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The planning, organising and delivery of a memorial service in critical care
SUMMARY • The Intensive Care Society (1998) recommends that facilities should be available to follow up bereaved relatives • As part of bereavement follow up, a memorial service has been held at Royal Preston Hospital for the last three years. Over 300 people attended in 2003 • A memorial service is often referred to as a ritual. Rituals seem to meet certain universal needs, such as confirming the reality of the death, assisting in the expression of feelings, stimulating memories of the deceased and providing support to the family and friends of the deceased • An audit in 2003 has confirmed the value of the service: 97% of attendees were glad they attended the service and 72% would like to be invited to the service again next year
Key words: Bereavement support • Critical care • Death and dying • Follow up service • Memorial service • Rituals
In a study of 26 intensive care units (ICUs) in the United Kingdom, the average intensive care mortality rate was 18% (Rowan et al., 1993). In most cases, relatives or friends will have been involved with the dying patient on the critical care unit (CRCU). Over the last two decades, health care professionals have been showing an increasing interest in issues related to death, dying and care of the bereaved (Jackson, 1998). The Intensive Care Society (1998) recommends that facilities be available to follow up bereaved relatives. Follow up of bereaved relatives often involves letters (Jackson, 1998) or phone calls (Wilson et al., 2000). At the Royal Preston Hospital, the follow up of bereaved relatives in the CRCU has incorporated a memorial service. The unit has organised a memorial service for the last 3 years, and in 2003, an audit was carried out a month after the service. The purpose of the audit was to ensure that the needs of those who attended the service were being met and thereby to evaluate the service.
THE VALUE OF A MEMORIAL SERVICE IN CRITICAL CARE
A literature review using MEDLINE (1984–2004) was undertaken to find examples of memorial services in health care settings. One study suggested that over 64·5% of hospices offer memorial services to bereaved family members (Lattanzi-Licht, 1989). The search revealed evidence of a memorial service on a renal unit (Ormandy, 1998), in a nursing home in Florida (Urbancek, 1994), for HIV health care workers in New York (Tiamson et al., 1998), and for palliative care patients in a hospital setting (Rawlings and Glynn, 2002), amongst others. However, no evidence could be found in the literature for a memorial service in critical care. This supports Granger and Shelly’s (1997) statement that most of the public work on bereavement deal with the consequences of anticipated death from chronic or malignant disease, rather than the effects of sudden bereavement in an unfamiliar environment. At Preston, we were unsure as to what response we would get to the memorial service as there was no supporting literature to guide us. Sudden and unexpected deaths are an integral part of critical care. Parkes (1975) identified that in sudden death, there was clearly a more emotionally disturbed response which persisted throughout the first year of bereavement. Despite often having only short-term contact with patients and family members, critical care nurses’ responses to relatives’ bereavement are
Names of the deceased have been changed to preserve anonymity. Author: J Platt, RGN, ENB100, BA (Hons), Senior Sister, Critical Care Unit, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2 9HT Address for correspondence: Critical Care Unit, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2 9HT E-mail: email@example.com
© 2004 British Association of Critical Care Nurses, Nursing in Critical Care 2004 • Vol 9 No 5
Our experience at Preston supports the importance of a memorial service as an important ritual following death in the CRCU. it will do much to ease their stress during a traumatic time (Hampe. Deciding when to hold the service was also an issue. 