research has demonstrated that while many ICUs provide some informal aspects of bereavement care, formalised follow-up programmes are uncommon. The impacts of COVID-19 on ICU-based bereavement support are currently unknown. ObjectivesThe objectives of this study were to explore the current provision of bereavement support in Australian ICUs and identify the impacts of the COVID-19 pandemic on these services. MethodsA cross-sectional exploratory web-based survey was used. The survey was distributed to one senior nurse in each public and private adult, paediatric, and neonatal ICU in Australia between April and July 2022. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Ethical approval was received from La Trobe University. ResultsOne hundred and four ICUs from 82 hospitals responded to the survey, with 36 units reporting a formal bereavement follow-up service. When compared to prepandemic levels, almost all of the common bereavement care practices explored in the survey were significantly reduced during the COVID-19 pandemic. Open-ended responses also demonstrated significant impacts of COVID-19 on bereavement care provision, particularly related to Restricted family togetherness, Logistical Challenges, and Impacts on Staff. Staff members reported adjusting care provision in response to these challenges by exploring Alternative family communications, Facilitation of family togetherness, and Increasing familysupports. ConclusionsMany of the common elements of ICU-based bereavement care were significantly reduced during the COVID-19 pandemic. In addition, the number of formal bereavement follow-up services in Australian ICUs remains largely unchanged since 2015. Ongoing research is needed to explore the long-term effects of these changes on staff and family wellbeing and on ongoing provision of ICU-based bereavement support.

What's in this Special Issue

What's in this Special Issue

Family-centred end-of-life care and bereavement services in Swedish intensive care units: A cross-sectional study.

Post-intensive care syndrome-family is a common problem in relatives of patients who die in an intensive care unit. Family-centred end-of-life care with support for the family during and after the death is supposed to prevent suffering and avoid illness. This study aimed to investigate family-centred end-of-life care and bereavement follow-up services offered to family members of patients who die in Swedish intensive care units. A cross-sectional study using a 16-question survey based on family-centred end-of-life care was sent to all 81 adult intensive care units. Data were analysed by descriptive statistics and chi-square. Respondents were able to add individual comments to the questionnaire. Although the majority (76.7%) offered some kind of follow up, this service was not always offered. Modes for invitation, timing, and contents in the follow up varied between the units. The staff tried to individualize the follow-up service according to the family's needs. Nurses and social workers were the only professionals who provided follow-up conversations on their own. Most of the intensive care units (97.3%) kept diaries that were handed over to the family when they left the unit after the patient's death or at a follow-up visit. Only 8.8% reported that they always offer the family the opportunity to be present during resuscitation. Most respondents reported that patients (60.6%) died in a private room. Family-centred end-of-life care varied among the intensive care units, and some families were not offered any follow up at all. Timing, invitation, and elements in the follow up differ between the units. Diaries were commonly kept and usually given to the family. Few units offered the family to be present during resuscitation. There is a need for national guidelines to ensure that all bereaved families receive equal and individual family-centred end-of-life care.

Elements of intensive care bereavement follow-up services: A European survey.

