Family Members' Experiences With Bereavement in the Intensive Care Unit

Care of the Patient Nearing the End of Life in the Neurointensive Care Unit

BACKGROUND

Neurologically critically ill patients present with unique disease trajectories, prognostic uncertainties, and challenges to end-of-life (EOL) care. Acute brain injuries place these patients at risk for underrecognized symptoms and unmet EOL management needs, which can negatively affect their quality of care and lead to complicated grief in surviving loved ones. To care for patients nearing the EOL in the neurointensive care unit, health care clinicians must consider neuroanatomic localization, barriers to symptom assessment and management, unique aspects of the dying process, and EOL management needs.

AIM

We aim to define current best practices, barriers, and future directions for EOL care of the neurologically critically ill patient.

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

BACKGROUND

Bereavement 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.

OBJECTIVES

The 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.

METHODS

A 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.

RESULTS

One 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.

CONCLUSIONS

Many 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.

Bereavement Experiences of Families in the Cardiac Intensive Care Unit

BACKGROUND

Losing a loved one in the intensive care unit is associated with complicated grief and increased psychologic distress for families. Providing bereavement support may help families during this time. However, little is known about the bereavement experiences of families of patients in the cardiac intensive care unit.

OBJECTIVE

To describe the bereavement experiences of families of patients in the cardiac intensive care unit.

METHODS

In this secondary analysis, an exploratory, descriptive design was used to understand the families' bereavement experiences. Families from 1 cardiac intensive care unit in a tertiary medical center in the western United States participated. Audiotaped telephone interviews were conducted by using a semistructured interview guide 13 to 15 months after the patient's death. A qualitative, descriptive technique was used for data analysis. Two independent researchers coded the interview transcripts and identified themes.

RESULTS

Twelve family members were interviewed. The majority were female (n = 8, 67%), spouses (n = 10, 83%), and White (n = 10, 83%); the mean age (SD) was 58.4 (16.7) years. Five main themes emerged: (1) families' bereavement work included both practical tasks and emotional processing; (2) families' bereavement experiences were individual; (3) these families were resilient and found their own resources and coping mechanisms; (4) the suddenness of a patient's death influenced families' bereavement experiences; and (5) families' experiences in the intensive care unit affected their bereavement.

CONCLUSIONS

This study provided insight into the bereavement experiences of families of patients in the cardiac intensive care unit. These findings may be useful for professionals working with bereaved families and for cardiac intensive care units considering adding bereavement support.

Healthcare professionals' knowledge, skills, and role in offering and facilitating memory making during end-of-life care in the adult intensive care unit

BACKGROUND

An activity to provide a tangible keepsake following the death of a loved one is termed 'memory making'. However, limited evidence is available related to professionals' education and support to provide memory making opportunities in the adult intensive care unit (ICU). Having a greater understanding of healthcare professionals' experiences can inform future patient/family care and support for professionals in end-of-life care.

OBJECTIVE

The objective of this study was to describe what participants perceive memory making to be, if they have facilitated memory making activities as part of their practice, if they perceive it as part of their role, and if they have the necessary skills to do so.

METHODS

Seventy-five registered nurses (75% response rate), 19 medical doctors (76% response rate), and two social workers (66.7% response rate) completed a survey at a single tertiary referral centre in an adult ICU.

RESULTS

Participants reported memory making to include the creation of tangible keepsakes as well as nontangible activities. Overall, participants reported high agreement scores that the responsibility for initiating memory making predominately belonged to the nurse. Participants reported skills most needed involved the ability to interact with the family, being open to the concept, and integrating memory making into their standard of care. Having developed a rapport with families was considered an enabler, whereas lack of knowledge and clinical workload were reported as inhibitors to offering memory making.

CONCLUSIONS

Overall, participants in this study reported positive experiences with offering memory making to families during end-of-life care in the adult ICU. Nurses are more likely to perceive professional responsibility for offering memory making, likely due to their increased time at the bedside and higher prominence and leadership in other end-of-life practices. To support professionals, education should include conceptual knowledge, procedural knowledge of keepsake creations, communication techniques using reflective practices, and organisational support to facilitate time requirements.

Enhancing Communication With Family Members in the Intensive Care Unit: A Mixed-Methods Study

Background

Nurses in the intensive care unit are central to clinical care delivery and are often the staff members most accessible to family members for communication. Family members’ ratings of satisfaction with the intensive care unit admission are affected more by communication quality than by the level of care for the patient. Family members may feel that communication in the intensive care unit is inconsistent.

Objectives

To use a shared decision-making model to deliver a communication education program for intensive care unit nurses, evaluate the confidence levels of nurses who undertook the education, and examine changes in family members’ satisfaction with communication from intensive care unit nurses after the nurses received the education.