2000). Breu and Dracup.Memorial service in critical care important and may have longer term implications (Sanders. and up to two meetings are held with the pastoral care department and catering staff. Funding is provided by the unit for tea and coffee after the service and all other expenses such as flowers. Also. and one held for the carers of deceased patients from the renal unit at Preston. especially in the first year after their bereavement. The meeting was led by myself and included six nursing staff who had expressed a particular interest in bereavement. assisting in the expression of feelings. to all those bereaved in the past year. It was believed that this would be extremely difficult to achieve on our unit as it has a very large throughput and the annual death rate is around 150. Some relatives have wanted an appointment with a doctor and/or nurse to review what happened to their relative while on the CRCU. Rituals seem to meet certain human universal needs. A meeting was arranged between the hospital chaplain. was contacted. In reality. such as confirming the reality of the death. any emphasis on Christmas during the service would be inappropriate for some. stimulating memories of the deceased and providing support to the family and friends of the deceased (Rando. These examples of professional and organisational collaboration are much appreciated. At the 2003 service. Also. the estates department had agreed to waive the car park fee for all those who attended the service. Holding the service in December was considered. MOVING FORWARD Members of bereavement group discussed the best way of raising awareness about the service. similar to a funeral. The purpose of this letter was to let them know they are still in our thoughts and to invite them to telephone if there is anything else we could help them with. candles invitations and postage. the manager on the unit and nurses who had expressed an interest in assisting with the organisation of a service. such as the coronary care unit at Blackpool. which provides an opportunity for the staff to be available for closure (Foulstone et al. At Preston. Part of the role of this group has been to write to the family or friends of those bereaved approximately 6 weeks after the death. others have asked for contact telephone numbers for local support groups such as ‘Cruse’ or ‘Compassionate Friends’. a study by Jackson (1998) evaluating follow up letters to bereaved families found that while 34% believed the letter gave them permission to call the ICU to ask questions if desired. A memorial service is a significant intervention in bereavement support. 1989). However. the date might be mislaid. We were aware that there was already an annual service organised by the special care baby unit. but it was felt that December is often a busy and potentially stressful time for some nursing staff due to Christmas preparations. 1984). Many bereaved relatives returning to the unit have said how difficult and emotional Christmas was for them.. There has been a lot of positive feedback from the letters. Other local units. A memorial service is often referred to as a ritual. A full working day is now allocated every year for writing invitations to carers. who had led the service from the renal unit. It was therefore decided that a better approach would be to send out invitations. 1975. envelopes and order of service were all provided free by the printing company used by the hospital. very few relatives call the unit at Preston as a direct result of the letter. The hospital chaplain. It was eventually decided to hold the service at the beginning of February This would mean that the invitations would 223 © 2004 British Association of Critical Care Nurses. We considered setting the date for the service well in advance and informing relatives of the date in the letter of support sent to them 6 weeks after the death of the patient. PLANNING OF THE MEMORIAL SERVICE There has been a bereavement group on the unit for 14 years. Many staff received personal replies of thanks in response to the letters. At a bereavement group meeting held in the autumn of the year 2000. 1993).. possibly because of this very reason. One suggestion of an advert in the local newspaper was dismissed as the unit has a large catchment area across the whole of the North-west of England. a month before the service. it was suggested that a memorial service could be a beneficial way of provid- ing an additional form of follow up. 25% believed the nurses to be too busy. Nursing in Critical Care 2004 • Vol 9 No 5 . Previous research has shown that if nursing staff ensure the delivery of humanistic care and make every effort to be sensitive to bereaved relatives’ needs in the ICU. the invitations. telephone relatives as part of a bereavement support programme (Wilson et al. However. we felt that weeks or months later. The unit manager supported the service and agreed to provide protected time for me to organise it and write the invitations. the memorial service has become an integral part of the delivery of humanistic and sensitive care. 1978). as not everyone in a multicultural society believes in or celebrates this occasion.
