Bereavement and Donation Salford Royal NHS Foundation Trust; Bolton NHS Trust; Wrightington Wigan and Leigh NHS Foundation Trust, collectively known as the Bereavement and Donor Alliance.

The purpose of the travel award to Australia, Singapore and India was to compare the experience of the dying, dead and their families with the bereavement care that is delivered across the Bereavement Alliance of Bolton, Salford and Wigan NHS Trusts. The mix of cultures across each organisation is diverse as is the challenge to meet the needs of the dying, deceased and their families.

Bereavement care is an explicit part of end of life care which should extend to those caring for the dying and the dead (WHO 2002).Quality bereavement care should ensure that patients, families and significant others are supported in any circumstance – from the diagnosis of dying, irrespective of place of death, mode of death, religion /spiritual needs must be delivered with sensitivity and informed compassion.

The author believes that bereavement care is the responsibility of all professionals regardless of workplace. In the majority of NHS organisations bereavement care is offered to patients and families of those expected to die, however offering bereavement support to families of patients dying suddenly or unexpectedly is a challenge and one that the majority of care settings do not meet. The acknowledgement that we have a NHS and social care system in crisis with an ever growing elderly population, increasing death rate year on year   and a hugely diverse population – all with differing needs indicates that creativity is needed to be able to deliver a first class bereavement service that is equitable to all those under the umbrella of end of life care.

Nursing teams caring for culturally diverse population should not presume that care of the dying within Western society ‘fits’ our patients and families. It is important to acknowledge the needs of our patients, despite our assumption that the care required for this group does not meet our expectation and sometimes feels uncomfortable to deliver within the patient or families expectation.

The overall aim of this study was to enhance my knowledge to enable me to inform future practice of our culturally diverse population to deliver quality bereavement care without exception.

The ‘End of life care for adult’s’ standards includes a clear reference to bereavement support;

”People affected by death, are communicated with in a sensitive way and are offered immediate and on-going bereavement, emotional and spiritual support appropriate to their needs and preferences”

Bereavement can give rise to a wide range of needs i.e. practical, financial, social, emotional and spiritual. There might be needs for information about loss and grief, needs to pursue particular cultural practices, needs for additional support to deal with the emotional and psychological impact of loss by death or, in a small number of circumstances, specific needs for health service intervention to cope with a health problem related to loss by death. However, the services for families and carers are poorly developed in many parts of England and Wales.

Formal bereavement support to the dying is mainly provided to discrete groups e.g. those bereaved by cancer. There are often significant gaps of care afforded to patients who have long-term conditions.

Carers and families of the dying are often invisible to professionals which results in them not being referred to, or made aware of, services available to support them.

The alliance model for bereavement & donor support is a nurse led service- it’s new, innovative and gives families and patients true choice at the end of their life. The major benefit of this scholarship has been the confidence and belief that the bereavement model we have created across the alliance is fit for purpose. Care up to and after death (including training regarding verification of death by nurses and the care after death policy) is being significantly enhanced across the bereavement and donor alliance.  We have secured funding for substantive bereavement liaison posts in each organisation to develop and implement a comprehensive bereavement pathway that will encompass care before, during and after death – and includes both sudden and expected deaths across the age range and care settings of the bereavement alliance which is fully supported by the coroner.

The bereavement model of care brings ownership to all those who care for the dying and the dead, aiming to be inclusive to all those we come in contact with.

Initially my goal was to undertake a visit to the Jewish Orthodox communities in Israel, however due to travel restrictions I have been unable to meet this need. Despite being unable to travel I have been able to work with the Jewish community within my area to better understand and enhance the care given to this group of dying and bereaved.