Despite technological innovations and continuous improvement in evidence-based treatments, mortality in the intensive care unit (ICU) remains high. Consequently, a large group of family members may be in need of, and could benefit from, bereavement follow-up support. To explore the elements, organization, and evaluation of ICU bereavement services in European countries. Specific objectives were to investigate: (a) the model of bereavement follow-up services (elements of support), (b) the workforce model (organization of staff), and (c) the evaluation model (evaluation strategies). This was a cross-sectional survey of conference delegates. A paper-and-pen questionnaire, including a cover letter assuring the respondents of anonymity and confidentiality, was distributed to 250 delegates during the opening ceremony of the 2017 European federation of Critical Care Nurses associations Congress in Belfast. The questionnaire was developed from a previously validated tool describing bereavement care practices in ICUs, including questions about the content and organization of bereavement follow-up services. Frequencies were calculated using yes/no questions, and content analysis was applied in additional free-text comments. We received 85 responses from publicly employed nurses, mainly in mixed adult ICUs. Respondents were 48 (56.5%) bedside nurses, and the remaining respondents represented clinical nurse specialists, researchers, managers, or academic nurses. Bereavement follow up had existed for about 1 to 15 years. Important follow-up elements were: viewing the deceased in the unit, 77 (90.6%); providing follow-up information, 67 (79.8%); sending a letter of sympathy, 17 (20%); and calling the family to arrange a meeting, 27 (31%). Bereavement follow up is common but variable in European ICUs. We recommend the development, implementation, and evaluation of evidence-based, but culture-specific, bereavement follow-up guidelines for European ICUs. More critical care nurses are realizing the need for bereavement follow-up guidelines. This paper provides an overview of common elements that might be considered. WHAT IS KNOWN ABOUT THIS TOPIC Many families experience the death of a loved one in intensive care unit (ICU). Bereavement services are offered at some ICUs. WHAT THIS PAPER ADDS Bereavement services are not systematically offered in European ICUs. Culture-specific guidelines are needed for bereavement follow up in ICUs. Common elements of bereavement services have been identified, for example, viewing the deceased in the unit, providing follow-up information, sending a letter of sympathy, and calling the family to arrange a meeting. Consequences of bereavement in ICU have been discussed, for example, prolonged or complicated grief and lack of closure in the bereaved.

Family-centered bereavement practices in Danish intensive care units: a cross-sectional national survey

BackgroundMortality in Danish intensive care units (ICUs) continues at 27%, resulting in a large number of bereaved family members being cared for in the ICU. ObjectivesTo investigate the provision of bereavement care and follow-up services for bereaved families in Danish ICUs. MethodologySelf-administered computerized cross-sectional nation-wide survey of Danish ICUs. ResultsNurses at 46 of 48 (96%) ICUs in Denmark responded. Bereavement care at the time of patient death included viewing the patient in ICU (100%), and in the hospital mortuary (59%). Information about hospital-based follow-up for the family was provided in 72% of units, whereas only one unit provided information on community-based bereavement follow-up. Bereavement follow-up services after hospitalization were offered to families in 59% of ICUs and included an ICU visit, meeting with the staff present at the time of death, a letter of condolence, a phone call to the family, referral to a priest or clergyman, or referral to other counseling. Although many interventions were common, there were variations within the elements offered. Nurses and physicians were the most consistent health care staff involved in bereavement services. ConclusionMost ICUs in Denmark offered bereavement follow-up services, but these varied in their approach, were not evidence-based, and lacked formal evaluation. More systematic quality improvement of bereavement practices is required.

The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey

BackgroundCaring for the bereaved is an intrinsic part of intensive care practice with family bereavement support an important aspect of the nursing role at end of life. However, reporting on provision of intensive care family bereavement support at a national level has not been well reported since an Australian paper published ten years ago. ObjectivesThe objective was to investigate provision of family bereavement support in intensive care units (ICU) across New Zealand (NZ) and Australia. MethodA cross-sectional exploratory descriptive web-based survey was used. All ICUs [public/private, neonatal/pediatrics/adults] were included. The survey was distributed to one nursing leader from each identified ICU (n=229; 188 in Australia, 41 in NZ). Internal validity of the survey was established through piloting. Descriptive statistics were used to analyse the data. Ethical approval was received by the ethics committees of two universities. ResultsOne-hundred and fifty-three (67%) responses were received from across New Zealand and Australia with 69.3% of respondents from the public sector. Whilst respondents reported common bereavement practices to include debriefing for staff after a traumatic death (87.9%), there was greater variation in sending a sympathy card to families (NZ 54.2%, Australia 20.8%). Fifty percent of responding New Zealand units had a bereavement follow-up service compared to 28.3% of Australian unit respondents. Of those with follow-up services, 92.3% of New Zealand units undertook follow-up calls to families compared to 76.5% of Australian units. Bereavement follow-up services were mainly managed by social workers in Australia and nursing staff in New Zealand. ConclusionsThis is the first Australia and New Zealand-wide survey on ICU bereavement support services. Whilst key components of family bereavement support remain consistent over the past decade, there were fewer bereavement follow-up services in responding Australian ICUs in 2015. As a quality improvement initiative, support for this area of family care remains important with rigorous evaluation essential.

