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Service evaluation of the bereavement care delivered in a UK intensive care unit

10 June 2021
15 min read
Volume 30 · Issue 11

Abstract

Background:

Losing a loved one in the intensive care unit (ICU) can be a traumatic experience. The literature highlights that relatives of those who have died in ICU can experience symptoms of stress, anxiety, depression, post-traumatic stress disorder (PTSD) and prolonged grief.

Aim:

To evaluate the service delivery of the bereavement care that is provided on a 20-bed general ICU.

Methods and analysis:

A literature review informing and supporting the service evaluation and development of the questionnaire. Thematic analysis was undertaken using the six-phase framework.

Findings:

Five main themes were found: timing; care, dignity and respect; support; information; and memory making. Bereavement care is described as after-death care. However, the participants stipulated that bereavement care should be discussed prior to the death. Participants described using a range of interventions, such as memorial services, condolence letters, follow-up meetings and diaries.

Conclusion:

Bereavement care was regarded as an important aspect of the care delivered in ICU. It was evident that participants strived to deliver an holistic approach, yet some found this difficult to achieve.

Bereavement care in the intensive care unit (ICU) affects many patients and families (Berry et al, 2017). One in five patients admitted to critical care die during their hospital stay (Faculty of Intensive Care Medicine (FICM), 2019; Intensive Care National Audit & Research Centre (ICNARC), 2019), and global estimates of death in critical care range from 10% to 29% (Coombs et al, 2012; Society of Critical Care Medicine, 2021). The ICNARC estimated that admissions to critical care in 2018-2019 totalled 175 700 (ICNARC, 2019). Of these admissions, 22 069 (13.6%) patients died in intensive care, with a further 8126 patients dying before being discharged from hospital (ICNARC, 2019).

The Collins English Dictionary (www.collinsdictionary.com) defines bereavement as the sorrow felt when a relative or close friend dies. The literature states that losing a loved one in the ICU can be a traumatic experience (Kentish-Barnes et al, 2017a)—death in the ICU can be complicated, unexpected and traumatic, so the bereavement process can be complex, which may lead to unresolved or protracted grief (Kurian et al, 2014; Buckley et al, 2015; Beiermann et al, 2017). Furthermore, due to the nature of ICU and life-limiting illness, relatives may grieve before death (anticipated grief) (Intensive Care Society (ICS), 1998; Coombs, 2010). For relatives of a person who has died in ICU, this is an extraordinarily stressful event and can lead to symptoms of stress, anxiety, depression, post-traumatic stress disorder (PTSD) and prolonged grief (Lautrette et al, 2007; Siegel et al, 2008; Kentish-Barnes et al, 2015a; Berry et al, 2017; Kentish-Barnes et al, 2017a).

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