Grief
What format and questions would you use in a bereavement debriefing session for health care staff?

The nature and format of bereavement debriefing sessions will vary depending on who is involved, the purpose of the session, the event that precipitated it, and whether the session is a regularly scheduled review. Essential for an effective session is staff support. Be sure to involve people who can help create a safe environment in which staff can ask questions, exchange information, and share thoughts and feelings triggered by a death.

Patient death reviews

Some palliative care units hold regularly scheduled meetings to review deaths that occur over a period of time (e.g., weekly or monthly). Death reviews have four main purposes:

1. To find out what happened

The nurse caring for the patient voice-records a summary of events leading up to the death, the actual moment of death, and the time after the death. She or he focuses not only on the condition of the patient, such as the patient’s symptoms and their management, but also on how the family coped. Staff then gather to review each death. They listen to the voice recording and discuss the case.

The recordings vary: some are like factual reports; others are moving descriptions of the scene at the time of death. Recording a summary is important for a number of reasons. It’s an opportunity for the nurse to debrief and experience some catharsis, and it gives staff who were not present an opportunity to hear what actually happened. Team members make an investment in a patient’s care, but they often don't witness the end of life. By listening to a summary of events, they can learn about what happened and have closure.

2. To evaluate the care provided

The recorded summary also helps the team evaluate the care provided and to learn from each event. Evaluation may involve questions such as the following:

  • What can we learn from this event?
  • Was there anything we could have done differently?
  • Were there things that we did well?

Affirming what the team did well, learning from mistakes or challenging staff to continue to grow are all important aspects of evaluating care.

3. To identify the bereavement needs of the family

During a patient’s care, various team members will have had an opportunity to learn something about family members. Research has provided considerable information about the risk factors associated with bereavement. During this stage of the review, team members identify the family members who may benefit from ongoing contact.

4. To explore the impact on staff

The review is an opportunity to reflect on how staff were affected by the death of a patient. Not every death has a major impact, but there are times when a patient’s death significantly impacts individual staff members and perhaps the team as a whole. In these situations, everyone can benefit by processing the event individually or together. By sharing reactions, staff can learn from each other and use their collective experiences to help put their own feelings and responses in context. Staff require a very trusting, non-judgmental environment to share openly, gain mutual support and learn from each other.

Multiple death reviews

Some palliative care units conduct reflections on multiple patient deaths, which serve the same purpose as patient death reviews but have a different format.

These sessions begin with one person reading the names of patients who have died since the last review. Staff may collect the obituaries of these people and have them available for other staff to read. A team member (who could be a chaplain, but doesn’t have to be) reads a poem or briefly reflects on living and dying, caring and compassion, joy and sorrow, trust and hope, or love and suffering. Then the team responds to questions, such as the following, to encourage open-ended sharing:

  • Which of the deaths do you feel best about? (This gives staff an opportunity to affirm themselves and each other, and to share their own thoughts about what makes for a good death.)
  • Which of the deaths do you feel least good about? (This gives staff an opportunity to discuss difficult patient situations and/or problems in the delivery of optimal care. Some people may also share how a particular death touched their own grief history or life situation.)
  • What changes would you make in the way the team or program cares for patients on the basis of these experiences? (Staff should be given a fair bit of freedom to brainstorm how improvements could be made or sustained. If the patient care manager is present, it’s important for her or him to assume a listening role and be open to considering staff’s suggestions. If the manager is not present, a volunteer could share staff concerns and suggestions with her or him later.)
  • How do you cope with the grief that accumulates in working with the dying? Do you need more from the team? (This gives new staff, in particular, the opportunity to ask team members what they do or find helpful to cope with grief.)

Reflections on patient deaths often end with a brief affirmation of staff’s goal to provide competent and compassionate care. Bereavement debriefing sessions are an important part of self-reflective practice and self-care.

Reference

Keene EA, Hutton N, Hall B, Rushton C. Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatr Nurs. 2010;36(4):185–9.