Bereavement Services Offered in Adult Intensive Care Units in the United States

Abstract

Background Losing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs. Objective To describe current bereavement follow-up services in adult ICUs. Method A cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of CriticalCare Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression. Results A total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care. Conclusions The study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.

The state of bereavement support in adult intensive care: A systematic review and narrative synthesis

“…Of the 14 papers included in the review, eight papers were assessed using the AXIS appraisal tool for surveys [35][36][37][38][39][40][41][42], four were assessed using the CASP tool for qualitative studies [42][43][44][45][46], and two were assessed using the CASP tool for randomised control trials [47,48].…”

“…In the US, almost two thirds (62.4%) of participating units did not offer any bereavement support while most (83%) of UK ICUs provided follow up information to relatives [36,40]. The most common bereavement support services offered included a condolence letter or sympathy card (US=62.9%, NZ=54.2%, Denmark=28%, Australia= 20.8%), phone call to the family (NZ=92.3%, Australia=76.5%, US=36%, Denmark=26%), a meeting with medical staff as routine (NZ=61.5%, Australia=39.4%, Denmark=24%), a brochure on hospital bereavement services (NZ=66.7%, Australia=64.8%), a brochure on community bereavement services (NZ= 58.3%, US=48%, Australia=45.6%) or a brochure on either hospital or community bereavement services (UK=76%) [36,38,40,41]. Educational provision was very important to support ICU staff to offer bereavement care [37].…”

“…However, in the UK, Berry et al reported that more than half of the participants were denied access to bereavement care training [36]. Almost half of the participants in the US study identified a lack of education as a barrier to offering bereavement services [40]. Organisational challenges, such as lack of funding and lack of time, were also reported as barriers to bereavement care [37,40].…”

The provision of nurse‐led follow‐up at Norwegian intensive care units

“…Follow-up of the relatives' grieving process after losing one of their loved ones in the ICU has also been part of nurseled follow-up. Experiencing a high risk of death, often sudden and unexpected, puts a lot of strain on family members in the ICU, and nurses have provided support afterwards in terms of condolence cards, brochures, phone calls and follow-up appointments (McAdam, Dracup, White, Fontaine, & Puntillo, 2010;McAdam & Erikson, 2016).…”

Spotlight on Bereavement Care

“…However, examples of innovation in ICU bereavement care can be found in the literature such as the focus group study of ambient music during after-death care by Holm et al (2012). Specific components of post-death bereavement care have been identified through national surveys in the USA (McAdam and Erikson, 2016), England (Berry et al, 2017), Denmark (Egerod et al, 2018) and across Australia and New Zealand (Coombs et al, 2016;Mitchell et al, 2017). Care practices at the time of patient death in ICU included viewing of the deceased, and providing information about 'what to do' following a death and available avenues of support.…”