Elsevier

Resuscitation

Volume 61, Issue 3, June 2004, Pages 341-348
Resuscitation

Perceptions, needs and mourning reactions of bereaved relatives confronted with a sudden unexpected death

https://doi.org/10.1016/j.resuscitation.2004.01.024Get rights and content

Abstract

Many individuals die suddenly and unexpectedly outside the hospital or in the emergency department (ED). The aim of this study was to determine the perceptions, needs and mourning reactions of their bereaved relatives and to assess the relationship with the cause of death. Data were collected prospectively in the emergency department of a university hospital by means of an interview and a standardised questionnaire. We registered 339 deaths over a period of 10 months, of which 110 met the inclusion criteria for sudden and unexpected death. The study group included 74 relatives of 53 deceased individuals. The majority of relatives were confronted with a traumatic death outside the hospital. Most frequently reported complaints concerned a lack of information and being left with unanswered questions. Psychological problems related to mourning were mainly associated with a traumatic cause of death. The results of this study highlight the specific needs of relatives in case of a sudden death either outside the hospital or in the ED and may serve as a basis for recommendations for improvement of psychological care of individuals who are suddenly bereaved.

Sumàrio

Muitos indivı́duos morrem de forma súbita e inesperada fora do hospital ou no departamento de emergência (ED). O objectivo deste estudo foi determinar as percepções, necessidades e reacções de luto dos familiares em sofrimento e a avaliar a sua relação com a causa da morte. Foram recolhidos dados de forma prospectiva no departamento de emergência de um hospital universitário através de uma entrevista e de um questionário standard. Registrámos 339 mortes durante um perı́odo de 10 meses, 110 dos quais satisfaziam os critérios de inclusão para morte súbita e inesperada. O grupo de estudo incluı́a 74 familiares de 53 indivı́duos falecidos. A maioria dos familiares foi confrontada com uma morte traumática fora do hospital. As queixas mais frequentes dizem respeito a falta de informação e a terem ficado com dúvidas persistentes. Os problemas psicológicos relacionados com o luto estavam associados principalmente com uma causa de morte traumática. Os resultados deste estudo salientam as necessidades especı́ficas dos familiares no caso de uma morte súbita quer fora do hospital quer no ED e podem servir de base para recomendações de melhoria dos cuidados psicológicos dos indivı́duos que perdem subitamente os seus familiares.

Resumen

Muchos individuos mueren súbita e inesperadamente fuera del hospital y del departamento de emergencias (ED). El objetivo de este estudio fue determinar las percepciones, necesidades y reacciones de aflicción de sus familiares y evaluar la relación con la causa de muerte. Los datos fueron recogidos prospectivamente en el departamento de emergencias de un hospital universitario por medio de una entrevista y un cuestionario estandarizado. Se registraron 339 muertes en un perı́odo de 10 meses, de los cuales 110 llenaban los criterios de inclusión para muerte súbita e inesperada. El grupo de estudio incluyó 74 familiares de 53 individuos fallecidos. La mayorı́a de los familiares fueron confrontados con una muerte traumática fuera del hospital. Las quejas reportadas con mas frecuencia concernı́an la falta de información y el ser dejados con preguntas persistentes. Los problemas sicológicos relacionados con el duelo estuvieron principalmente asociados con una causa de muerte traumática. Los resultados de este estudio destacan las necesidades especı́ficas de los familiares en caso de muerte súbita ya sea fuera del hospital o en el ED y puede servir de base para las recomendaciones para mejorar los cuidados sicológicos de individuos que quedan bruscamente desolados.

Introduction

Staff in mobile intensive care units (MICU) and emergency departments (ED) are frequently confronted with sudden and unexpected death. They are faced with the difficult task of telling close relatives about the traumatic event, without having a prior relationship with them [1]. They commonly have only a short and single, but intense, contact with the bereaved family. Nevertheless, this contact may be important as the initial interaction between the staff and the bereaved family at the time of the intervention may have longstanding consequences for the grief reactions by the family [2], [3], [4]. Sudden death is known to put relatives at increased risk of problematic bereavement [5] and may be associated with poor subsequent adjustment [6]. Therefore it is important to study the psychological needs of relatives. Most studies in the literature are not prospective and therefore may be prone to incompleteness and bias.

