Bereavement follow-up service in intensive care

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

BACKGROUND

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.

OBJECTIVE

To describe current bereavement follow-up services in adult ICUs.

METHOD

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.

RESULTS

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.

CONCLUSIONS

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.

A good death

The Institute of Medicine defines a good death a “one that is free from avoidable death and suffering for patients, families and caregivers in general accordance with the patients’ and families’ wishes.”. The current system creates barriers to reducing the stress and suffering that accompany a patient’s end of life. Data and eHealth technology, if it were more accessible, could help patients, families, and caregivers to cope with end of life issues.

Developing and evaluating critical care follow-up

The effects of critical illness not only affect the patient and relative during the intensive care stay but often affect for a considerable time afterwards. A growing body of opinion and evidence suggests that many of the needs of those who have been critically ill can be met through critical care follow-up services. A growing number of follow-up services now exist. Their establishment, development and evaluation pose significant challenges for those involved. This paper describes Bassetlaw hospital's critical care follow-up service, how it was established and what an elementary service evaluation project has shown. The findings and experiences are compared with others in published literature, and the paper may be of interest to those who are currently involved in follow-up or who plan to develop such services in the future.

Promoting a peaceful death in the ICU

Care for the dying ICU patient and family should be inclusive of respect for their goals, preferences. and choices. Care should be comprehensive, inclusive of all the patient domains (physical, psychosocial and, spiritual), and inclusive of all the specialties and disciplines that can be helpful at this complex time. The families' concerns should be acknowledged and support given. Our ICUs need to develop supportive environments for those dying patients who stay in the unit. Quality improvement and ongoing evaluation will provide avenues of change for care of this special group of patients and families.

The role of advocacy in critical care nursing: a caring response to another

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

Care of the suddenly bereaved in cardiac care units: a review of the literature

This paper considers the experiences emerging from relatives whose loved ones die suddenly in a Cardiac Care Unit (CCU). It examines how best to address their needs and how to facilitate the normal grieving process during their brief yet traumatic hospital encounter. There appears to be no primary research relating specifically to sudden bereavement in a CCU. Several authors assume that findings can be applied between specialties but there is no empirical evidence to support this assumption. The research which does exist is predominantly in the areas of bereavement generally and in Accident and Emergency (A&E) in particular. This paper contains a critical examination of this literature and consideration of the extent to which findings from these fields can be relied upon to lead practice in the CCUs. It is concluded that recommendations for practice arising from such literature, e.g. those supporting the allocation of an advocate nurse to accompany relatives and allowing observation of resuscitation, may not be readily applicable to CCUs. The paper concludes with a consideration of future cardio-specific research needs.

Meeting the informational, psychosocial and emotional needs of each ICU patient and family

The acquisition of counselling skills and a review of current practice within a cardiothoracic intensive care unit (ICU) have revealed the need for a nursing development that will focus on meeting the informational, psychosocial and emotional needs of patients and their families. The findings from a literature search suggest that these needs are not always adequately met. Difficulties may be encountered by patients and their families whilst trying to adjust to a stay in the ICU, to transfer to the ward, and following discharge home. Providing a client-driven service that effectively meets these complex needs could be achieved by developing a specialist role in intensive care nursing. The patients and their families could be offered provision of information and supportive strategies that extend from admission to the ICU, through transfer to a ward, and beyond. The aim of the service would be to provide patient- and family-centred continuity of care throughout the acute and rehabilitative stages of the crisis (Turner 1992). The utilization of counselling skills could help to facilitate the service, and help each client to feel supported (Tschudin 1995, p 33).

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.

A qualitative study to establish the self-perceived needs of family members of patients in a general intensive care unit

Admission to an intensive care unit (ICU) invariably causes a considerable degree of distress and anxiety to both patient and family. If we profess to deliver holistic care then it is essential that intensive care nurses are able to identify the specific needs of family members and provide appropriate supportive interventions. This small study was designed to gain the perspectives of the families. Through unstructured interviews participants were invited to discuss their experiences of visiting a critically ill relative, particularly in relationship to their own needs. Interviews were tape-recorded with permission and subsequently transcribed. Thematic content analysis adapted from Glaser & Strauss' 'grounded theory' approach (1967) by Burnard (1991) occurred, with formation of six categories, exemplified by verbatim quotations. The study may contribute towards a framework for preventative, supportive and therapeutic intervention with family members in the intensive care setting.