Mediating factors in the grieving process of the suddenly bereaved

Good and Bad Experiences of Family Presence During Acute Care and Resuscitation. What Makes the Difference?

Background: Family presence (FP) in the resuscitation room is still controversial, and its appropriateness for patient and family has been discussed. We examined both positive and negative experiences in order to establish the reasons for the difference.

Aim: The aim of the present literature review was to describe patients', relatives' and staff's opinions and experiences of FP during invasive procedures and resuscitation.

Method: 12 original papers, published between January 1995 and February 2003, were reviewed.

Results: Most patients and relatives agreed that they had positive experiences of FP. They described how FP enhanced the feeling of support and connectedness within the family. Family members believed that FP helped them in their grieving process. Most staff members without FP experience felt that FP would increase the risk of psychological distress for the family. Those who had participated in an FP programme believed that FP was not only beneficial for the family but also for staff.

Conclusion: Family presence during resuscitation and acute care has the potential to enhance the care of the patient and to benefit everyone involved. However, implementation of FP during resuscitation must take account of potential problems.

Viewing the body after bereavement due to suicide: a population-based survey in Sweden

Background

Research on the assumed, positive and negative, psychological effects of viewing the body after a suicide loss is sparse. We hypothesized that suicide-bereaved parents that viewed their childs body in a formal setting seldom regretted the experience, and that viewing the body was associated with lower levels of psychological morbidity two to five years after the loss.

Methods and Findings

We identified 915 suicide-bereaved parents by linkage of nationwide population-based registries and collected data by a questionnaire. The outcome measures included the Patient Health Questionnaire (PHQ-9). In total, 666 (73%) parents participated. Of the 460 parents (69%) that viewed the body, 96% answered that they did not regret the experience. The viewing was associated with a higher risk of reliving the child's death through nightmares (RR 1.61, 95% CI 1.13 to 2.32) and intrusive memories (RR 1.20, 95% CI 1.04 to 1.38), but not with anxiety (RR 1.02, 95% CI 0.74 to 1.40) and depression (RR 1.25, 95% CI 0.85 to 1.83). One limitation of our study is that we lack data on the informants' personality and coping strategies.

Conclusions

In this Swedish population-based survey of suicide-bereaved parents, we found that by and large everyone that had viewed their deceased child in a formal setting did not report regretting the viewing when asked two to five years after the loss. Our findings suggest that most bereaved parents are capable of deciding if they want to view the body or not. Officials may assist by giving careful information about the child's appearance and other details concerning the viewing, thus facilitating mental preparation for the bereaved person. This is the first large-scale study on the effects of viewing the body after a suicide and additional studies are needed before clinical recommendations can be made.

Death in the hospital: Breaking the bad news to the bereaved family

Informing the family members about the sudden death of their loved one is a highly stressful experience for the treating doctors. Breaking the bad news to the bereaved family needs special skill on the part of the clinicians. An elaborate, step-wise modified action plan for breaking the sad news and grief reduction based on the literature has been presented here. The guidelines mentioned in the article are simply the tips to the clinicians and not to be considered as any form of protocols. Inclusion of this subject into the undergraduate medical curriculum has to be considered. By doing so, we can look forward to produce junior doctors who are better at coping with this awkward but extremely important aspect of clinical medicine.

Family Members' Experiences with Viewing in the Wake of Sudden Death

Sudden deaths leave families in crisis and interacting with many professionals from notification through to burial. Whether to view the deceased is often central to discussion. Practice guidelines have evolved over time regarding where, when, how, and why viewing should or should not occur. Unfortunately, there is much contradiction in existing recommendations and a marked absence of a supporting evidence base for the practice of viewing itself, and the influence of this practice on the overall bereavement process. Using a qualitative approach, this study explored the perspectives and experiences of the suddenly bereaved with respect to: viewing or not having viewed; whether or not their viewing experiences have impacted on their bereavement process; and explored particular aspects of their experience such as interactions with various professionals. Results of this study are clustered and presented under three core themes: viewing specifics; intrapersonal responses; and professional interactions.

Evidence-based protocol. Family bereavement support before and after the death of a nursing home resident

Front-line caregivers in nursing homes frequently provide bereavement support to family members before and after the death of a nursing home resident. Use of the evidence-based guideline "Family Bereavement Support Before and After the Death of a Nursing Home Resident" (Davidson, 2002) can reduce uncertainty and increase the confidence of staff providing before and after death care to families, and can ensure all families receive consistent bereavement support.