Activity 10: Bereavement
The experience for a caregiver doesn't end when the person he or she is caring for dies. This is a time of major transition and adjustment for the bereaved person. In the period following death, the caregivers may need social and psychological support.
According to the World Health Organization, Palliative care:
- "offers a support system to help the family cope during the person's illness and in the family's bereavement
- uses a team approach to address the needs of people with life-limiting illnesses and their families, including bereavement counselling, if indicated." 
Palliative Care Australia's Standards for Providing Quality Palliative Care to all Australians identifies the following two criteria for bereavement support provided by primary care providers:
- "information (both verbal and written) on loss and grief and the availability of bereavement support services is routinely provided to family members prior to and after death of the patient
- bereavement risk for caregivers and family members is assessed during the patient's illness and support is offered based on need." 
Bereavement is an individual experience. There's no standard response to the death of a close family member or friend. For most people, the feelings of loss and grief will wane over time. However, for some, there is the potential for negative effects on the physical and mental health of the bereaved that can last for some time.
As a health professional caring for the dying, you will be involved in the provision of bereavement support to grieving relatives. Identifying risk factors is an integral part of this process. It is important to seek guidance, if necessary, from an experienced member of the multidisciplinary team to ensure that optimal bereavement support is provided.
Risk factors for complicated bereavement may include:
- childhood experiences of the bereaved person, including death of a parent, childhood sexual abuse or childhood separation anxiety
- levels of closeness with the deceased, time since death, and relationship with the deceased
- younger age of the deceased
- violent death
- gender of the bereaved person - women show greater grief.
Some patients may be extremely resilient, even when they have multiple risk factors that would suggest possible vulnerability, and so assessment should be individualised. 
The CareSearch review of the grief and bereavement literature suggests the following key messages:
- Expressions of grief can vary widely from person to person. No-one can tell others how they 'should' be grieving.
- Most people who experience normal grief reactions do not require specialist counselling.
- For those people who experience normal grief reactions reassurance, acknowledgement of their losses and access to information may be all that is required.
- A proportion of people who grieve may develop complex grief
- A number of options for referral for complicated bereavement exist:
- specialist bereavement counsellors
- palliative care services usually offer bereavement follow up to their clients, often based on a risk assessment, and may accept referrals from other sources
- other mental health professionals with appropriate skills and expertise. 
1. World Health Organization (WHO). (1998). WHO Definition of Palliative Care. Retrieved September 15, 2010, from www.who.int/cancer/palliative/definition/en/
2. Palliative Care Australia. (2005). Palliative Care Australia's Standards for Providing Quality Palliative Care to all Australians. Canberra: Palliative Care Australia. Retrieved September 15, 2010, from http://palliativecare.org.au/national-standards-assessment-program/
4. CareSearch. (2010). Bereavment and grief. Retrieved June 17, 2010, from www.caresearch.com.au/caresearch/ClinicalPractice
/PsychologicalSocialSpiritual/BereavementandGrief/tabid/1345/Default.aspx. Used with permission.
Activity 10: Bereavement
It's time to reflect on Bob's complete story and answer the following questions.
- Identify some factors that might impact on how Margaret copes with Bob's death.
- What resources are available within your community to help bereaved caregivers? These may be formal and informal.
- As a health care professional, it's important to understand that the death of patients in your care may have an effect on you. What self-care strategies will you adopt when a person you're caring for has died?