Quality palliative care to me as a healthcare professional would mean to improve the quality of life and provide support to help patients and their family members cope with the illness. Bereavement support to me as a nurse would be a period in which mourning after a loss happens especially after losing their loved ones and being able to provide support to the family members.
I would be discussing on providing bereavement support in the community and how it would have an impact on the quality palliative care services. This topic interests me as bereavement support it’s not just about providing support or comfort to a family who loved ones had just passed away, in fact, there are many stages of grief and loss that will occur and the types of support or counselling to be given will vary from different individuals and how each individual will be able to cope with the bereavement.
Bereavement support is to help a person to go through the process of grieving, such as coming to terms with the loss, adjusting to life without the deceased and finding a way to remember the deceased while continuing with life. To me as a healthcare professional, providing bereavement support would be giving them an opportunity to talk about their loved ones, their loss and how they have been coping as well as reassuring and encouraging the individual to begin a new life.
Palliative care should not only improve the quality of life for patients but also for their families hence comprehensive support for bereaved family members is also important (Hundson et al, 2012). Caregivers or family members typically are prone to physical and psychological lifestyle changes after the death of a loved one such as being financially disadvantaged, becoming socially isolated or experiencing psychological distress. They are often not aware that there is support available to them despite having very limited prior exposure to death and are often excluded from information and care planning and consequently feel underprepared for their role. This can help improve the care of their caregivers/family members and have the potential to gain positive outcomes from their role.
We need to address on providing bereavement support in palliative care services because a bereaved person is important to anyone and everyone. No matter what it is, nobody would want to have no one to support or to lean on especially after losing the one that’s been there for you. Everyone reacts differently to death and utilizes individual ways of dealing with grief.
Adapting to the demise of a friend or family member is a difficult encounter for enduring relatives. There are four positive impacts of addressing bereavement support in relation to quality palliative care outcomes. Firstly, patients will have lower social and spiritual distress and a lower risk of complicated grief. For example: in bereavement support, bereaved family members are identified through screening and assessment for any signs of distress or grief (Hundson, Hali, Boughey & Roulston, 2017). Secondly, it can protect individuals from major stressors. Through bereavement support, it provides support through counselling or support groups that help individuals from the deleterious effects of the passing of their loved ones (Schut & Stroebe, 2010).
Thirdly, individuals will feel a sense of security and companionship allowing them to explore their feelings and not feeling alone as through bereavement support individuals will slowly open up their feelings and thoughts sharing it with others (Cox, 2010). Lastly, it is letting the bereaved individuals know that they are not alone in this journey. Feeling alone after the loss of someone close to you can be rather depressing, through bereavement support the individual will feel that is someone for them to go through this depressing phase with (Smith, Robinson & Segal,2018).
As a general public, we stay traditionalist with regard to talking about death-related issues, and regularly maintain a strategic distance from it. The current practices of bereavement support in palliative care in Singapore is to provide support to help family members cope with their grief as well as counselling and support groups run by social workers. In addition, Singapore Hospice Council (SHC) in conjunction with Temasek Foundation Cares and Ang Chin Moh Foundation launched two books: caring for yourself and others after a death and when death occurs- a guide to practical matters. These books were launched to help raise the levels of understanding about grief and knowledge, supporting the bereaved (Lee & Tan, 2018). In Singapore, there are many centres in which they provide counselling and support groups for bereaved individuals to seek help. For instance, the Institute of Mental Health (IMH) and Singapore Silver Pages (SSP) provides professional counselling for individuals seeking help. Viriya Community Services and O’Joy care services are some community bereavement service providers that provide counselling and bereavement support (SHC, 2018).
The practices in global bereavement support in palliative care delivery provides a self-help support group that allows individuals to communicate one to one with others providing an opportunity to share their feelings and emotions. Written communications have also been used as self-expression by either writing a letter, keeping a journal or just feeling a page with thoughts and emotions. Meditation can help individuals to focus on problem-solving to move beyond on the self-pity they are prone to suffer (WHO, 2000). In other countries, the death of a loved one can leave one depressed and sad and the need to return to work adds on the stress to the individual. In the state of Oregon, an employee can take up to two weeks off after the death of a family member, providing them adequate time to grief and accept the loss (WYG, 2017).
