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A service to support bereaved families: a team of nurses at Auckland City Hospital's department of critical care medicine provides support to the next of kin of those who have died in the department.

The Department of Critical Care Medicine (DCCM) at Auckland City Hospital provides a bereavement follow-up service to the next of kin (NoK) of all patients who have died in the department. Established in 1994, it is a support service, not a counselling service.

The DCCM provides intensive care and high dependency care for adult patients (15 and over) with all conditions, except heart, lung and blood vessel surgery. Specialist areas include intensive care for liver, kidney and pancreas transplantation and neurologic (brain) conditions.

Deaths in critical care are often sudden and approximately 10 percent of our patients die.

There are always some questions and concerns after the death of a patient: Were the needs of the family met? How will the family cope later on? How was the service in the department? What could we do better? It was these sorts of questions that led a group of nurses to establish the bereavement follow-up service.

The service gives family members the opportunity to ask any questions or clarify any misunderstandings they might have had. This, in turn, enables us to identify any issues that may need to be addressed. The bereavement service team is six nurses who each spend one shift a week for two months of the year in the clinic. This clinic is a small room with a computer and phone in the hospital's support building.

The impact of grief

Two weeks after the death of a patient in the department, the service sends a pamphlet to the NoK explaining the role of the service and advising that somebody will be getting in touch with them. The pamphlet also refers to the physical and emotional impact of grief and describes what the family may be experiencing. For some NoK, the death in the DCCM is first death they have experienced and the grief response can be overwhelming.

About six weeks after the patient's death, a nurse from the bereavement service calls the NoK. It can take many attempts to get in touch and evenings are often the best time to call. The conversation centres around a set of core questions: Are they sleeping? Do they have a good support system? Has the death of their loved one affected them financially? Has their employment status changed since the death of their loved one? Are their activity levels back to normal? Their answers indicate how they are coping with their grief.


We also ask whether they understood the sequence of events that led up to the patient's death, whether they were kept well informed by the DCCM staff and whether anything could have been done better. The answers to these three questions provide us with invaluable feedback on the quality of our communication and service for the dying patient and their family/whanau. We finish the conversation by asking "Is there anyone else you would like us to contact?" This often results in one of the team calling other family members.

After the phone call, we write a letter thanking the NoK for their time and we include reading material about grief, a resource pamphlet listing helpful grief websites, and resources available online and in the community. At the first anniversary of the patient's death, we send a card to the NoK, saying the family is remembered at this time.

Information collected on the call is put into the bereavement follow-up database. This allows us to look at trends and over the years many changes have occurred. One of the most important has been better communication with families. There are now frequent meetings with our families/whanau and the medical team. If we feel an individual or a family needs helps, we often refer them to the department's social worker or an outside agency that can provide assistance. Recently I made a call about the death of a non-New Zealand resident. The family had received the hospital bill of more than $20,000 and was struggling to pay the funeral costs, let alone the hospital bill. I arranged with the social worker to liaise with the family. The social worker, in turn, liaised with the hospital's finance department and a manageable payment plan is now in place.

After a bereavement call, feedback is given to individual staff member(s) who looked after the dying patient. If there are unresolved questions that require further follow up, a family meeting with an intensive care consultant and the bereavement nurse occurs. Such meetings generally occur if the family does not understand why their loved one died and needs clarification about the illness process. The last family meeting I arranged was for a family whose loved one was transferred from a medical ward to our department. He died within two hours of arriving and the family did not have a chance to visit him before he died. Sitting down with the family and detailing the circumstances of his death and answering the family's questions helped relieve some of their anxiety about the death.

Looking after the team

The six members of the bereavement service team are experienced critical care nurses who have an interest in the area. Each of us has attended a three-day course run by Australian grief counsellor and educator, Mal Mackissock. This provides an insightful and interesting overview on grief. An annual bereavement study day is run by the team for the team. At the end of each of our two-month stints in the clinic, we attend the employment assistance programme. This helps promote self care. Calls can sometimes be long and emotional, and we will often debrief with our colleagues after any particularly difficult calls.

The department is proud of its bereavement follow-up service. It provides support to families and others close to patients who have died in our department. It also provides our department with a great quality tool to measure the care we deliver to our dying patients and their family/whanau.

Sue Garland, RN, MN, is a clinical charge nurse in the department of critical care at Auckland City Hospital.
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Title Annotation:PRACTICE
Author:Garland, Sue
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Nov 1, 2011
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