Caregivers' and relatives' grief in intensive care unit: a literature review on nursing practices

Introduction The sudden and unexpected nature, which often characterizes death in intensive care, complicates the processing of the loss by relatives and caregivers increasing the risk of complicated grief (CG). Due to the high social impact and long-term consequences on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. This review aims to identify nursing interventions for the management of the bereavement of relatives and caregivers and to assess their effectiveness, relatives' and caregivers' satisfaction and prevention of CG. Methods Research was performed in CINAHL, PubMed, Psycinfo and Scopus databases with no limits on study design and publication timespan. The population included relatives or caregivers of patients died in intensive care unit. Results 14 studies met inclusion criteria. Two studies show that the communication of the bad news through dialogue between the team and relatives/caregivers can reduce, in the latter, the levels of anxiety and depression and the incidence of post-traumatic stress disorder. The quality study by Kentish-Barnes et al. (2017) shows that subjects perceived support in receiving a letter of condolence, but the RCT of the same author concludes that those who received the letter were more exposed to the risk of CG. Four studies claim that follow-up meetings facilitate the process of adaptation to loss by providing relatives/caregivers the opportunity to clarify the circumstances of death. Finally, two studies report that the events of commemoration arouse positive emotions in family members. Conclusions The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines. Further research is needed and it should consist of RCTs of high methodological quality. Key messages Due to the long-term consequences of the sudden death on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines.