Analysis of Bereavement Support and Its Significance

Introduction

The word Quality refers to the degree of excellence of something. In this case, we’re looking at Bereavement support and quality palliative care services. Palliative care is holistic. Healthcare professionals not only care for the person who is suffering from a life-limiting illness but also the people around the terminally ill person. This topic interests me as I would like to specialize in palliative care in the near future. My clinical instructor from my previous clinical posting specialized in palliative care. I was astonished by observing the way she treats people. I watched tirelessly cared for the person as a whole and it’s not for just one person but for the whole lot of them. Rendering quality palliative care services refers to the interdisciplinary way of dealing with specific medicinal and nursing care for individuals with life-restricting ailments. The uniqueness of palliative care is that there isn’t a specific group of people who will particularly require this care. In palliative care, healthcare professionals do not have a fixed way of doing things as the care required varies from person to person. The ultimate goal of this care focuses on improving the quality of life for both the terminally ill and their family members. I will be discussing more on the following points :

• What is Bereavement support?
• When do we initiate Bereavement support?
• My personal view as a healthcare professional about Bereavement support.
• Why is Bereavement support crucial?
• Positive impacts, current practices, and areas of improvement in Bereavement support.
• Challenges, causes, solutions, and evaluation of the desired outcome

Section 1

Bereavement derives from the word bereave. The word bereave refers to taking a valued or necessary possession by force; in this case through death. In this case, Bereavement support is provided to the family and others who have a close relationship with the palliative care client. After a loved one is deceased, the process of grief and loss can be agonizing. It is a very normal and healthy response to loss. However, people suffering from grief and loss can sometimes encounter difficulties. Hence individual support and family support such as counseling can be rendered through this bereavement support. My personal view as a healthcare professional about bereavement support is that everyone needs it be it young or old. It doesn’t have to be formal counseling but I would encourage anyone who is grieving to go up to someone; it could be anyone they are comfortable with expressing their feelings; not necessarily need be a healthcare professional but preferably them due to privacy concerns and to obtain professional advise. A few individuals think that it's hard to feel intense sorrow. Grief, genuinely, can have a lasting effect on a bereaved individual's life. Individuals who find it difficult to grief or push their emotions away may discover that the immense sadness catches up in a matter of time expressing itself in the later years e.g.health and social issues. Other individuals who grief completely for their loved one will see themselves ready to be optimistic for their future. This is to reassure them that it’s not the end and that they do not have to be alone in this grieving process. Counseling advice can help with temporary mental altercations caused by desolation which could lead to permanent or long-term pensive sadness; which is often harder to recover from than the initial time of grievance. It is important to seek bereavement support as what works for one individual does not work for everyone, so finding the way that's right for each person is extremely significant. It's not about proceeding forward or overlooking them, it's about figuring out how to keep the memories of that individual while proceeding with your life, without feeling guilty. A person once received feedback saying “One person told me how they were at the lowest point of their life and at breaking point but thanks to our sessions together I learned how to live a day at a time until I was able to look to the future and still hold onto those precious, precious memories.” (Martletshospice, n.d.).

