Bereaved find most support in friends and family states TCD Study

Posted on: 26 November 2007

Most bereaved people manage to deal with their grief without recourse to professional services, according to a new TCD study into the bereavement services of a large Dublin Hospital . The study into Beaumont Hospital ‘s innovative Bereavement Care Service was undertaken by researchers at the School of Social Work & Social Policy in Trinity College Dublin.

The study found that for a third of bereaved people, family had been useful to them since their bereavement. For a quarter friends were important and for one in five it was children. Lower down the list, pets ranked ahead of priests and spiritual advisers, books and films and professionals. Approximately 30,000 people die in Ireland each year, 18,000 of them in hospital. About 1,000 a year die in Beaumont , which is one of Ireland ‘s busiest acute hospitals and has a large number of patients referred to it for neurosurgery and brain injury.

Beaumont established a palliative care team in 1996 and in 2001 became the first Irish hospital to appoint a bereavement co-ordinator. The TCD study looked in depth at the effectiveness of the tiered approach to bereavement developed by Siobhan O’Driscoll, known as the O’Driscoll pyramid model of bereavement care (2004) through a survey of  a year’s census of over nine hundred bereaved next-of-kin. With over three hundred and thirty returned questionnaires, plus focus groups with hospital staff, the data base was sizeable.

The O’Driscoll Model is a whole-hospital approach which caters for education, training and support needs of staff as well as direct service and referral provision for the bereaved. It seeks to reach bereaved who may need or want support which is not available or is not sufficient within their own natural support systems. Under the model, all bereaved next-of-kin resident in Ireland are contacted on an outreach basis, provided with information and a bereavement handbook, and invited to access memorial services, group and individual support and information lectures. Hospital staff also utilise the services and describe their presence as an important reassurance for them.

Led by Dr Trish Walsh, the TCD researchers concluded that Beaumont’s bereavement care service is a true innovation in service delivery to the bereaved from an acute hospital setting, when compared to existing services in Ireland and internationally.

Among other findings were:

Respondents most frequently (65%) found it a comfort to receive an initial letter from the bereavement service 10 to 12 weeks following their loss. Just 2% regarded this approach as an unwelcome intrusion.

There is a marked difference between men and women in terms of the timing of information. Most respondents (57%) felt they received initial information from the bereavement service at the right time. Of the third who would have preferred it earlier or later, women wanted it sooner while mainly men felt it came too soon.

Bereaved people found the most helpful aspects of the service were information and advice (49%); speaking to someone about their feelings (26%) and sharing experiences with other bereaved people (20%).

For a very large number of people bereavement in a hospital comes unexpectedly. A quarter of people who die in Beaumont did so within a day of admission. In the survey 41% of the bereaved said the death of their loved one was unexpected and 30% said it was sudden. A quarter of all deaths involved a post mortem, adding to the distress of family and friends and making funeral arrangements more complicated.

Where death was unexpected the proportion of people making contact with the service (30% of respondents) was twice that where death was expected (15%).

The three main problem areas associated with the death of a loved one in hospital were cited by respondents as: information and communication; the need for privacy for the dying patient and family and overcrowded conditions in the Emergency Department.

Fifty two per cent of respondents felt the care received in Beaumont was excellent and a further 28% felt it was good.

Martin McCormack, Head of Social Work at Beaumont said he welcomed the study, which validated the approach developed by his colleague, Siobhan O’Driscoll.

The ripples of bereavement are far reaching. For every one person who dies, there are on average 10 others who will be directly and deeply affected.  Siobhan’s model implicitly acknowledges that the experience and need of each individual is different and seeks to provide appropriate support for each person at the right time for them. This study, undertaken by TCD with the support of Beaumont Hospital , the Health Services National Partnership Forum and the Irish Hospice Foundation, shows that the model works.

As part of the hospital’s commitment to a process of continuing quality improvement, he added, Beaumont had recently signed a memorandum of understanding with the Irish Hospice Foundation to officially participate in the Hospice Friendly Hospitals Programme.

Dr Trish Walsh, who undertook the study with colleagues Ms Maeve Foreman and Dr Philip Curry, said: The O’Driscoll model predates more recent initiatives in bereavement care and is unique in providing a practical example of a tiered approach to bereavement. It should be seen as a model of best practice in bereavement care provision in acute hospitals. Given the positive results from this evaluation we believe that the conceptual framework devised for this service certainly warrants a wider dissemination internationally.

The launch of the study coincides with the republication by the HSE Health Promotion Unit of its most requested publication, Bereavement: When someone close dies.

First produced 10 years ago by SiobhᮠO Driscoll and Annette Winston, Bereavement Care Co-ordinators and Senior Social Workers at Beaumont Hospital , and Erna OConnor, now a Lecturer in Social Work and Fieldwork Co-ordinator, School of Social Work & Social Policy, TCD, this publication has been extensively revised and updated by the same authors.

Written for bereaved people and those close to them, it addresses the difficult feelings, social changes and practical concerns they face. It includes sections on feelings of loss, parent’s grief, children’s grief and the experience of accidental or traumatic death. There is also information on post mortems, registering the death, financial and legal matters, and a directory of support services.

Copies of both the TCD study and the booklet were presented to the Minister for Health & Children Mary Harney TD earlier this week by their respective authors.