Abstract
Dear Editor:
For staff working in children's palliative care, the decision about whether to attend the funeral of a patient can be a difficult one to make, and may need to be addressed. Feedback from professionals working in this field suggested the need for guidelines to support best practice in this decision-making process.
It is important to acknowledge the emotional impact of a patient's death and to provide support for staff in managing this. The grief experienced by a professional can be intense when a patient dies and attending a funeral can be helpful in supporting staff. However, within a professional role, the decision to attend needs thoughtful consideration and planning, as part of the professional relationship.
Reflection from practice, audit, and consultation with others has led to the development of the following guidelines. These guidelines may be helpful to other services when developing their own policies.
• Family wishes need to be sought to confirm that an invitation extends to those professionals involved in caring for the child and family.
• Attendance at a funeral needs to be meaningful for both family and professionals, reflecting the professionals' involvement and relationship in caring for the child and family.
• Attendance at a funeral needs to be a choice for individual staff members and not a mandatory expectation.
• Consideration needs to be given as to whether professionals will attend the funeral service only or also the event after the funeral, taking into account the boundaries of the professional role.
• Expectations for attendance need to be clarified, for example, is there a theme of dress or color.
• Cultural expectations and wishes need to be clarified and respected.
• Those wishing to attend a funeral need to discuss attendance with their manager or supervisor before the decision to attend is being made.
• Funeral attendance should be supported within working hours; staff should not be expected to attend in their own time as they are representing an organization in this role. There needs to be a clear policy about how this is managed with regard to shift work/part-time working, to include claiming time back in lieu if required.
• Services need to consider the number of staff who will attend each funeral, their relationship with the family, and their role in on-going bereavement work. For example, no more than two people, those most involved in care of the child and family.
• Those who do not attend can be offered an opportunity to remember the child in other ways if they wish, for example, burning a candle or a minutes' silence.
• Discussion regarding attendance should be covered in supervision, including clarification of the reasons for attending to ensure appropriateness and to offer review of psychological well-being and support needs, which would include the offer of a debrief session after a child's death. Care needs to be taken to ensure that any one staff member is not becoming “burnt out” or overwhelmed by repeated attendance at funerals.
• Training should be sought and provided for teams regarding attendance at funerals and “care of self” in this process. Training should include a discussion around role/responsibility and representation at a funeral.
Recommendation is that good practice guidance should be locally developed and be endorsed by the relevant management teams to ensure successful implementation. One of the aims of these guidelines is to be helpful to other services when developing their own policies and protocols.
Dr. Jackie MacCallam, Clinical Psychologist and Dr. Fiona Finlay, Consultant Paediatrician, Child Health, Bath, January 2017, with contribution from Helen Bennett, Director of Care, Alexander Devine Hospice.