Establishing a bereavement program: caring for bereaved families and staff in the emergency department

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Abstract

The successful planning and implementation of a Bereavement Program in the Emergency Departments of two of Melbourne’s major metropolitan teaching hospitals, Monash Medical Centre (MMC) and Dandenong Hospital (DH) was in response to staff dissatisfaction regarding their capacity to care for bereaved families and involved staff. Key influencing factors were identified and literature evidence was sought. A multidisciplinary team was brought together to form a Planning Group and guidelines were developed. The aim was to improve the care of all those involved with a death in the Emergency Department, both family and staff. Fundamental to facilitating these improvements was the need for staff education in the needs of families, self and staff and a grief education program was arranged, and provided through multiple sources, utilising the expertise of the Centre for Grief Education. The extremely positive feedback, which has been received from families and ED staff is testimony to the care delivered and the difference the Program is making at Southern Health, to those experiencing a death in the Emergency Department.

Introduction

‘…sudden unexpected death shocks even professional observers let alone those whose lives will be seriously changed’ stated Dubin & Sarnoff (1986). It appears that the manner and attitude displayed and the level of assistance provided by staff at this time can have far reaching positive or negative effects on the grieving process for these families, with a potentially poor outcome (Dubin & Sarnoff 1986, Parrish et al. 1987, Prigerson & Jacobs 2001).

Acknowledging these statements and with the view to improving the level of satisfaction experienced by families of the deceased in ED and that of the staff directly involved, it became necessary to review the entire process in the Emergency Departments in two of Melbourne’s major metropolitan teaching hospitals, Monash Medical Centre and Dandenong Hospital.

Section snippets

Background

This review occurred in response to staff expressing feelings of frustration and inadequacy when involved in the care of a deceased patient and their family.

During discussion and informal interviews with many staff from the areas of ED nursing, medicine, reception, clerical, security and even switch board operators, staff confirmed that they do often experience difficulties following a death.

Several factors were identified by staff as being strongly influential on care delivery to bereaved

Stages of care for families and staff

The experience in our Emergency Departments suggested that two distinct stages required focus for improved care: (1) in the Emergency Department following the death for families and staff, and (2) in the form of routine family follow up and staff follow up as indicated and possible.

Preparation, and the search for evidence

Insight and focus for the program was provided by staff experiences in the respective Emergency Departments. An extensive literature review revealed much evidence to support guideline development for such a program,

Evaluation

Staff are requested to complete a comprehensive Evaluation form following each death in ED. This is designed to collect qualitative and quantitative data of the family time spent in ED, and involvement of/referral to ancillary departments.

Additional data is collected through review of staff and family feedback of their ED experience, letter/s received, and following provision of assistance in response to a family or staff request.

While a low response rate to the letter has been experienced,

Results

The first letter has been sent to the next of kin of 96% (127/132) of patients who have died in the Emergency Departments since the end of December, 2001. There was no known next of kin in 3.8% (5/132) patients. Presumed contact rate with the first letter was 97% and 98.5% with the second letter, indicated by rate of ‘return to sender’.

There was an 11% (n=14) response from families following the first 127 letters sent and phone calls to targeted families as indicated by ED staff. Family

Discussion

A ‘snapshot questionnaire’ was carried out in April 2002, which aimed to determine the awareness and perception of the Bereavement Program amongst ED staff, over 3 days at each site, five months after its official launch. This provided staff with the opportunity to comment and make suggestions. While the suggestions centred on the need for greater expansion of related education, the comments were overwhelmingly positive and supportive of the Program. The following staff comments were taken from

Conclusion

Establishing a Bereavement Program in the Emergency Departments of two of Melbourne’s major metropolitan teaching hospitals was readily achieved due to the strong support of the ED staff and management, the multi-disciplinary team involved and the proximity and co-operation of the Centre for Grief Education.

Staff and family feedback has confirmed the success of the program in improving the care delivered to bereaved families and involved staff. This has occurred through increased awareness and

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