six read out a piece of poetry or prose. A candle lighting ceremony was held as part of the service. was a clear indication to us of the value of the service. In January 2002. over 320 people attended the February 2003 service. Table 2 summarises details of how many invitations were sent for each month in 2002. The bereavement group therefore decided to make the service an annual event. hence we decided to introduce a ‘flower ceremony’. The service was led by the Head of Pastoral Care. In total. During the year following the first service. The service was held in the hospital chapel.Memorial service in critical care be posted in the first week of January and would perhaps be viewed by some as welcome support after the emotions at Christmas. This response. on the day. A ‘Book of Remembrance’ was also provided. Table1 Numbers of participants at the 2003 memorial service Type of participant Bereaved relatives or friends Nursing staff Medical staff Pastoral care staff Number 320 9 1 4 ORGANISING THE MEMORIAL SERVICES 180 people attended the first memorial service. 52 families replied to say they would like to attend. However. which seemed overwhelming. opposite the chapel. as well as four members of the pastoral care department (Table 1). talked to members of staff and wrote in the Book of Remembrance. We received a lot of verbal encouragement and thanks on the day of the service. the number of attendees was around 320. In the light of this experience. Families and friends stayed for tea and coffee. many stayed for a long time after the service. and as part of the service. each newly bereaved family continued to receive a letter from the bereavement group 6 weeks after the death of the patient. Nine members of the nursing staff attended. Again. Of those 159. and several families wrote afterwards to explain what the service had meant to them. they were invited to present the flower at the front of the restaurant in a ceremony of reflection and remembrance. the bereavement group sent invitations to all the families bereaved over the previous 12 months. One consultant from the unit attended. Nursing in Critical Care 2004 • Vol 9 No 5 . John Prysor-Jones. In total. based on the number of replies received. it became apparent that the chapel could not hold the numbers of expected people. which was left in the chapel after the service. The candle lighting ceremony had proved to be a very emotional part of the original service in the chapel. The final column of Table 2 gives the number of people expected from the replies received. the 2003 service was also planned to take place in the restaurant. 300 people attended. Each family was given a white carnation on arrival. Invitations were sent to the next of kin and/or friends and family of those bereaved between January 1 2000 and January 1 2001. A decision was taken to change the venue to the hospital restaurant. due to the presence of smoke alarms. One disadvantage of the restaurant is that the candle lighting ceremony cannot take place. A total of 159 invitations were sent. but that this would be reviewed and evaluated after the service. we were expecting 258 people to attend. Clearly. Many of these past carers stayed for up to an hour and a half after the service. Six relatives who had been bereaved prior to 2002 had also expressed a desire to attend the service. Everyone was also invited to light a candle in the hospital chapel after the memorial service. We recognised that the timing of the service would be more appropriate for some rather than others. and we wanted to include some224 thing similar in the 2003 service. talking to staff. Each family was asked to give an indication of how many people would be attending. The letter was extended to include information regarding the memorial service scheduled for February 2002 and stated that a Book of Remembrance was available. although it was emphasised that it would be a nondenominational service. some Table2 Details of numbers of invitations and replies Timing of deaths (2002) January February March April May June July August September October November December Pre-2002 deaths Total Number of replies 2 3 4 6 3 5 3 4 3 5 4 5 5 52 Number expected to attend 9 12 14 27 9 43 12 22 18 34 17 28 13 258 Number sent 16 12 13 13 13 9 7 13 13 15 9 20 6 159 © 2004 British Association of Critical Care Nurses. Again the response was overwhelming. so much so that 2 days before the service. lighting a candle in the chapel and writing in the Book of Remembrance. On the day of the service.
In question five. 33 were returned (compliance rate 63·5%). the ethics committee were made aware of the audit by letter. as well as people who turned up on the day without replying to the invitation. an aspect of the service. the data were analysed by staff of the Department of Clinical Governance and Audit who then forwarded a report to the CRCU Audit methodology Audit questions were adapted from a questionnaire used in an evaluation of a palliative care memorial service in Australia (Foulstone et al. We worried that there would be an expectation that the service. who supplied prepaid return envelopes. More than 350 would have presented a fire risk. after a tragic incident. Advice was sought from the Department of Clinical Governance and Audit within the hospital. The chairman replied that he was satisfied that the questionnaire represented audit and therefore did not need to come before the ethics committee. and we also had to allow for the members of staff who would be attending. but we had to limit the total numbers. However. particularly. The full list of questions can be found in Appendix 2.Memorial service in critical care people had attended without replying. Venue Memorial services are reported in the media regularly. and some families had brought more people on the day than they had originally indicated. ‘No’ or ‘Don’t Know’. and they are frequently held in a church or cathedral. 100% n = 33 94% n = 31 97% n = 32 72% n = 24 55% n = 18 55% n = 18 20 10 0 Venue suitable Poetry/prose helpful Right religious input Involvement of staff adequate Formality of service right Happy with no singing Happy not to Like sitting contribute round a table Flower ceremony appropriate Glad attended Like to be re-invited Figure1 Percentages of positive responses © 2004 British Association of Critical Care Nurses. it would be informative to carry out a formal audit to evaluate the February 2003 service. Ethical approval is not normally required for audit purposes. the unit manager and the Head of the Pastoral Care Department. Those who had not replied. Respondents were also invited to write comments following each question.. To ensure anonymity: • no personal details or details regarding the deceased were requested from respondents • all questionnaires were returned to the Depart• ment of Clinical Governance and Audit. Some families had telephoned the unit to ask whether extra people could be brought. were not included. Nursing in Critical Care 2004 • Vol 9 No 5 225 . as an act of courtesy.e. Examples of the comments added by respondents are included in the following discussion. approving) responses to each question and also gives this data as percentages of the total number of respondents. respondents were asked to tick either ‘More formal’ or ‘Less formal’. Several staff who had attended the service were asked to comment on the questionnaire. these included six nurses. AUDIT OF THE MEMORIAL SERVICE It was decided that whilst we had had a lot of informal positive feedback from attendees of the memorial services (Appendix 1). but then turned up on the day of the service. The audit was undertaken by distributing a questionnaire to those who had accepted the invitation to attend the service. Each question addressed 100 90 80 70 60 50 40 30 52% n = 17 97% n = 32 94% n = 31 82% n = 27 61% n = 20 FINDINGS Figure 1 details the numbers who gave positive (i. and minor changes were made to the first draft as a result of comments received. A total of 52 questionnaires were distributed. and the responses given in all questions except question five were ‘Yes’. 1993).
