The lived experience of losing a loved one to a sudden death in KwaZulu-Natal, South Africa

SPOUSES AND CARERS

The lived experience of losing a loved one to a sudden death in

KwaZulu-Natal, South Africa

Petra Brysiewicz DPhil

Senior lecturer, School of Nursing, University of KwaZulu-Natal, South Africa

Submitted for publication: 16 February 2006

Accepted for publication: 21 December 2006

Correspondence:

Dr Petra Brysiewicz

School of Nursing

University of KwaZulu-Natal

Durban 4041

South Africa

Telephone: þ27 31 2601281

E-mail: [email protected]

BRYSIEWICZ P (2008)BRYSIEWICZ P (2008) Journal of Clinical Nursing 17, 224–231

The lived experience of losing a loved one to a sudden death in KwaZulu-Natal,

South Africa

Aim. The aim of this study was to describe the lived experiences of families in

KwaZulu-Natal, South Africa, who had lost a loved one to a sudden death.

Background. Sudden death implies a natural or unnatural death which is unex-

pected; occurs without warning; and in some cases, could have been prevented. It

usually occurs out of hospital, in the emergency department, or shortly after

handing the client over to either critical care or operating theatre personnel. A

sudden death has the capacity to leave the bereaved emotionally damaged and may

exaggerate the responses to grief.

Method. An interpretive hermeneutic phenomenological research approach was

chosen for this study, as this allows the researcher to describe a phenomenon as

experienced and to attempt to provide an understanding of the internal meanings of

a person’s experiences in the lived world.

Sample. The sample included five bereaved family members who had lost a loved

one to a sudden death and who were all members of a bereavement support group

held in Durban, South Africa.

Results. Bereaved families interviewed described five themes namely: ‘cold recep-

tion’ of the hospital staff, lack of closure, acknowledgement of loss, ‘loneliness of

grief’ and helping others.

Relevance for clinical practice. This qualitative study provides rich data regarding

what bereaved family members view as important in their care during this time of

crisis. The value of simple, small gestures by the health professional is enlightening.

This information can be used to ensure that health professionals purposely direct

their interventions and interactions with the bereaved family to ensure that they are

managed in the most therapeutic way possible.

Key words: bereavement, death, families, nurses, nursing.

Introduction

Sudden death implies a natural or unnatural death which is

unexpected; occurs without warning; and in some cases, could

have been prevented. These deaths often result in a damaged

or mutilated body which suggests to the family that the death

was neither peaceful nor easy and possibly caused their loved

one much pain (Wright 1996). Family members are often

unable to comprehend that their loved one has died as death

was immediate or occurred within a very short period of time,

224 � 2008 The Author. Journal compilation � 2008 Blackwell Publishing Ltd

doi: 10.1111/j.1365-2702.2007.01972.x

and the last time the family saw their loved one they were

alive and healthy (Raphael 1984, Iserson 1999). A sudden

death, as compared with an anticipated death, exaggerates the

reactions of grief for the bereaved and can result in a more

pronounced development of post-traumatic stress disorders

(Kaltman & Bonanno 2002). Bereaved family members may

become angry as they search for answers. In their search, the

grieving process often comes to an abrupt halt, thus holding it

up or prolonging it (Wright 1996). Kubler-Ross’s (1969)

model of the five-stage responses to death and dying has

gained worldwide acclaim and acceptance, although there is

also criticism regarding its accuracy and validity (Raphael

1984, Copp 1998). Thayre and Peate (2003) suggest that the

bereaved move back and forth between the different stages as

suggested by Kubler-Ross (1969), and that these stages should

not be expected to occur in a set order.

Study aim

The aim of the study was to explore the lived experiences of

family members who had lost a loved one to a sudden death.

This was part of a larger study which involved exploring the

experiences of sudden death from the perspectives of three

unique groups of participants, namely health professionals

in the emergency departments (Brysiewicz & Uys 2005);

suddenly bereaved family members and mortuary staff

members. A model was then developed to guide the

management of sudden deaths in hospitals based on further

analysis of the combined findings from these three groups

(Brysiewicz & Uys 2006).

Method

An interpretive hermeneutic phenomenological research

approach was chosen for this study, as this allows the

researcher to describe a phenomenon as experienced and

attempt to provide an understanding of the internal meanings

of a person’s experiences in the lived world. This approach

‘borrows’ other people’s experiences and their reflections on

their experiences to provide a deeper meaning of the

experience and to allow the reader to become more experi-

enced themselves (van Manen 2003). Data collection and

analysis were conducted using van Manen (2003) proposed

six research activities.

Data collection

Participants

Purposive sampling was used to identify the participants,

although this proved to be very difficult and time consuming.

After unsuccessful attempts at accessing suddenly bereaved

families through local hospital emergency departments,

churches and a local radio website, the researcher made

contact through a support group for the suddenly bereaved.

