Losing loved ones can trigger overwhelming emotional responses and severe distress. Therefore, the process of breaking bad news and grief support to survivors and their families require care and caution. Here are some suggestions of supporting survivors through acute grief reactions:

  Tasks of acute grief support Practical tips for healthcare workers & first responders
1 Notifying the family
  • Notify the family in person and give the information in a calm and caring manner.
  • Talk to the nearest next of kin and consider the order of notification, e.g. spouse or parents before siblings.
  • If no family member is present in the hospital, call the nearest next of kin and confirm his/her identity. Introduce yourself and invite him/her to come to the hospital as soon as possible upon the critical conditions of his/her beloved one.
  • Suggest the family member to bring a companion for emotional support.
  • Suggest the family member to notify other significant others.
2 Arrival of the family
  • Escort the family to a quiet area where they can have privacy and minimal interruption.
  • Introduce yourself.
  • Verify the identity and relationship of the family members with the patient or deceased victim.
  • Do not ask the bereaved to sign any document at this stage.
3 Breaking bad news
  • Do not delay breaking the bad news or communicating patient’s condition.
  • Be warm and compassionate. Show your concern and condolence.
  • Break the news in stages if the patient is badly injured.
  • Clearly explain the occurrence of relevant events in a chronological order (e.g. what happened to the patient, what actions were taken, what treatments and specific care were provided and responses of the patient).
  • Gently reassure the family that all possible treatments have been administered.
  • Use the patient's name instead of an indefinite address “the deceased”.
  • Explain the actual cause of death in simple language.
  • Do not use jargons or vague descriptions.
  • Support expression of emotions in different ways.
  • Be patient and allow the bereaved to ask questions.
  • Answer all questions honestly as much as possible.
  • Identify if the family shows any risks of self-harm or harming others. Make proper referrals if necessary.
4 Viewing the deceased victim
  • Treat the deceased person with dignity and respect.
  • Try to make the deceased person's appearance more presentable and acceptable to the bereaved. For example, remove unnecessary medical equipment, clean up wounds, put him/her on a bed, or cover the body with a clean sheet.
  • Arrange the bereaved to view the deceased as soon as possible. If the deceased was disfigured, prior preparation is essential. Family members should be prepared for this psychologically.
  • Encourage the family to say goodbye to their beloved in their own ways, for example, make prayers, give blessings, touch or hold the hand of the deceased.
  • Give space and time to the family and respect their need for privacy.
  • Ask if the family would like to spend time with the deceased. Check whether the family needs to have the company of hospital personnel.
  • If the family experiences difficulties coping with the stressful situation, encourage them to take a break in a quiet and comfortable place before returning to see the deceased again.
5 Concluding remarks
  • Explain to the family what will happen to the deceased person, for example, if autopsy is required.
  • Check the family's readiness to receive the personal belongings of the deceased. Put the items in a presentable box or container neatly, not in a trash bag. Explain what the items are and their conditions.
  • Clearly list out things they need to do and give them a written step-by-step list to follow, for example, the procedures for obtaining the death certificate.
  • Do not leave the bereaved alone. Arrange someone to accompany him/her anytime when possible.
  • Re-express the willingness to address their concerns.
  • Do not speak to the media without the family's explicit permission. 
6 Identification of high risk groups for referral to professional psychosocial care
  • Risk factors if the deceased is:  
    • Young e.g. an infant, child.
    • Pregnant or had young children.
  • Risk factors if the bereaved has:  
    • Excessive blaming of oneself / others.
    • Uncontrollable rage.
    • Poor social support.
    • Inadequate coping skills.
    • Financial difficulties or were unemployed.
7 Facilitation of continued care
  • Provide a contact number for the bereaved and invite them to call back for clarifications or questions.
  • Educate them on the signs and symptoms of complicated and prolonged grief.
  • Provide the bereaved with a list of contact numbers for emergency mental health services and grief support services. Encourage them to seek help if necessary.
  • Immediately refer the bereaved to medical or mental health services, if he/she needs services beyond your training and work capability.
  • Give follow-up phone calls to the bereaved, particularly those in high risk groups.

Note:

  • Adapted from Disaster Triage and Management Manual (2014).