should be held in the chapel. we vary the choice of readings or poems and try to get a mixture of some that identify with the pain of bereavement. Perhaps. which proved to be more than enough.e. and some that try to look towards the future with hope. Given the numbers of people involved. Respondents understood the difficulties that including religious content could pose with so many different faiths involved: ‘I am a Catholic. all but one (97%. the fact that the service was not being held in the chapel encouraged some nonreligious and different faith families to attend. it would be impossible for it to be just right Religious input Only 36% (n =12) would have liked more religious input. 12% (n =4) would have preferred it to be more formal. one respondent (3%) replied ‘don’t know’ and 15% (n =5) did not indicate a reply. Nursing in Critical Care 2004 • Vol 9 No 5 . but could not attend due to other commitments. This gratitude is reflected in the comments given: ‘the involvement of the busy nurses amazed me. ‘the staff have my full admiration’. they were so caring and dedicated’ and ‘staff involvement greatly appreciated’. they were wonderful’. Indeed. This is supported by positive comments such as: ‘very moving and meaningful’. ‘helpful and emotional’ and ‘it was very appropriate as we could associate with other people’s feelings'. because we have had so many positive comments about how appropriate it is in that setting (this poem is included in Appendix 3). we would risk upsetting the majority. However. although no comments were given as to how it should be made more formal. Comments included: ‘comfortable and pleasant’. Comments given included: ‘the format was just perfect’ and ‘I think the formality of the occasion was about right’. Each year. unfair’ and ‘opening prayers and at the end would be nice’. Frequent rotation of junior doctors meant that they were unlikely to know many of the families and therefore unlikely to wish to attend. Six members of the nursing staff also read out part of the ‘Order of Service’. However. In 2003. Our priority has been to include content that would be acceptable to a variety of religious faiths. Reading of poetry/prose In total. but so many different faiths it would be 226 © 2004 British Association of Critical Care Nurses. one consultant attended. 6% (n =2) did not know and one respondent (3%) did not indicate a reply.Memorial service in critical care although essentially non-religious. as a small part of the service in the future. It is reassuring to have such a positive response to the venue. Two other consultants were very supportive of the service. we printed 300 copies of the ‘Order of Service’. We now acknowledge that some religious content may be appropriate. So far. with great care taken not to introduce too much of a religious theme. 9% (n =3) said the level was not adequate. It may be necessary in the future to hire equipment from an outside source. Continuous multiprofessional working with the medical staff may increase their presence at future services. many relatives commented on how grateful they were for the staff involvement and their willingness to participate in the service itself. 94% (n =31) felt that the reading of poetry/ prose was helpful to them. Interestingly. One of the few criticisms of the service was that we needed ‘better audio as we could hardly hear’. and the fact that staff attended in their own time at a weekend. ‘very touching’. Only 9% (n =3) would have preferred it to be less formal. we have not included religious content. i. They have found this to be a very important part of their grieving and healing process. In the last 3 years. n =32) thought that the hospital restaurant was a suitable venue. we must take care to remember that the majority did not want more religious input as they thought it was ‘just right’. The audit reflects that we seem to have achieved the right balance for the majority. The reasons for not holding the service in the chapel were clearly explained as part of the introduction to the service. or those with no religious faith. we considered the attendance was excellent. Formality of service An encouraging 61% (n =20) felt that the formality of the service was just right. one person commented that they ‘didn’t see many doctors’. nine nursing staff as summarised in Table 1. We have used one poem at every service. 52% (n =17) did not want more religious input and 12% (n =4) did not know. However. several families have been able to talk to a Consultant at the service. ‘the staff did a wonderful job. Given the fact that the unit had to be adequately staffed. If we were to change the format to suit the minority. The remainder of the readings were chosen from a variety of sources. there was a problem with one of the speakers in the restaurant on the day of the service which only occurred after the service started. All the readings and poems are printed in the ‘Order of Service’ which families can take away with them to read again at home. Staff involvement A total of 82% (n =27) stated that the involvement by the staff was adequate. one respondent (3%) indicated it was not helpful and one (3%) responded with ‘don’t know’. Two of the poems used in the service had been written by relatives who had lost a family member on our unit. One person (3%) did not indicate a reply. ‘very informal but nice’ and ‘it was very peaceful and appropriate for families’. On the day of the service. and which we were unable to resolve on the day.
