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