P105
Grieving and Bereavement in the dialysis unit- re-defining the white Elephant in the room
Christine Laukam and Jyoti Baharani
Department of Renal Medicine, Birmingham Heartlands Hospital, B95SS
Background
After the death of a dialysis patient, dialysis providers are often the source of psychosocial and
spiritual support to not only the deceased’s carers but also to other patients albeit in an unstructured
way. Despite this, it is infrequent that a dialysis unit will formally recognise or acknowledge the death
of a patient. The reason often quoted for this is to avoid upsetting other patients or staff.
If one considers the Kubler –Ross model of grief, it is far from complete when staff are faced with an
empty dialysis chair. Is there any benefit in openly acknowledging loss? Yes, because denying pain
does not avoid it and can lead to further anguish not only amongst patients but also staff who have
cared for deceased, sometimes for many years. It is not usual for the authors to have heard quotes
from bereaved families questioning the lack of contact or indeed care shown to them following the
death of their loved one.
Methods
At our centre, over the last 36 months we have had a structured approach to end of life (EOL) care in
the Haemodialysis unit with the introduction of the Concern Register in response to the national EOL
strategy. Whilst confident that we address EOL care to a high standard, it was still apparent that the
final link in the chain of namely bereavement and grieving were still woefully lacking despite our
structured approach.
We therefore sought to address this using 3 strategies. Telephone contact at 48 hours by a named
member of the nursing staff to the bereaved carer. If the patient was on the concern register, contact is
made by the supportive care nurse who often knows the family well. A series of indiscrete questions
are asked and if there is any concern, this is escalated to the consultant in charge and a referral made
to Cruise following consent.
Personal letters of condolence are sent to the bereaved NOK within 2 weeks of the death written by
the consultant who dealt most with the patient. Included within the body of the letter, is information or
anecdotes to personalise the message.
The final stage of the process is an annual memorial service.
Results
To date, we have had over 120 families that have been through the three stage process. Letters of
condolence have resulted in thankful acknowledgements from family members.
In the summer of 2013 we had the first ever renal memorial service which was attended by over 100
staff and family members. The service was organised by the renal department with help from the
hospital chaplaincy and local kidney patient association council members.
All patients, pre-dialysis, on dialysis or transplanted were invited as were bereaved carers and all renal
staff. Notices were displayed in all renal clinical areas, including dialysis units and wards. Notice of
the service was also published by the local press. The service was advertised as non-denominational
and for those of faith and of none. It was held at a local community centre and culminated in the
planting of a ‘memorial tree’ in the grounds on the main dialysis unit.
Since we introduced these measures, staffs have reported better well-being and greater ability to cope
when dealing with patient death.
Conclusions
Denying the effect that an empty dialysis chair poses to patients and staff is no longer acceptable
practice at our centre. We propose that every dialysis unit needs to acknowledge bereavement and
employ a locally acceptable policy to deal with it.
Death, like birth, divides time in two and needs to be acknowledged by everyone who knows the
deceased patient. It is only by doing so, will renal healthcare professionals continue to provide truly
holistic patient care- from diagnosis to the dialysis machine or that elusive transplant and to the final
resting place.