Transcript GP BEREAVEMENT TRAINING

GP BEREAVEMENT TRAINING
Wednesday 30 January 2012
Tuesday 12 March 2012
Jane Cato
Counsellor
The Martlets Hospice
WELCOME
Aims and objectives for session
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To gain knowledge of NICE guidelines in relation to
delivery of bereavement support.
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Identifying normal grief.
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Identifying complicated grief.
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A model of bereavement support: The Martlets Hospice
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What you can do at your GP practice.
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Any questions?
‘The loss of a loved is one of the most
intensely painful experiences any human being
can suffer and not only is it painful to
experience but also painful to witness, if only
because we are so impotent to help’
Bowlby: Attachment and Loss Vol 3 1981
Bereavement
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Mourning is the process occurring after a loss.
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Grieving is the personal experience of the loss.
(Worden)
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Bereavement is a turning point in personal
development, a psychological transition that
causes an increased risk to physical and mental
health. (Colin Murray-Parkes)
NICE guidelines (2004)
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Level 1: All bereaved people should be offered
information about grief and about how to
access support services.
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Level 2: About 33% may require additional
support over the emotional and psychological
impact of loss by death.
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Level 3: Specialist interventions are required by
a small proportion (7 – 10%) provided by
counsellors.
NICE guidelines 2011
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Draft Spiritual Support and Bereavement Care
Quality Markers and Measures for End of Life Care.
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Statement 13: Family and carers of people who
have died receive timely verification and
certification of death.
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Statement 14: People closely affected by a death
are communicated with in a sensitive way and are
offered immediate and on-going bereavement,
emotional and spiritual support appropriate to
their needs and preferences.
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Service providers need to ensure that systems are in place for
people closely affected by a death that include sensitive
communications and provision for immediate and on-going
bereavement, emotional and spiritual support appropriate to
their needs and preferences.
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This may include information about practical arrangements
and local support services, supportive conversations with staff
and in some cases referral for counselling and more specialist
support.
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Recommends bereaved people are offered support at the time
of the death that is culturally and spiritually appropriate,
immediate and available shortly afterwards. It is not limited to
immediately after the death, but may be required on a longer
term basis, and in some cases, may begin before death.
What this may look like for your
service?
A stepped approach to emotional and bereavement support may be
appropriate, which could include but is not limited to:
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Information about local support services.
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Practical support such as advice arranging a funeral, information on
who to inform of a death, help with contacting other family members
and information on what to do with equipment and medication.
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General emotional and bereavement support, such as supportive
conversations with generalist health and social care workers or
support from voluntary, community and faith sectors.
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Referral to more specialist support from bereavement counsellors and
mental health care workers.
Sources of information
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When a patient dies: guidance for professionals on
developing bereavement services (DOH 2005)
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Model of bereavement support NICE Cancer
Service Guidance recommendations 2011
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UK Standards for Bereavement (London
Bereavement Network)
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Guidance for bereavement needs assessment in
palliative care 2nd edition 2010 HelptheHospices
Normal manifestations of grief
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Physical: nausea, hollowness in stomach, tightness in
chest, dry mouth, feeling short of breathe, lack of energy,
headaches, low level viral/bacterial infections, repeating
symptoms of loved ones illness, may think they have a
serious illness, muscle weakness, reduced appetite,
insomnia, sexual sensations.
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Cognitive: disbelief, sense of unreality, pre-occupation
with thoughts of the deceased person, a sense of the
presence of the deceased e.g.: smell, hear, see, shortterm memory loss, reduced sense of purpose, dreams,
loss of concentration, foggy mind.
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Emotional: shock, numbness, anger, guilt/regret,
yearning, anxiety, helplessness, disorganisation,
sad, depressed, relief.
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Behaviour: social withdrawal, avoiding reminders
of the deceased, acting absent mindedly, restless
over activity, planning radical changes, seeking
sexual contact, changes in habits and routines e.g.
eating, sleeping, over emphasis t routine.