Areas for improvement relating to addressing and improving bereavement support in palliative care settings would include embracing grief in the workplace area. In Singapore, there is no statutory entitlement for bereavement leave. These leaves are only granted at the employer’s discretion. Besides policy change, companies need to develop flexibility and a compassionate culture. Some bigger companies might give only three days per death of an immediate family member (Tse, 2013).
Bereavement support is an important aspect that should be provided to an immediate family member of the deceased. Providing adequate time off from work can help the bereaved individuals to grief and accept the loss at their own pace. The first challenge would be that companies will not be provide bereavement leave for more than three days as it will cause a reduce in their manpower in the company. This is caused by the current lack of employees in some jobs in Singapore, hence going on a bereavement leave for more than three days will cause other workers to overwork. Which brings the next challenge, which is companies not granting of bereavement leave. There are many companies out there that don’t grant individuals of bereavement leave. The usual cause for this is often that many companies lack proper policies to support employees dealing with traumatic events (Pinto, 2017).
Another challenge confronted would be companies can’t choose who meets all requirements for the bereavement leave as to how can one choose when employees ought to be permitted to get some much-needed rest to grieve somebody’s demise. The cause of this would be due to the company’s indecisiveness to choose whether to provide leave only to the death of an employee’s immediate family: parents and partners or also to those employees who are deeply impacted by the death of a close friend or pet? Lastly, it’s too subjective. The issue with the passing criteria for mourning leave is that it could be excessively emotional. The perfect length of loss leaves it is difficult to build up. This challenge is brought about by not having the option to choose how long workers ought to be permitted to go on bereavement leave. Also, some would want to work remotely to help deal with the psychological injury while others may need to be totally disengage from work (Pinto, 2017).
These are the problem-solving strategies that can be used to overcome the four identified challenges in the quality improvement plan. Firstly, companies can hire more staff or temporary staff to take over the job of the bereaved individuals temporary, allowing them more time to grieve and recover. Hence the company will be able to provide longer leaves for the individual and not lacking any manpower. Secondly, due to lack of proper policies in companies to support bereaved individuals, suggestions have been made that human resources (HR) department can begin by developing high trust and great employee connections. This is so when a loss happens, HR can take part in genuine human discussions with the employee about how they would want to be bolstered, and afterward approach making that space (Mui, 2017).
Thirdly, the strategies used to address the issue on how companies decide who qualifies for the bereavement leave can be resolved on a case-to-case approach, where the manager should use their discretion to sanction the leave and also talking to the individual finding out whether he/she would need to go a bereaved leave as it should not only be provided for the loss of an immediate family member but also for the loss of a close friend. Lastly, the issue on its too subjective can be addressed by offering a flexible bereavement leave policy which offers a range of different choice to grieving employees: time off from work, remote working or fewer hours in the office. The key is to talk to employees and agree on the best option for them and whether he/she would like to head back to work as soon as possible or would like to go on a bereavement leave (Pinto, 2017).
There are various assessment tools that can help measure the effectiveness of strategies in improving bereavement support in palliative care. For instance, with the implementation of the flexible bereavement leave policy, it has been proven to be helpful as it is designed in the most efficient way that suits the company best as well as the individual (Pinto, 2017). Surveys and questionnaires have been done to evaluate the problem-solving strategies of the bereaved individuals and it has shown that with the flexible bereavement leave policies the grieving individuals returning to work will be more focused more productive and pose a lower safety risk as compared to those who returned to work without a time off.
The death of a loved one can occur in a peaceful, timely manner with ample opportunity to say goodbye, or it can follow a violent, untimely death that comes without any forewarning or possibility for preparation. Whatever the circumstances, the loss of a loved one is associated with intense suffering and can lead to serious mental and physical health problems. With the implementation of this quality improvement plan, there will be more time for individuals to seek bereavement support. The need to return to work after a death can add more stress to the individual and hence a longer time off from work will allow the individual to grief and settle their thoughts and problems. Accompanying someone through a grief process and no matter how it is played out, what they reveal or don’t reveal, being there for them at that point of time will benefit them more than you thought.
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