relatives who have sent poems/prose to the unit have been contacted to gain permission to use them at the service. and one respondent (3%) did not indicate a reply. it would not be wise to change the formality of the service in any significant way. very thoughtful’. Seating arrangements It is totally reassuring that 100% (n =33) liked sitting around a table. the first couple had remarked that they found it quite traumatic to be sitting with a woman experiencing such great tragedy. Yet. at present. Since the audit. The staff on the unit were intrigued by the comment that perhaps singing could be done ‘by the staff’. ‘a lovely touch’. Perhaps. as each person presented the flower at the front of the restaurant as part of a moment of remembrance. we were encouraged by the positive comments given in the audit. As something totally new in 2003. There was particular concern that some would be forced to share a table with strangers at a time when they would possibly have preferred not to talk to others. Flower ceremony In total. However. Twenty-four per cent (n =8) did not know whether they wished to contribute. we have discussed this issue and wondered whether it should be mentioned when the support letter is dispatched 6 weeks following the bereavement. This is something we may consider when planning for the next service. and wished to be. Contribution to the service by relatives The recent policy statement Comprehensive Critical Care asserts that partnership between professionals and patients should form the basis of critical care provision (Department of Health. sat at a table with a young woman. I was very proud’. It is difficult to know how we could achieve this. more detached sitting in a row rather than around a table. one respondent (3%) did not think it was appropriate and one more (3%) did not indicate a reply. only 18% (n =6) would have wished to contribute ideas regarding contents of the service and 55% (n =18) did not wish to contribute ideas. where families were sitting in rows. at least one person per year has chosen to send to the unit a piece of poetry or prose that they have written themselves following their bereavement.Memorial service in critical care for everyone. Even the person who stated that the flower ceremony was inappropriate gave a positive written response: ‘would have liked to take the flower home to press’. However. We believe that as a result of the audit. Members of the nursing staff on the unit have chosen poems or prose that they feel to be the most appropriate. 94% (n =31) felt the flower ceremony was appropriate. Were relatives glad they attended? In total. no one has admitted to such talents. ‘we said goodbye to our loved ones with the flowers’. However. in the present survey. The overall positive response to this question is particularly rewarding and was reinforced by many positive comments: ‘I am still in awe of the depth of caring by the nurses’. the concern would be that we would perhaps be inundated with requests. and we should perhaps take comfort from the fact that the majority did not believe that there should have been some singing. The flower ceremony proved to be emotional and symbolic for many. we could ensure that some extra flowers are available for those who would like to take one home. One such relative commented: ‘one of my poems to my son Anthony was read out. 97% (n =32) said they were glad they attended the service. In the previous year. All the flowers were taken into the chapel after the service and left on the altar in vases. So far. After the ceremony. If there was a member of staff gifted in that field. One of the respondents who did not wish to contribute stated ‘the nurses can only do so much. from a variety of sources. There was concern that we were thrusting people together. it was a concern to us the following year that they would be sitting around a table in the restaurant. One respondent (3%) was not glad they attended but gave no reason for this response. Some people may have felt. Preference for singing Compared to the enthusiastic response for poetry/ prose. it could perhaps add some poignancy to the service. and it would be difficult to choose one over another. Nursing in Critical Care 2004 • Vol 9 No 5 . and an appropriate replacement for the candle lighting ceremony. ‘I felt this was one of the most moving parts of the service’. given that only one-third of respondents wanted any singing at all. After holding the first service in the chapel. So far. We have then contacted these people prior to the service to ask permission to use their contributions at the service. ‘it brought my son closer and made me realise other 227 © 2004 British Association of Critical Care Nurses. although finding the right song could prove difficult. only 33% (n =11) would have preferred there be some singing. The comments given about the flower ceremony were very positive: ‘very simple. This is acknowledged with the comment: ‘because of different views it would be hard to pick a song with the right words’. and therefore would not be able to identify their own flower afterwards. one family who had lost their elderly father. 55% (n =18) did not want singing and 12% (n =4) replied ‘don’t know’. and they should decide how much’. whose husband had suddenly died of pneumonia when she was heavily pregnant with their second child. 2000). the audit result has reassured us that this arrangement is appropriate.