Moreover, little attention has been paid to the influence of the nature and cause of death on bereavement. According to several clinical reports, the cause of death may lead to specific psychological effects after bereavement [7]. However, standardised measurements of psychiatric symptoms in association with bereavement related to an accidental, suicidal or natural cause of death have not been made [8], [9].

Finally, little data are available for death outside the hospital. In this respect, it should be noted that in Belgium prehospital care is provided by a physician-staffed MICU and that individuals are pronounced dead outside the hospital after an unsuccessful resuscitation attempt.

This study aimed at (1) identifying the perceptions and needs of close relatives confronted with a sudden and unexpected death after an intervention of the MICU outside the hospital or in the ED in Ghent (Belgium); (2) evaluating the intervention by the staff of the MICU and ED, the death notification by the police, and the services of the funeral director; (3) identifying the needs of the bereaved relatives in the immediate aftermath and during the subsequent months; (4) assessing whether there is a relationship between the perceived needs and the cause and place of the death; (5) exploring physical, psychological and social reactions related to mourning and assessing the relationship with the cause of death and being a witness.

Based on the findings of this study, we discuss a proposal for the optimisation of existing guidelines for psychological care of the relatives during the intervention of the MICU and in the ED.

Section snippets

Methods and measurements

From 1 June 1998 to 30 April 1999, a survey was made of all consecutive cases of sudden death either outside the hospital after intervention by the MICU based in the Ghent University Hospital and in the ED of the Ghent University Hospital. A longitudinal design was used to identify the perceptions and needs of bereaved relatives and to assess associations with the cause of death. Bereaved subjects were contacted approximately at 2, 7 and 13 months after the death.

The study group included

Results

During the study period of 10 months 339 patients died either outside the hospital with an intervention by the MICU (n=293) or in the ED (n=46). About one third (n=110) met the inclusion criteria. As shown in Table 2 the major cause of death was natural death followed by accidental death and suicide. Most patients died outside the hospital after a failed resuscitation attempt. The mean age was about 50 years and male patients were predominant.

Main reasons for exclusion were being older than 70

Discussion

Due to the system of prehospital care by the MICU service, our study group mainly included patients who died outside the hospital. Although a natural death was the main cause of death, especially relatives confronted with a violent death participated. Participating also seemed to be related to an untimely death. The younger the deceased, the more likely the bereaved would participate.

The participation rate was satisfying. Most agreed to participate by returning the reply card. The others were

Acknowledgements

This study was funded by a research grant from the Ghent University. The authors would like to thank the staff of the Emergency Department for their kind co-operation and the steering committee for their valuable feedback during the whole process. Special thanks are due to all participating relatives for sharing their feelings and experiences.

References (23)

  • D. McNiel et al.

    Family survivors of suicide and accidental death: consequences for widows

    Suicide Life-Threatening Behav.

    (1988)
  • Cited by (75)

    • What are the care needs of families experiencing cardiac arrest?: A survivor and family led scoping review

      2021, Resuscitation
      Citation Excerpt :

      One article included data from Finland and Poland. Research methods used in the studies were qualitative (28 qualitative research studies and 8 qualitative abstracts (77%)),5,6,9,26–51 mixed methods (six mixed methods research studies and one abstract (15%))52–59, and quantitative methods (three quantitative research studies and one quantitative abstracts (8%)).60–62 The majority of studies (n = 31, 66%) interviewed family members who experienced unexpected cardiac arrest.

    • 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families

      2021, Heart Rhythm
      Citation Excerpt :

      There was a lack of psychological support in the immediate aftermath, with many family members seeking their own care, including grief counselors and support groups. The need for support in the early aftermath has been shown to be important in other studies examining suddenly bereaved parents.128,129 Community or peer-based bereavement support groups can also enhance social support.120,130

    View all citing articles on Scopus
    View full text