Review of Clinical Service Enhancement: Bereavement Support Service in Kwong Wah Hospital Lo S.F.J., Chong Y.C.S., Po Y.C., Cheng H., Ip K.T.R., Lai Y.Y.C., Li W.Y., Ho S.F., Ip T.W.S., Chan C.B., Cheng K.M., Law W.S., Wong M.Y.H.
Introduction
In Hong Kong Total number of deaths per year > 34,000 > 80% of deaths occurred in the hospitals of Hospital Authority? Hospital-based bereavement support service in acute care settings
Bereavement Reflect a complex multidimensional reaction to loss Higher physiological morbidity Higher psychiatric morbidity Higher mortality rate Induce family & social problems
Bereavement Working Group To initiate improvement on bereavement care service in 1998 Multi-departmental Bereavement Working Group was established SURG PRI PAED AED ICU CND M&G O&T O&G NEURO
Staff Survey It was important to meet the needs of the dying patients and their families Lack of skill was the most common barrier in caring the dying patients & their families Helping people facing death & loss Helping patients & relatives in crisis Handling difficult situations
Staff Training 54 training courses were provided (> 1000 attendances) Significant improvement of skills was identified by Pre & post course assessment Seminars of related topics e.g. Hospice care, Therapeutic communication, Ethical issues in decision of DNR were held (> 2000 participants)
Bereavement Support Programme
Condolence Cards/ Leaflets
Report of Service Coverage 1400 1200 1000 800 600 400 In-patient death Families served 200 0 01-02 02-03 03-04 04-05 05-06
Service Evaluation Conducted in 2001 Setting - ICU Total number of deaths - 119 (9/00-8/01) 80 bereaved participants (spouse/ offspring/ parent/ brother/ sister) completed the questionnaires during telephone follow-up
Results of Service Evaluation 86% of respondent agreed that the communication between relatives and health care providers was sufficient 97.5% of respondent agreed that nurses provided necessary information (e.g. death certificate issue) 76% of respondent stated that nurses provided psychological support at the time of patient s death 74% & 68% of respondent expressed positive feedback on receiving sympathy card & telephone follow-up
Qualitative & Quantitative Study Conducted in 2003 Setting - ICU Total number of deaths - 61 (4/03-8/03) Eligible subjects - 43 29 bereaved participants (spouse/ offspring/ parent/ brother/ sister) completed the questionnaires during telephone follow-up
Qualitative & Quantitative Study Objectives - 1. To identify the perceptions and experiences on death and bereavement 2. To identify the influences of Chinese cultural beliefs of bereaved individuals 3. To study bereaved clients opinions towards hospital-based bereavement service 4. To suggest recommendation for planning culturally sensitive hospital-based bereavement service in Hong Kong.
Results (Quantitative) Items Strongly agree Agree Neutral Disagree Strongly disagree Missing 1. Nurses provided necessary information to you 2. Nurses provided you psychological support at the time of patient s death 3. The sympathy card expressed our concern to you and your family 4. The telephone followup is helpful to you and your family 3.4% 89.7% 3.4% 3.4% 0.0% 0.0% 6.9% 62.1% 17.2% 10.3% 3.4% 0.0% 3.4% 51.7% 10.3% 3.4% 0.0% 31.0% 10.3% 75.9% 6.9% 3.4% 3.4% 0.0%
Results (Qualitative) Expressions of experience on death & bereavement - birth, aging, sick and death are inevitable parts of life cycle - I I feel so lonely, so silence - treasure your family members especially the parents when they were alive Ways of coping with bereavement - Time/ Family & friends/ Religious thoughts - Internal cognitive measures/ Natural manners
Results (Qualitative) Expressions of the impact of Chinese cultural beliefs - Positive / Negative / Denied impact - Views on death / Rituals and mourning Expected hospital-based bereavement service - Needs before death - Psychological support - Actual problems
Implications for Clinical Practice Although death was widely regarded as taboo in Chinese society, there was increased awareness of life & death issues The advantageous role of nurses would facilitated the provision of bereavement support service Supportive interventions should be started at predeath phase, such as the ways to manage end-oflife care
Implications for Clinical Practice The Chinese cultural beliefs served to explain human existence and to determine the rituals of death, mourning & bereavement To acknowledge the Chinese cultural beliefs when caring dying patients & bereaved families - pay attention to moral norms, social proprieties and filial piety e.g. Song-zong, Family-centered - respect individual beliefs system - cultural stereotypes should be avoided
Recommendations Strengthen the role of nurses in bereavement care service Develop a culturally sensitive bereavement service in local acute care settings - Training and support - Hospital policy - Collaboration with community sectors
Conclusion A caring culture and the growing awareness of our frontline staff and hospital administration on the needs for dying and bereavement are nurtured through years of efforts
Acknowledgements The Administrators of KWH The Director of ICU / KWH The GM(N) of KWH Members of KWH Bereavement Working Group All colleagues of KWH Especially, all bereaved relatives who participated in the studies
Thank You