and we are also keen to share ideas with any other units who may already be holding memorial services. (1998). Bereavement in the ICU. it gave us peace’. It is something which would need careful consideration in the future. 24: 13–120. Girolamer T. In particular. Sanders CM. Helping the spouses of critically ill patients. Lattanzi-Licht M. we were seeking to evaluate the effectiveness of our service and to further reinforce a need to continue with it each year. Intensive care society's APACHE II study in Britain and Ireland-II. This indicates a positive feeling towards the service as reflected in the comments: ‘I was very comforted’. Cole R. Comprehensive Critical Care. 3: 141–150. A desire for annual invitations? Seventy-two per cent (n =24) would like to be invited to the service again next year. Intensive Care Society. Grief the Mourning After. Evidence-Based Practice. The author also thanks all the bereaved families who took the time to complete the questionnaires. Rando T. we feel we could help others who wish to start up their own service. Wright J. we plan to continue to develop and improve the service. we have learned a lot and do feel we are doing the right thing. Gray A. Norbury E. it is appropriate to conclude with a plea from one of the respondents in the audit: ‘Please carry on this service. Nursing in Critical Care. 5: 288–293. at the right time. Richardson K. Glynn T. General Hospital Psychiatry. We need to assess the need for 228 © 2004 British Association of Critical Care Nurses. The institutional memorial service: a strategy to prevent burnout in HIV healthcare workers. Foulstone S. (1998). Palliative Medicine. (2000). Vessey MP. Bereavement services: practice and problems. London: Department of Health. Snowball R. (1993). McPherson K. Nursing Research. Urbancek A. Mant J. Jay M. organisation and delivery of the service. However. 20: 124–126. Major E. REFERENCES Breu C. Jackson I. holding more than one service each year.). as time goes on. Bereavement support: evaluation of a palliative care memorial service. it is a great comfort to know people care’. In carrying out our audit. London: Penguin. New York: Wiley. to the right people. thank you again’. to the right people. Even the comments from the respondents who did not wish to attend again were positive: ‘let someone else have a chance. 78: 51–53. and ‘it closed a door for me and I was able to view the hospital that I won’t ever have to come back to’. Granger C. (1989). Horowitz H. the service as a whole had proved to be a positive experience. Hospice Journal.. 7: 307–311. ‘I wouldn’t have missed it. 307: 977–981. Dying. Dracup K. Seers K. (1997). In: Champaign IL. Rowan KM. and Death: Clinical Interventions for Caregivers. Ormandy P. This suggests that whatever minor changes respondents felt could be made. EDTNA/ERCA Journal. (1984). and that currently only minor changes need to be made in the planning. 14: 22–24. Edinburgh: Churchill Livingstone. Grief. one (3%) replied ‘don’t know’ and one (3%) did not indicate a reply. or. For the future. (1993). we turned down such a lot of relations of Malcolm because of the numbers being limited. Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. alternatively. 8: 40–47. Perhaps. Have you ever thought of a memorial service? Geriatric Nursing. This would increase the time spent in organisation. relatives to return each year and try to identify reasons why many families chose not to attend the service at all. and also increase costs. However. (1998). Department of Health. Caring for broken hearts – patients and relatives: three years of bereavement support in CCU. Although we still have much more to learn. British Journal of Intensive Care. Dawes M. (2000). Therapeutic interventions with grievers. (2002). 