Section 2

Positive perspectives of bereavement support will be meeting with friends, sharing emotions, and exchanging pieces of advice and information. This way it gives the bereaved a sense of belonging as there are other people who has lost their loved ones too but they have regained their sense of optimism and get back on track to lead their lives as normal. Quality palliative care on the other hand is for healthcare professionals to anticipate grief so that they can render appropriate bereavement support to the living. Positive impacts that happen as a result of death is that it could bring families closer together, mend broken relationships of the past, learn to appreciate life more, and eventually find out that they are stronger and more capable than they had thought. In Singapore, our current practices of Bereavement support in accordance to the National Guidelines for Palliative Care implemented by the Ministry of Health (MOH) is to offer timely bereavement support to family members who are affected by death according to their needs and preferences. It is strongly believed by MOH that timely identification of complications in grief experienced by families before and after the patient's death is crucial. The provision of direct bereavement support or referral of families to bereavement services should be based on the necessity of the families. Psychotherapeutic interventions have been found a benefit to those who have marked difficulties adjusting to the loss. Family members will be informed on appropriate information about practical death-related issues (e.g. funeral arrangements). In addition, family members and caregivers who are identified to be at risk of complicated grief are referred to bereavement support services. There is also a system in place to screen caregivers and families for bereavement support. This is to ensure that the person who is undergoing or being referred to this bereavement support service truly needs it as this is to prevent mishaps from happening during the support group discussion such as irrelevant sharing of information causing further distress for people who genuinely require the bereavement support service. In the global context shown in research that people with cancer receive palliative care in comparison to other illnesses such as heart disease, dementia and organ failure. The support for family caregivers before and after their relative’s death was not considered optimal. Only a handful of the bereaved reported being specifically queried about their emotional and psychological distress pre-bereavement, and just half of the bereaved perceived they had enough support from palliative care services. The others had a follow-up contact from the service at 3–6 weeks, and a few others had a follow-up at 6 months. Their subjective feedback underlined the limited helpfulness of the blanket approach to bereavement support, which was described as “generic”, or “just standard practice”. (Aoun SM,Rumbold B,Howting D,Bolleter A,Breen LJ,2017) Whereas in Singapore, our palliative care system is well established that everyone gets treated fairly; in accordance to their needs and necessities. HCA hospice care rendered free services to about 70% of home hospice patients in Singapore. They operate both home hospice care and daycare service for patients who are well enough to move about independently and would enjoy social activities in a communal setting (CNA,2017). I think it’s only rationale that everyone be counseled fairly and no one gets left out when it comes to bereavement support as silent cries are deadlier than loud ones. Its outcome may be fatal if neglected.

Section 3

Some of the challenges in rendering bereavement support will be training healthcare professionals on what to say and what not to say. As per say, they can be anxious about how to acknowledge what has happened and how to respond; worrying about making things worse, saying the wrong thing, or getting upset and overwhelmed themselves. All too often, they end up saying nothing at all. This can be corrected by providing training covering awareness of grief reactions, how to respond, and where to refer for more help, which is mandatory for those likely to come into contact with bereaved people through their professional role; i.e. healthcare professional. Next is to implement better bereavement support at work. In any workforce, bereavement is an issue for employees, their colleagues, line managers and HR staff. Some employees will have needed time off to care for the person who is dying, and then to organize the funeral and to begin to adjust to life without them. Some will want to return to work as quickly as possible, while others will need more time. Some will need to change their working patterns to manage new caring responsibilities. In the UK, there’s no statutory entitlement to paid bereavement leave whereas in Singapore, we’re only entitled for two days of compassionate leave which is absurd as there is no sense of sensitivity portrayed to the bereaved. Grief cannot be limited to a specific number of days as everybody grief in their own way. Support from family, friends or even employers may be good in the aftermath of a death, it often dwindles over time as others get back to ‘normal’ routines. There are strong beliefs in society about how grief should be. Comments such as ‘you should be over it now’ can be meant kindly but experienced as hurtful and unhelpful. It is quite rhetorical that a person offering support be meaning a phrase with good intention while the person receiving it perceives it negatively. Genuinely, nobody’s at fault but its just that moment of dismay could lead to undesired outcomes. Instead, a simple conversation in the street or the shops, or making time to go round and visit, or keeping notes of significant dates. For example, birthdays, anniversaries etc when someone might appreciate some extra support. For an instance, bringing a meal can be more helpful than making an abstract offer such as ‘let me know if there’s anything I can do’. People would not be forthcoming to seek help due to egoistic concerns; in times like this shoulders offered are more appreciated as it provides the bereaved person a sense of dignity and comfort that there’s someone who understands them without having to ask for. It’s quite a challenge as only a person who knows the bereaved well enough will be able to carry out such a gesture.

Conclusion

In conclusion, grieving is healthy to express the loss of a loved one(s). But just like everything it has got to be in proportion. Getting back on track is crucial as the dead is gone and will never return but the living has to live their life to their utmost ability to serve life’s purpose; which is to embrace the good and bad equally as that’s how nature has its balance. Sarah Dessen once said from the book The truth about forever; Grief can be a burden, but also an anchor. You get used to the weight, how it holds you in place. Grieving helps us remember the torment of losing a loved one for a lifetime. Getting over it and resuming life is what matters at the end of it.