End of life and bereavement

There will be situations where you cannot say to a grieving relative, 'We did all we could' but, 'We did our best with what we had available, but it wasn’t enough.' That is a very tough message for you and for bereaved people. Know that this is a situation created by the pandemic. It is not your fault. Sometimes, we can forget that we can only do our best.

• Take a direct, open and always kind approach
• Use plain language, listen and don’t feel the urge to give information
• Show sensitivity and empathy
• Be genuine
• Show honesty
• Don’t judge how people respond to you, especially in such a moment
• Remember that culture and religion may be very important to the person and their relatives

• It may be impossible to arrange for close relatives to be present as death approaches a patient on your unit
• Try to arrange for video calls or some other way for the relative(s) to say what they need to share with the dying person, even if this person seems to be in a coma by that point

• Given the restrictions, funerals will be organised and held under unprecedented circumstances (due to sanitary security measures)
• Give what support you can and signpost the family to other sources of support
• You might suggest that they consider thinking about arranging a celebration of the person’s life later, when this pandemic has passed

• Staff may wish to mark a death of a patient at the time or about the time of the funeral with a short silence
• The team may have an agreed ritual or staff may differ in how they wish to show respect for people who have died. Of course that is also fine

• Feelings can include numbness, shock, sadness, anger, guilt, helplessness and shattered assumptions. Whatever you do or do not feel, it is natural and understandable and no one can tell you what you should or shouldn’t be feeling
• You might say to yourself, 'Can I step back and just notice what I feel?' Maybe it’s sadness, or frustration, or just fatigue. Those feelings are to be anticipated. And remember these Covid-19 times are distinctly abnormal
• Your buddy, team leader, colleagues and or the chaplain might be able to help

• It's ok to feel doubt or worry. You are probably not the only person on the team feeling like this. What help can you get from your colleagues to help each other manage day to day?
• Being very strong for those around you may just mean that you end up not coping for yourself, so be strong by reaching out. Don’t be alone, and do ask for support or just a chat

• Grief does not follow a straight line; it comes in waves
• This is true for us and for relatives
• These waves change their pattern over time... before the tide gradually recedes

• You may find any of these or other activities help you with grief
• Remember not to turn to unhelpful things that will make matters worse even if they help immediately (alcohol and other substances, gambling, obsessive internet use etc)

You may be troubled by images from your loss or bereavement at work or elsewhere. Seek support from your peer/s, team manager or somebody else that you trust. If it persists, you may need extra help. There is no shame in this. It is part of being human.

If you have to carry on working after experiencing loss at work, recognise that at some stage you will have to process the loss and make sense of what happened on your own terms. You will need time, and space, to experience this.

NHS Scotland - Palliative and end of Life care
Gives general advice about bereavement

Cruse Bereavement Care 
Coronavirus: grief and trauma 

Mayor London and London Assembly website - How to cope with bereavement and grief during the coronavirus outbreak
Offers advice and further links to useful sources of support to bereaved families in the context of the COVID-19 pandemic

Marie Curie Foundation - Coronavirus and end of life care resources for health care professionals
A very useful list of resources for healthcare staff put together by The Marie Curie Foundation

NHS Scotland - Palliative and end of Life care
Gives general advice about bereavement