Viewing Volume 5 Issue 2 Summer 2002
The Redfern Inquiry:
Chap12, recommendations
This is an extract from ‘The Royal Liverpool Children’s Inquiry: Summary & Recommendations; bereavement advisor.
2.1 We have considered the evidence and recommend that the functions of a bereavement adviser include:
Explaining the circumstances of death, identifying when, where and who was present.
Arranging and attending a meeting for relatives with anyone who was present at the death if requested.
Encouraging a meeting between relatives and the treating clinician to explain the clinical circumstances of death and, if requested, arranging and attending the meeting.
Ensuring that relatives have a full explanation of the reasons for post mortem examination including therapeutic, medical education and research.
Explaining the need for the consent to carry out a hospital post mortem examination (HPM) and the retention of organs.
Explaining that consent is necessary for the retention of organs following a Coroner’s post mortem examination (CPM) and that the consent must be obtained before the CPM is undertaken.
Ensuring relatives have sufficient time , privacy and support to reflect upon the request for consent to an HPM or the retention of organs following a CPM or an HPM.
Ascertain whether a clinician will attend the post mortem examination.
Facilitating meetings between parents, clinician and pathologist as appropriate.
Noting discussions between relatives, clinicians and pathologists providing a copy to each party involved.
Developing and using information packs for relatives on all aspects of death in hospital.
Assisting relatives in the following practice matters:
- collecting the deceased’s personal belongings and arranging return to relatives;
- ensuring provision of certificate of death and the formal notice;
- explaining the procedure to register the death;
- providing support in attending the registry office if requested;
- arranging contact with funeral director;
- arranging contact with hospital chaplain / or local priest as required.
- contacting the Coroner’s Office as appropriate;
- offering to attend if contact with police necessary;
- ensuring that the General Practitioner is informed;
- ensuring that schools are informed as appropriate (including siblings);
- assisting the relatives in informing other persons including other relatives, friends and employers, of the death and its consequences;
- assisting the relatives in dealing with the Benefits Agency, insurance companies and housing matters;
- assisting relatives to place announcements in newspapers if wished;
- discussing counselling or long term support needs with relatives, including the needs of wider family members and making contact with appropriate counselling / support agencies if requested;
- ensuring that relatives are aware of a full range of counselling / support resources available, including those external to the hospital and bringing these matters to the attention of the relatives;
- accessing translation / interpreting services including services for people with hearing or visual impairment and providing appropriate written / taped information;
- assisting with any other problems presented by relatives in consequence of the death ;
- undertake general liaison duties.
2.2 We intend this list to be illustrative rather than prescriptive. There must be recognised training courses for bereavement advisers. Qualifications should be certificated, perhaps at a National Vocational Qualification level. Annual assessment and appraisal should be routine and the role should be performance managed. Continuing education and training is essential. The bereavement adviser should work closely with the hospital management, clinicians, the Coroner and the full range of non-medical services including counsellors and other non-medical professionals. There will of course be relatives who do not wish to avail themselves of the services of a bereavement adviser. Nevertheless the service should be offered to everyone, as should the facility to return to the bereavement adviser in the event of their services having been declined in the first instance.
2.3 The distinction between a cardiac liaison nurse and the bereavement adviser is that the nurse has the advantage of contact with the parents in the period prior to death. We suggest that some aspect of the bereavement adviser’s multi-factorial function will bring them into contact with the parents before the death of their child.
2.4 We have been heartened at the support for the concept of bereavement adviser from parents and clinicians. We commend the concept for development and implementation.
By:
The Redfern Inquiry: Chap12, recommendations
January 2001.
The Counsellors Own Grief.
J. William Worden (1991)
Grief Counselling and support presents a special challenge to those of us who choose this field. Most of us go into grief work in order to benefit the people who come to us for help, but there is something about the experience of grief which precludes our ability to help.
Bowlby teaches us this when he says: “The loss of a loved person is one of the most intensely painful experiences any human being can suffer, and not only is it painful to witness, if only because we’re so impotent to help” (Bowlby, 1980, Pg.7)
Because the experience of grief makes it difficult for us to be or feel helpful to the person experiencing bereavement, the counsellor can easily feel frustration and anger. Or the counsellor may be uncomfortable witnessing the pain in the other person that this discomfort causes him or her to cut the relationship short.
In addition to challenging our need to be helpful, the experience of bereavement in others also teaches the counsellor personally in at least three ways:-
1. Working with the bereaved may make us aware, sometimes painfully of our own loss.
2. The counsellor’s own feared losses, if the client is experiencing a loss similar to the one we ourselves most fear.
3. Existential anxiety and ones own personal death awareness.
Exploring workers own history of losses can make them more effective counsellors. Because not everyone can work adequately with all types of dying patients, it is important for the caregiver to recognise personal limitations and make referrals to other colleagues who can handle certain cases more effectively.
It is important for grief workers to know the kind of grieving person with whom he or she cannot work effectively and to be able to make a referral or share the support when faced with such a client.
Many bereavement counsellors who work with the terminally ill and have contact with the deceased as well as the family prior to the actual death, may experience stress. Mary Vachon has compared staff stress among those working in a hospice setting and among those working in a general hospital. She finds stress in both settings and concludes that the best care can be given if caregivers are cognizant that they too have needs. (Vachon, 1979).
a) Know your own personal limitations in terms of the number of patients with whom you can work.
b) A counsellor can avoid burnout by practicing active grieving, allow themselves to experience feelings.
c) The counsellor should know how to reach out for help and know where his / her own support comes from.
By:J. William Worden
Cited in: “Grief Counselling and Grief Therapy”
1991.