Supporting the bereaved in palliative care

Loss, grief and bereavement are relatives in palliative care terms, as these three notions are connected. Loss in the form of death leads to grief, which is the expression of the pain or hurt caused by the loss. The expression of grief and the period over which it is expressed is often referred to as the bereavement phase. It follows, therefore, that when bereavement is discussed, the loss and grief associated with it should also be kept in mind. Bereavement comes directly from grief that has been triggered by a loss. In palliative care, the loss is often the death of a loved one. The term ‘loved one’ suggests that there is affection (emotional connection) between the person who has died and those left behind. It is true that the depth of the emotional connection (affectionate bond) with the deceased person often determines the degree of grief (emotional pain/hurt) felt during the bereavement phase. It is, therefore, normal for the bereaved who had a deep affectionate bond to experience more painful grief, and this should not always be pathologised (Bayliss, 2004). What has simply happened is that the bereaved may be trying to make sense of their loss and determine how to carry on with life without the deceased person. In some cases, people fail to see a way forward and may experience suicidal ideation, with some acting on these thoughts. As community nurses, our skills of assessment are crucial, whereby we can decide the level of support to offer. This means first distinguishing the ‘normal’ grieving reaction to a painful loss and identifying when the grief is so immense that the bereaved would benefit from additional support.