The nature of death, coping response and intensity of bereavement following death in the critical care environment

Introduction: Bereavement, defined as the situation of having recently lost a significant other, is recognised as one of life's greatest stressors and may lead to decrements in health status, psychological morbidity and excess risk of mortality. Aim: The aim of this study was firstly to describe the relationships between the nature of death and bereavement intensity following death in the adult critical care environment and secondly to examine the modifying effects of coping responses on intensity of bereavement reaction. Method: Prospective evaluation of the impact of the nature of death and coping responses on bereavement intensity. 78 participants completed a nature of death questionnaire within 2 weeks of bereavement and at 3 and 6 months completed the Core Bereavement Items Questionnaire (CBI-17) and Brief COPE Inventory. Results: At 6 months, univariate variables significantly associated with bereavement intensity were: being unprepared for the death (p < 0.001), a drawn out death (p < 0.001), a violent death (p = 0.007) and if the deceased appeared to suffer more than expected (p = 0.03). Multivariate analysis revealed being unprepared for the death appears to account for these relationships. Regarding coping, there were significant increases from 3 to 6 months in both acceptance scales (p = 0.01) and planning (p = 0.02) on The Brief COPE Inventory. Greater use of emotional support (p = 0.02), self-blame (0.003) and denial (p < 0.001) were multivariate variables associated with higher bereavement intensity at 6 months. Conclusion: The results from this evaluation provide insight into the impact of bereavement after death in the critical care environment and inform potential preventative approaches at the time of death to reduce bereavement intensity. (C) 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.