Methods

A mixed-methods design was used. Seventeen nurses and 81 family members participated.

Results

Staff members were overall very confident with communicating with family members of critically ill patients. This finding was likely linked to staff members’ experience in the position, with 88% of nurses having more than 11 years’ experience. Family members were happy with care but dissatisfied with the environment.

Conclusions

Environmental factors can negatively affect communication with family members in the intensive care unit.

Family Bereavement Adaptation After Death of a Loved One in an Intensive Care Unit: Impact of Race/Ethnicity

Limited longitudinal studies have hindered the understanding of family adaptation after loss of a loved one in an intensive care unit (ICU). Based on the Double ABCX Model, this study examined changes in adaptation to bereavement for family members in the first year after the ICU death, with special attention to the effects of race/ethnicity. A repeated-measures design was used to conduct the investigation using 3 time points (1-3, 6, and 12 months) after the ICU death. Data were analyzed using linear mixed modeling. Family members (n = 30) consisted of 60% non-Hispanic Whites and 40% African Americans (AAs). During the first 1 to 3 months, moderate to severe symptoms of posttraumatic stress disorder, depression, anxiety, and stress were found (60%, 40%, 30%, and 26.7%, respectively). Initially, non-Hispanic Whites had higher depression scores than African Americans. The change in depression and posttraumatic stress disorder symptoms over 1 year differed by race/ethnicity. Many family members tended to be at risk of psychological sequelae in the early months after a patient's death in an ICU. Racial/ethnic differences in bereavement process need further exploration to understand the broader context within family members grieve and effectively offer support over the course of the first year.

Beyond the hour of death: Family experiences of grief and bereavement following an end-of-life hospitalization in the intensive care unit

End-of-life decision-making is an important area of research, and few sociological studies have considered family grief in light of end-of-life decision-making in the hospital. Drawing on in-depth interviews with family members in the intensive care unit (ICU) during an end-of-life hospitalization and into their bereavement period up to six months after the death of the patient, this article examines bereaved family members' experiences of grief by examining three aspects from the end-of-life hospitalization and decision-making in the ICU that informed their subsequent bereavement experiences. First, this article explores how the process of advance care planning (ACP) shaped family experiences of grief, by demonstrating that even prior informal conversations around end-of-life care outside of having an advance directive in the hospital was beneficial for family members both during the hospitalization and afterwards in bereavement. Second, clinicians' compassionate caring for both patients and families through the "little things" or small gestures were important to families during the end-of-life hospitalization and afterwards in bereavement. Third, the transition time in the hospital before the patient's death facilitated family experiences of grief by providing a sense of support and meaning in bereavement. The findings have implications for clinicians who provide end-of-life care by highlighting salient aspects from the hospitalization that may shape family grief following the patient's death. Most importantly, the notion that ACP as a social process may be a "gift" to families during end-of-life decision-making and carry through into bereavement can serve as a motivator to engage patients in ACP.

Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients

BACKGROUND

Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families.

OBJECTIVE

To evaluate the effectiveness of bereavement follow-up on family members' anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care.

METHODS

A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey.

RESULTS

Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder.

CONCLUSIONS

Bereavement follow-up after an ICU death reduced family members' prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.

Spiritual care in neonatology: analysis of emergency baptisms in an Irish neonatal unit over 15 years

BACKGROUND

Emergency baptism remains an important emotional and spiritual element for many parents of critically ill infants in the neonatal unit. There is no published data available as to which neonates are baptised and their outcomes.

OBJECTIVES

To evaluate trends, outcomes and characteristics of newborn infants baptised over a 15-year period in an Irish maternity hospital.

METHODS

Retrospective study of infants baptised in University Maternity Hospital Limerick (UMHL) over a 15-year period. Patients were identified from the 'register of baptisms' for the years 2002-2016.

RESULTS

A total of 354 neonates were identified and further information was available for 341. We observed a gradual decline of emergency baptisms over the 15-year period. A total of 114 (32.2%) infants were term and 199 (56.2%) preterm. A total of 288 infants (81.5%) were baptised by Catholic priest, 61 (17.3%) by staff member, 1 (0.3%) by family member and in 3 cases (0.9%) the person baptising was unrecorded. Day of baptism varied from 1 to 88 with a mean age of 4.6 days. A total of 113 (31.9%) neonates died after baptism. Majority of infants baptised were preterm and low birth weight, with predominance of extremely low birth weight (ELBW) who also had proportionately higher mortality 47 (47.5%) following the baptism.

CONCLUSION

Emergency baptism remains an important element in the spiritual care of the critically ill newborn infants and their families. Maternity hospitals and neonatal units should have access to emergency baptism service or other equivalent 'spiritual blessings' as appropriate to the faiths followed by the family, especially in an emerging multi-faith population.