Understanding How Bereaved Parents Cope With Their Grief to Inform the Services Provided to Them.

Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents' individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents' relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.

The intensive care bereavement follow-up service 10 years on: Results of a New Zealand and Australian Survey

The intensive care bereavement follow-up service 10 years on: Results of a New Zealand and Australian Survey

Bereavement Services Offered in Adult Intensive Care Units in the United States.

Losing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs. To describe current bereavement follow-up services in adult ICUs. A cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of Critical-Care Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression. A total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care. The study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.

The Antidepressant Effect of Hospice: Need for a More Potent Prescription.

The Antidepressant Effect of Hospice: Need for a More Potent Prescription.

Five years experience of critical care bereavement follow-up

We believe that by explaining and answering the questions of those relatives that wish it, we can alleviate the grief caused by the death of a relative in critical care. Death is a common outcome of critical illness and relatives are at high risk of problems with complicated or unresolved grief due to the sudden, often unexpected, manner of that death. We describe the establishment and results of a bereavement follow-up service.

Bereavement care for families part 1: a review of a paediatric follow-up programme

The World Health Organization suggests that palliative care needs to offer a support system to the family during the patient's illness as well as during his/her bereavement. Bereavement follow-up services in paediatrics offer families an additional source of support in their grieving process. This article reviews the development of a bereavement follow-up programme delivered by the paediatric palliative care team and explores the lessons learnt and challenges faced in developing the programme.

Bereavement follow-up after critical illness.

To describe the establishment and initial activity of a Bereavement Follow-up Service for next-of-kin of patients who died in an intensive care unit (ICU) and to quantify aspects of their experience including quality of intensive care service and the early impact on next-of-kin of their bereavement. Cross-sectional prospective study, which was conducted by a structured telephone interview. A 14-bed adult general ICU in a tertiary university hospital. A total of 99 next-of-kin of patients who died in ICU. Referral to other agencies if requested. Attempts were made to contact the next-of-kin of all 151 patients who died in 1995, and 104 were contacted. Five declined to be interviewed. The results refer to 99 who consented to telephone interview a median of 33 days after the death. A total of 84 considered themselves well informed during the intensive care period, 76 understood the fatal sequence of events but 19 of them would have liked more information. A total of 77 had positive comments about the quality of care, most commonly about compassionate behavior (58), but 30 had negative comments, most commonly about poor communication (13). Only 7 were living alone, 85 had resumed normal activities, 40 of 47 workers had returned to work, 58 had sleep disturbance at some stage (still present in 44), but only 12 were taking sedatives or antidepressants. A total of 32 had financial difficulties and 21 were referred to other agencies, most commonly grief counselors. We were disappointed to contact only two thirds of next-of-kin, but results from these subjects demonstrated a high level of satisfaction with the care given. Nevertheless, some were dissatisfied with the quality of service they experienced. Most had resumed their normal activities, including work, and few were living alone. However, sleep disturbance and financial difficulty were common, and some requested help from other support agencies.

Critical care nurses' perception of a bereavement follow-up service.

Over the last decade, care of patients' relatives has increasingly been seen to be of growing importance in the holistic approach to nursing care. Care of recently bereaved people has been encompassed within this and is now being seen as part of the nurses' role. Although there has been little empirical research, there is an increasing school of thought with the belief that much improvement can be achieved in the care of bereaved people in acute settings. The aim of this report is to give an insight into benefits and failings of a bereavement follow-up service within a critical care setting, as perceived by nurses.

Bereavement follow-up service in intensive care.

Following the death of a patient nurses sometimes wonder later how the surviving relatives have coped with the death of their loved one and whether there was any further help that could have been given. This report describes services available to bereaved relatives in Intensive Care Units (ICUs) throughout the UK and how, with limited resources, a formal follow-up service to all bereaved relatives can be achieved.

Providing hospice bereavement follow-up services: Practicing the art of doing more with less

Bereavement is one of the most difficult aspects of hospice work. This article provides information on theories of grief, a model for a bereavement team, and suggestions for training. Minimal resources exist for bereavement; therefore, the task must be accom plished in a creative, cost-effective manner.