5: 1–28. Parkes CM. Bereavement – Studies of Grief in Adult Life. The American Journal of Nursing.Memorial service in critical care people are suffering like us’. We hope to act as a resource and to try and encourage the development of memorial services as an integral part of bereavement follow up. Owen F. McArdle R. A memorial service for renal patients. (1989). (ed. while 22% (n =7) did not wish to be invited again. Harvey B. Looking back over the last 3 years. (1994). the author thanks her managers Gill Nixon and Lindsay Bury. A study of bereavement in an intensive therapy unit. ACKNOWLEDGEMENTS The author thanks everyone who has helped in any way with the organisation of the memorial services. many may believe that they no longer wish to attend again. 15: 100–101. (1975). Nursing in Critical Care 2004 • Vol 9 No 5 . Guidelines for Bereavement Care in Intensive Care Units. John Prysor-Jones (Head of Pastoral Care) and Sarah Haslam and Susan Baxter from the Clinical Governance and Audit Department. March/April: 55–57. 1999). Davies P. (1978). 2nd edn. at the right time?’ (Dawes et al. Needs of the grieving spouse in a hospital setting. London: The Intensive Care Society. This question does raise the issue of should relatives be invited each year. To do so would require finding a venue suitable to hold increasing numbers. The evidence gained from the audit supports the need to continue with the service as an annual event. it must be remembered that of those who did not return questionnaires. some may have chosen not to due to a negative experience. ‘it provides a special time for remembrance’ and ‘it is another link with Mary’. (1999). British Medical Journal. Wilson A. CONCLUSION The purpose of audit was to find out ‘am I doing the right thing. ‘it helps to share the grief of others’. Nursing in Critical Care. Hampe SO. Kerr JH. New York: Research Press. Rawlings D. (1975). (1998). The development of a palliative care-led memorial service in an acute hospital setting. Short A. Shelly MP. International Journal of Palliative Nursing. Tiamson M.
Nursing in Critical Care 2004 • Vol 9 No 5 229 . It is the same as it ever was. or any part of the service? Did you like sitting around a table? Did you think the flower ceremony was appropriate? Were you glad you attended the service? Would you like to be invited again next year? © 2004 British Association of Critical Care Nurses. Speak to me in the easy way which you always used. Wear no forced air of solemnity or sorrow. There is absolutely unbroken continuity. I am I and you are you. (Canon Henry Scott Holland. It was very moving. Let my name be ever the household word that it always was. All is well. Call me by my old familiar name. may I thank yourself. Just around the corner. APPENDIX 3 Death is nothing at all Death is nothing at all… I have only slipped away into the next room. think of me. Put no difference in your tone. A lot of thought and hard work went into the occasion. smile. would you have wished to contribute ideas about songs. poetry. It helps to see other people who you know have gone through the same experience as ourselves. Why should I be out of mind because I am out of sight? I am waiting for you for an interval. St. Once more. pray for me. Let it be spoken without effort. Paul's Cathedral 1847–1918) APPENDIX 2 Audit questions 1 2 3 4 5 6 7 8 9 10 11 Was Charters Restaurant a suitable venue for you? How did you feel about the reading of poetry/prose? Was it helpful to you in this setting? Would you have liked the service to have more religious input? Was the level of involvement by staff adequate in your opinion? Would you have liked the service to be more or less informal? Would you have preferred there to be some singing? If you had been given the opportunity. Play. but also a lovely afternoon. although the word is very inadequate – thank you all’. all your staff and everyone who helped make Sunday such a special day. Laugh as we always laughed At the little jokes we enjoyed together. I realise we are not alone. Without the ghost of a shadow on it. Life means all that it ever meant. Other people are grieving as well. Whatever we were to each other that we are still.Memorial service in critical care APPENDIX 1 Letter of thanks from a relative who attended the service in 2003 ‘On behalf of all my family. Somewhere very near.
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