Palliative Care Nursing: Principles and Evidence for Practice

By Sheila Payne; Jane Seymour et al. | Go to book overview

25
The care and support of
bereaved people

Mark Cobb


Introduction: in the company of the bereaved

Being present at the moment of someone's death is a familiar experience for many nurses and other health care professionals. Bearing witness to the consequence of fatal pathological events is an inevitable part of clinical practice and there are protocols and procedures to guide the necessary practicalities of dealing with a dead body (Mallett and Dougherty 2000). This unexceptional biological reality, however, is an incomplete description because death is more than a clinical punctuation. In the presence of death, we face the significance of human absence and loss, the deprivation of future possibilities, and the emptiness of an embodied space once filled with life. Most immediately, nurses find themselves in the company of the bereaved wanting to care and console, fearful of making matters worse, and aware that death imposes a loss that must be lived with.

Most people begin their bereavement in the company of health professionals and in the unfamiliar environment of health care institutions (Office for National Statistics 2001). Many of these deaths will occur in acute care settings of hospitals and be the result of diseases of the circulatory system and respiratory system as well as neoplasms. Consequently, while informal and ad hoc bereavement care may exist, largely as a result of the interest of individual staff, consistent and well-resourced bereavement care is unlikely to be available because it is not a common feature of most hospitals beyond the practicalities necessary for the disposal of deceased patients (Department of Health 1992, 1997; Kissane 2000). In addition, professional boundaries, the discontinuities between care settings, and the relatively brief encounters bereaved people often have with health professionals may contribute to both a neglect and paucity of bereavement care.

It can be argued that bereavement has no part to play in health services and that nurses have no obligation to offer care to the bereaved beyond everyday compassion and the human desire to alleviate the suffering. There

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