Dr Silvia Noné and nurse Ricardo Fernandes of the Sisters Hospitallers’ Casa de Saúde da Idanha in Portugal, explain how they have developed a grief intervention programme.

The grief intervention programme at the Sisters Hospitallers’ Casa de Saúde da Idanha in Portugal emerged from the realisation that the loss of a loved one is unique in the human experience. Though universal, we experience the loss of those close to us in singular ways; it is a suffering that only those who suffer can describe. Though grief has no time, it does have a place and a purpose: to organise our interior and exterior worlds, which have been overturned in the absence of the one we love. The grieving process can prompt questions, induce misgivings, cause a breakdown in day-to-day routines, trigger physical and mental health issues, and be a period of adapting to a new reality in the absence of a loved one.

Therefore, it is essential that care providers display empathy and demonstrate an ability to accompany those grieving a loss. To that end, Casa de Saúde da Idanha has developed an intimacy programme for those who have lost someone during their hospitalisation, in an effort to facilitate the grieving process. The programme emerged organically from the palliative care unit, based on the objectives and philosophy of that type of care. Subsequently, the programme spread to all inpatient units and care homes, because it is our belief that care does not die with the patient but continues in the form of supporting relatives and preserving therapeutic (and humane) ties with the people the institution welcomes.

Multidisciplinary care plan

In this context, intervention is based on accompanying those in mourning as they adapt to the loss, a process that begins even before death occurs. In palliative care, due to the severity of the prognoses, death is almost always expected. It is in this phase of severe illness that family members realise death will occur in a relatively short period of time. The loss of autonomy, the loss of the ability to communicate verbally, physical changes to the person, and changes in social and family roles also symbolise losses in the run-up to a death and can cause anticipatory grief. At the same time, the need to make decisions and the trials that family members encounter over the course of an illness can exacerbate suffering; this requires attention and monitoring in due time and can affect one’s experience of grief.

In these moments, care professionals can ease the process by helping family members assimilate through systematised, multidisciplinary and fundamentally human and existential intervention. The team promoting the programme consists of a clinical psychologist and a nurse specialised in mental health; both have expert training in the grieving process. They analyse each case and develop an individual intervention plan, which is shared and updated with input from the entire multidisciplinary team. In the anticipatory grieving phase, the opportunity exists to create a time and place for people to say goodbye, which often has a positive effect on the experience of grief.

A specific multidisciplinary care plan in the anticipatory grieving phase can have a decisive impact on people’s lives by mediating forms of complex grief. In this way, we prioritise visits from the family members of hospitalised patients and encourage their participation in care (after conducting meticulous and rigorous assessments on the benefits for both patients and family members in the performance of these tasks). Issues that may exacerbate suffering are also addressed in each individual case. Psychotherapeutic follow-up in this phase is extremely important in order to address any risk factors that may cause future complications in the grieving process after the patient’s death.   

At the same time, patients also sense changes resulting from the disease and undergo their own process of preparatory grief as they confront their own finiteness, often reviewing their lives over and over and redefining their current experience.  

The process of adapting to loss

After a loss, survivors experience bereavement in a unique way and it is important that the care team is available and present during this process. When death occurs, the team members inform the family and stay with them in order to help in any way possible. The family is informed of the team’s intention to call some two months after the patient’s passing. Meanwhile, our professionals send a personalised letter, reflecting on the deceased and their life, expressing sympathy and condolences for the loss and including some guidelines to spot a level of suffering that may require further attention. The letter states that a professional will be in touch by phone shortly, and that the entire team is available to help anyone in the grieving process.

Telephone contact is intended primarily to conduct a clinical interview to assess outward expressions of grief that may indicate a more complex form of bereavement involving significant suffering that warrants clinical care. During these phone conversations, in which the bereaved interact freely with healthcare professionals, important clinical data is extracted about how the individual is coping with their loss. This information determines the level of follow-up that the professional will carry out, in accordance with the individual’s wishes and availability. It is possible to change contacts when the situation justifies, and to arrange in-person consultations with a specific healthcare professional in order to clarify any issues that have persisted since the hospitalisation period, or to refer the person to a specialised bereavement counsellor and/or community resource specialising in these situations. Above all, it is possible to help the person based on their needs and experience of loss.

It is worth emphasising the extreme importance of training in this specific area. At Casa de Saúde da Idanha, the grief intervention team regularly refreshes its expertise through training sessions in order to fine-tune technical, scientific, and human intervention when helping those in need as we get to know them through our care.

This grief intervention programme would not exist if it were not guided by the Hospitaller values as reflected in the words of St. Benedict Menni: ‘To do good, well’.

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