Case study:

22 February 2012

A protocol to help nurses support bereaved carers

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Key points

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NHS Gloucestershire has developed a bereavement protocol to help community nurses in their practice and standardise the information and support provided to bereaved relatives and carers in the last days of life and after death.

The new standard was produced after a baseline audit of services revealed there was no standardised community bereavement follow-up and limited information provision. A survey commissioned by the bereavement charity CRUSE indicated a lack of a structured approach and some ignorance about available services.

As a result a working group was formed in September 2009 consisting of CRUSE, hospice and specialist palliative care representation and a cross-section of community nurses from across Gloucestershire.

The aim was to develop a standard that concentrated on bereavement support and not counselling. Counselling from other agencies may be required if particular issues have been identified relating to the bereavement.

Using a framework developed by a Gloucestershire GP surgery, the group first agreed the key principles of care:

• Respect for the individual
• Recognising and acknowledging loss
• Provision of information – Liverpool Care Pathway (LCP) resource pack
• Support
• Ensuring the environment and facilities are appropriate for the bereaved
• Review and audit.

The second section of the protocol focused on the practicalities of community bereavement follow-up, including contact information, access to ongoing support and communication pathways across a multidisciplinary team.

Two tools were developed to help assessment and to document the follow-up visit. An audit tool was adapted from the acute trust critical care unit. A prompt sheet was also created to support the nurse in asking key questions that indicate if the relative/carer needed further support from CRUSE or another identified bereavement service. Answers are recorded on the audit tool for future reference.

A standardised letter was devised for those who did not respond or who had left the area and a contact card produced to inform the bereaved of the planned follow-up. A resource file was produced with all the necessary documentation and information leaflets for when the LCP was begun.

NHS Gloucestershire has also produced a resource pack about the introduction of the LCP to support the bereavement protocol. It provides useful information to families and carers in the form of leaflets about the LCP, what to do after a death and bereavement and a contact card explaining standardised follow-up. It also has useful tools for the nurses, including an LCP guidance sheet, a prompt sheet, a bereavement documentation tool and a letter of unresponsive contact.

The resource pack, which has been in use since June 2010, has been recognised by the NHS South West and in the Department of Health booklet When a person dies. Colleagues in other parts of the South West region are also considering using the standard in their own practice.

NHS Gloucestershire and representatives from key stakeholders in end of life care have now developed guidelines to bring a standardised approach to bereavement follow-up across the whole county.

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