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Care after death: the grief journey for those bereaved during COVID-19

How a redeployed nursing team supported families affected by visiting restrictions

How a redeployed nursing team supported families affected by visiting restrictions

Debbie Critoph (centre) and Stephanie Smith (right), with Lily Martin, who helped the nurses set up the service for bereaved relatives

Many hospitals made the difficult decision to suspend hospital visiting during the recent lockdown something particularly difficult for those relatives whose loved ones died during inpatient stays.

Public health measures to slow the spread of the virus left many families grieving alone in a socially disconnected world and health professionals communicating in ways we would not choose.

Unexpected consequences of COVID-19 visiting restrictions

At Cambridge University Hospitals NHS Foundation Trust we followed national guidance to restrict visiting, with some unavoidable consequences.

As the visitor restrictions continued, deceased

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How a redeployed nursing team supported families affected by visiting restrictions

Debbie Critoph (centre) and Stephanie Smith (right), with Lily Martin, who helped the nurses
set up the service for bereaved relatives

Many hospitals made the difficult decision to suspend hospital visiting during the recent lockdown – something particularly difficult for those relatives whose loved ones died during inpatient stays.

Public health measures to slow the spread of the virus left many families grieving alone in a socially disconnected world and health professionals communicating in ways we would not choose.

Unexpected consequences of COVID-19 visiting restrictions

At Cambridge University Hospitals NHS Foundation Trust we followed national guidance to restrict visiting, with some unavoidable consequences.

As the visitor restrictions continued, deceased patients’ personal belongings began to accumulate in clinical areas. As two nurse clinical communication skills tutors, we were redeployed by our trust’s lead nurse for end of life care, Tina O’Hara, to address this issue sensitively.

End of life care and COVID-19: com the Nursing Standard-Marie Curie survey

Returning deceased patients’ possessions to the bereaved

With the help of patient advice and liaison service administrator Lily Martin, we created a new service to reunite bereaved relatives with their loved one’s personal effects.

Our experience has been both heartwarming and heartbreaking.

To begin, we would telephone relatives to explain our role and offer our condolences, then arrange to meet them.

Ms Critoph with one of the cloth bags
given to bereaved relatives

Often, we were the first people they had seen face to face in weeks. The appointment, carried out in a light, airy room in a non-clinical hospital area, provided an opportunity to talk about their experiences and share their grief.

When the rituals of death cannot be observed

Grief can be a lonely journey. We could see that feelings of sadness and isolation were heightened for bereaved relatives due to the government measures to limit physical interactions.

This extended beyond the immediate pain of not being able to visit a dying loved one.

Regardless of whether a death was COVID-19-related, rituals and practice normally seen after a death – such as family and friends visiting, registering the death, and in-person communication with the hospital teams – were removed.

‘Redeployment allowed us to give relatives time and support and hear their unique experiences at this extraordinary time. It has been a privilege to meet these bereaved people’

Communication related to the severity of a loved one’s condition was given to relatives over the telephone, often by a clinician they had never met.

Sometimes, this news was expected and followed a warning incident; at other times it was not and left people alone in shock and disbelief at the end of a telephone line.

When bad news came, some relatives were alone at home. Some were self-isolating or shielding, which enhanced their feelings of loneliness.

In June, one healthcare professional commented on social media that they were ‘more upset’ after bad news calls than face-to-face discussions.

Tips for communicating with bereaved relatives

  • Give grieving family members enough time – some of our appointments lasted an hour
  • Use the names of the deceased person and their relatives to personalise interactions
  • Listen actively and verbally acknowledge the relative’s journey
  • Use silence to encourage emotional disclosure
  • Mirror the relative’s emotional state in your tone and pace of voice
  • Signpost family members to bereavement services

Feelings of guilt and conflict about saying goodbye during the pandemic

Other people had been allowed to visit their dying loved one for a short amount of time, for which they were grateful, but this also raised worries about bringing COVID-19 home.

Fear of catching the potentially lethal virus should not be underestimated. Some relatives were too scared to come into hospital, instead preferring to meet us outside the entrance.

Those who had been given the choice to visit their inpatient relative but opted to video call instead described guilt and conflict about their decision.

One man spoke of his guilt in being the only sibling in his family allowed to visit their dying mother.

Others were unable to attend after the death, due to shielding or travel restrictions, and property had to be posted to them.

In these situations, we sent a personalised card and packaged property in hand-sewn bags, endeavouring to carry out the family’s wishes with kindness, compassion and respect.

Beautifully made cloth bags demonstrated care after death

When we first set up the service, we encountered a lot of personal property stored in large plastic bags, which resembled bin bags.

On one occasion, we found a deceased patient’s jewellery in a pathology specimen bag.

Examples of the bags made to return belongings to relatives of the deceased

Demonstrating care, compassion and empathy felt paramount, so we contacted the sewing community via social media groups who, with enthusiasm and skill, made beautiful cloth bags for us, which we used to return the items.

With useful long straps and strong material, these bags served not only a practical purpose but an emotional one, symbolising care after death.

Our trust has now adopted this practice change permanently to improve end of life care.

View our COVID-19 resource centre

The journey of grief: immeasurable and life-changing

Finding alternative ways to demonstrate empathy from behind a mask and at a social distance was crucial.

Words and phrases from bereaved relatives, such as ‘guilt’, ‘fear’, ‘conflicted’ and ‘disbelief’ were commonplace during the three-month redeployment. Losses are immeasurable and life-changing.

But redeployment to ‘behind’ the front line allowed us to give relatives time and support and hear their unique experiences at this extraordinary time.

It has been a privilege to meet these bereaved people.

We hope our skilled communication and practice has made one small part of the grief journey more bearable.


Debbie Critoph is senior clinical communication skills tutor at Cambridge University Hospitals NHS Foundation Trust



Stephanie Smith is clinical communication skills tutor at Cambridge University Hospitals NHS Foundation Trust

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