Factors influencing grief
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Suddenness of death
Anticipated death
Cause of death e.g. Accident, illness, suicide,
murder
Meaning of relationship to deceased
Personal vulnerability/resilience of bereaved
Social support
Economic resources
Mental health history
Past coping strategies
Nature of previous losses
Complicated grief
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Intensity of reaction to loss
Length of time passed since death
Continued high levels of distress
Preoccupation with loss
Confused and unpredictable behaviour
Isolated
High anxiety
Doesn’t expect death
Dominant feelings e.g. Anger, sadness
Doesn’t access support
Can’t see a future
Complicated grief cont.
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Secondary losses:
- health
- work
- money
- relationships
- identity
- home
Developed health problems
Self destructive behaviour
Compulsive need to keep dead person in the
present
The Martlets Bereavement Model
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Make appointment for Bereavement Meeting within 48 hours
of the death with next of kin and appropriate family and
friends with an IPU trained nurse and member of Patient and
Family Support Team (counsellor, social worker or chaplain)
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Give next of kin and family bereavement information leaflet
‘the next steps.....helping you during the first days after your
bereavement’.
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At Bereavement Meeting give the medical certificate, talk
through registration of death, funeral arrangements, care
deceased and family received at the Hospice, any unanswered
questions or remaining concerns and give information on
Bereavement Service. Confirm names and contact details of
significant bereaved.
Bereavement Service
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Bereavement profile form: complete bereavement
assessment of all significant bereaved, where possible,
and record on bereavement profile form.
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Routine letter: send routine letter to all identified
significant bereaved individuals at 6 weeks following the
death, inviting them to contact the bereavement service
if they would like bereavement support.
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Bereavement assessment: face-to-face meeting by
Hospice counsellor to assess level of support needed.
Bereavement support
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Counselling: an agreement to provide weekly/fortnightly
counselling for an agreed period of time. This can be anything
from a one-off session, 6 sessions and review to agree further
sessions or end counselling. Very occasionally an individual
with very complex needs may receive up to 24 sessions over a
year.
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Following assessment some clients are referred externally to
more appropriate services.
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As completion of the bereavement counselling approaches
occasionally clients are referred on to further psychological
support.
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Counselling is provided by experienced, qualified counsellors
who are BACP accredited or UKCP registered.
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Bereavement visiting: Clients are supported in their
homes by trained bereavement visitors.
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The team of bereavement visitors are Hospice volunteers
who have undergone a robust recruitment process and
thorough bereavement training programme and are
supervised monthly by the bereavement counsellors.
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The bereaved are offered up to 12 visits usually on a
fortnightly basis which can change to monthly visits if
appropriate as the client moves through their
bereavement.
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Children and families are also offered bereavement assessment and support
which is provided by the counsellors.
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Occasionally pre-death support provided by our social worker or chaplain
may move into bereavement follow-up when appropriate.
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Time to Remember events are held at the Hospice between 6-9 months
following the date of death, where the bereaved are invited to attend a formal
act of remembrance and meet other people who have been bereaved around
the same time. This is led by the bereavement team and other members of
the Hospice team, such as IPU nurses, social workers, the chaplain also attend.
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Annual Light up a Life event is held in the community before Christmas where
the bereaved can come and remember their loved one. Some people continue
to attend these years after the death of their loved one.
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Memorial book lives in The Sanctuary at the hospice, which holds the name
of the people who died at the Hospice on the date of their death. People can
come and visit the Sanctuary at any time.
What can you do?
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Primary Care and GSF
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Acknowledge the death ASAP by phone/letter/card/visit
Record contact details of relative/carer
Marker of death in relative/carer’s notes
Inform colleagues/professionals internally & externally
Give information
Offer follow-up appointment after death
Anniversary card
Assessment tool
Designated person to lead on bereavement care in GP
practice
Pool resource from all GP practice’s through GSF
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Thank you
And I hope this presentation has
provided you with some information
and some ideas on how to
strengthen and develop bereavement care in
your GP practices.
Best wishes

Jane Cato