key: cord-0992569-s3sg3vjp
authors: Smith, Stephanie Jane; Critoph, Deborah Joy
title: The impact of missing property for relatives and healthcare professionals: Communicating with grieving relatives during COVID-19
date: 2021-12-07
journal: Patient Educ Couns
DOI: 10.1016/j.pec.2021.12.003
sha: 38f7adfd0deaa457a1857b0714d8df38b276ec93
doc_id: 992569
cord_uid: s3sg3vjp

nan

The COVID-19 pandemic challenges us to work in different ways. Our roles as nurses and clinical communication skills tutors (in medical education) were put on hold while we returned to the clinical setting during COVID-19. Following discussion with the Lead Nurse for end-oflife care, we were assigned the responsibility of developing a taskforce to ensure that deceased patient's property was returned to their relatives. Deceased patients' property could not be returned due to the visiting restrictions set by the national guidelines [1] . Significant amounts of property gathered in clinical areas in bags resembling bin liners -a visual reminder to staff of the global trauma they were experiencing. We created an interim service, away from clinical areas, that complied with hospital guidelines and allowed us to meet with relatives to return their loved one's belongings. During these 10 weeks we communicated with more than 150 grieving relatives.

Lockdown removed in person contact and left grieving relatives isolated. We provided people the space to express their emotions and talk about their experiences through active listening and empathy. We acknowledged how difficult this had been for them, asked how they were coping with their grief, what support networks they had, and gave them contact details for follow up bereavement support. We offered advice on practicalities such as finding a funeral director that permitted loved ones to view their relative and we investigated missing property. Throughout these conversations family members would smile at the precious memories they shared of their loved one's life, which was a privilege to hear.

The collective grief [2] experienced has compelled global acts of human kindness. An example was the response from a local group of tailors who sewed beautiful bags to replace the clinical nature of returning deceased's belongings in what resembled waste bags. We were deeply uncomfortable about what message this gave relatives experiencing grief and the moral distress it caused us as professionals. This triggered our appeal on social media, resulting in handsewn bags which had a practical and emotional function, symbolising care after death. The hospital has adopted this change in practice beyond the pandemic, and will continue to use handsewn bags.

I will always remember Jack, a husband of 54 years, to Sybil. Sybil had been in hospital on multiple wards before taking up residence in a care home, separated from Jack. She deteriorated rapidly due to COVID-19 and was transferred back to hospital where she went into cardiac arrest in the ambulance bay and died. Jack's shock and grief was palpable days later when he recalled the events saying that she "had been fine" when he called the care home that morning. The realisation that her necklace, which Jack had given to Sybil on her last birthday, was missing only added to his grief.

Many relatives have been similarly separated from their loved one(s). The shock of a sudden deterioration and the challenges of navigating grief when communities are disconnected, led us to question the incidence of complicated grieving [3] . This highlighted the impact of visiting restrictions: when relatives cannot see loved ones first-hand, cannot hear the rationale of the healthcare professionals (HCPs) caring for their loved ones, they are removed from participating in their care. Some relatives reflected that the daily communication from the clinical area was a lifeline, and whilst they appreciated HCP's time during a period of exceptional pressure, it was not the same as being physically present. There were common themes expressed by relatives: imagining their suffering, fearing them being alone and the guilt of separation. In Jack's case, it impacted his ability to comprehend the events described by HCPs.

I spoke to Jack on the telephone several times whilst attempting to locate the missing necklace. Talking on the telephone was difficult because I wanted to be physically present when he was crying. He had no children; his only support network was his neighbour who could not go into his house or give him a hug. The loss of this necklace was exacerbating his distress, and I was determined to return this item that held tremendous sentimental value, something which he could hold onto at a time of despair. The only time he talked without crying was when he was sharing memories of Sybil. He recalled how he met her at work in her job on the Post Office lines. He recalled how he felt on the day she walked in looking beautiful in a purple dress. He reminisced about how clever she was and that she was a "true lady" who never said a single swear word in her life.

I searched across multiple areas and organisations over several weeks to find the necklace. I had to accept that it was lost. I experienced a wave of dread about breaking the news to Jack. It was time to say sorry and saying it with sincerity was not going to be the challenge, it would be holding it together emotionally. It was difficult because of my anticipation of his distress at this loss of the physical connection to his wife. We had built a rapport and he had put his hope in me to resolve this. I knew he would be alone when he received the news.

I telephoned him and re-introduced myself. I asked him how he was and if now was a good time to talk, he mentioned how the funeral had gone well and that he was "okay". I summarised our previous conversations about the investigation into Sybil's necklace and gave him a warning shot to prepare him that I had information that was not good news. I could feel my heart racing. I grounded myself, maintaining a clear voice and soft tone to tell him that I was very sorry that we had not been able to find his wife's necklace. I remained silent. The space I left for him was quickly penetrated as he began to cry uncontrollably at the other end of the telephone. I had anticipated correctly; it was heartbreaking hearing his crying and I sensed it was like being told his wife had died a second time over. I wanted to touch his hand, to be present with him and convey that I knew how important this was. I could feel tears rolling down my face and I felt that I had failed him and his wife. The picture in my mind of him alone with no one to comfort him compounded my discomfort and feeling of helplessness, knowing the magnitude of his grief. It did not feel like sorry was enough, his grief was raw, and I would not know how he was beyond that call. This raised feelings of sadness, anger, and frustration in me.

This pandemic is having a similar impact on HCPs across the globe as every contact leaves a mark on us. The question has been posed that this global crisis has led to shared grief with patients, families, and providers. Are we entitled to say we can share in Jack's grief? Jack's grief is his to own, I am not entitled to share it. We all experience grief uniquely but for me it is true to say we are experiencing collective stressors and losses [2] . As HCPs we need to give ourselves permission to have feelings about these losses and find coping strategies to manage them. What was my coping strategy in this instance? Debriefing with my colleague who cared and listened. Jack's story was not one in isolation, and she too had similar communications with relatives. We made recommendations and presented these to a senior team in the hospital. Realising that although I had not been able to return the precious necklace to Jack and it felt like a failure, there was some consolation in the realisation that he had someone who really tried, cared and was truly sorry.

We hope sharing Jack's story will raise the importance of patient's personal belongings. Our recommendations to the hospital included: improvements in documentation on admission, transfer and discharge on property forms, ward accountability, processes for investigating losses, and adding property to quality metrics for each clinical area. Relatives really valued having a key point of contact to provide compassionate communication and hear that a tenacious investigation of missing property had been conducted. Protecting patient property must be a valued part of continuity of care. I look forward to a time when hospitals and care homes are not places where sentimental items go missing. I also look forward to a time when I can use touch to demonstrate empathy with a distressed relative without the remoteness of the telephone or zoom and without personal protective equipment (PPE). At this moment in time, neither appear to be close on the horizon.

Stephanie Smith: Conceptualization, Writing − original draft, Writing − review & editing. Deborah Joy Critoph: Writing − review & editing.

Clinical guide for supporting compassionate visiting arrangements for those receiving care at the end of life. NHS England and NHS Improvement date viewed 24th

Covid -19 Q&A on individual and collective stress and grief

A silent epidemic of grief': a survey of bereavement care provision in the UK and Ireland during the COVID-19 pandemic

The authors confirm all names/ personal identifiers have been removed or disguised so that the person(s) described are not identifiable and cannot be identified through details of the story.