This support group (the only one in the area not associated

with a particular religious group) was based in Durban,

South Africa, and comprised of bereaved parents, grandpar-

ents and siblings. After explaining the research to the leader

of this bereavement support group, the researcher was invited

to speak about the proposed research at a group meeting and

to ask for participants. The leader informed the group about

the researcher’s visit prior to the researcher meeting with the

group. The researcher presented her research, the purpose

and the data collection procedure to be followed. Volunteers

were asked to approach the researcher after the meeting

during teatime, where they then provided her with their

contact details. Brief discussions were held regarding the

most suitable time for them to be contacted. Inclusion criteria

included any individuals (belonging to the support group)

over 18 years of age who had lost a loved one to a sudden

death and who spoke Zulu or English. See Table 1 for a

description of the participants.

Interviews

The participants were then contacted by the researcher and

interviewed at whatever location they preferred. Owing to

the sensitive nature of the research, the researcher was very

aware of monitoring the psychological stress experienced by

the participants in retelling their distressing stories. The

researcher developed a good relationship with the partici-

pants although they were interviewed only once, and they

met the researcher at the support group meetings on two

occasions and spoke over the phone. The participants were

aware that the researcher had recently given birth to a baby

and many asked about the baby. Being a new mother made

the experiences more difficult for the researcher to deal with,

as she now was able to start to relate to the loss of a child in a

far more personal way. The interviews with the bereaved

families proved to be very difficult for the researcher who

found herself close to tears at times. After the interviews, the

researcher made it a point to informally debrief by discussing

aspects of the interview which had been emotionally difficult,

either with colleagues or her own family members. Profes-

sional psychological support for the participants and the

researcher was available if necessary (further details later).

The interviews, with five participants, were taped and

lasted approximately 30–40 minutes. The researcher used an

unstructured interview where she started with the following

question: ‘Can you tell me about the experience of losing

your loved one to a sudden death?’ This was then followed up

Spouses and carers Losing a loved one to a sudden death

� 2008 The Author. Journal compilation � 2008 Blackwell Publishing Ltd 225

with general probing questions such as: ‘Can you tell me

more about this. How did this make you feel?’

Data collection and analysis was carried out simulta-

neously with the researcher analysing the collected data after

each interview, while still busy with the data collection

process. After completing the individual interviews, the

researcher was invited back to the support group to report

back and allow the opportunity for all members present to

verify the findings. The members of the support group

expressed a great deal of interest in ensuring that health

professionals are made aware of bereaved families’ experi-

ences and how they could improve the situation for bereaved

families in the future.

All the interviews were conducted in English by the

researcher, taped and then transcribed verbatim by a research

assistant. Any interruptions to the interview (INTER-

RUPTED), silences (SILENCE) or a pause in the interview

(PAUSE) were indicated in the text and additional informa-

tion was added from the field notes written during the

interviews. A computer package designed to aid with the

organization of qualitative data, NVIVO 2, was used.

Ethical considerations

Permission to conduct the research was obtained from the

Ethics Committee of the university and from the leader of the

bereavement support group. The selection of participants was

done on a voluntary basis and the participants gave verbal

consent for their involvement in the research. The partici-

pants were informed of their right to withdraw from the

research at any time and that this would not affect their

support group membership in any way. The participants were

informed about the purpose and objectives of the research in

addition to the anticipated significance. The researcher en-

sured that her contact details were available so that any of the

participants were able to follow up with her as necessary. The

interviews were carried out in private at a location chosen by

the participants. Permission was requested to tape the inter-

view. Psychological support was given to the participants

where necessary and enough time was scheduled after the

interviews to allow debriefing of the participants as needed.

The researcher had sufficient counselling skills to do this and

was aware of additional professional psychological support

services available for referrals if any of the participants, or the

researcher, required further assistance. The participants were

asked to choose a pseudonym so that the data could not be

traced back to an individual.

Data analysis

Activity 1 of van Manen’s (2003) six research activities, is

concerned with the nature of lived experience, where the

researcher attempted to make sense of the phenomenon

through deep thought and questioning regarding the partici-

pants’ accounts, becoming full of experience. The second

activity focussed on investigating the experience as we live it

and the researcher actively explored the lived experience of

losing a loved one to a sudden death. Reflecting on the

emerging themes that characterize the phenomenon was

carried out in activity 3. This activity involves asking ques-

tions about what it is that gives the experience its special

significance. Activity 4 involved describing the phenomenon

in writing and bringing the experience ‘into speech’. Activity

5 required that the researcher attempt to understand the

Table 1 Description of the participants

Pseudonyms General comments Brief details of their loved one who died When the death occurred*

Shaun and Carol Interviewed at their home where

they showed pictures to the

researcher of their dead son; both

in their 50s

Their 19-year-old son was killed in a motor

vehicle collision; they had to identify him at

the mortuary

Three years ago

Chantelle Asked to be interviewed at work

and is in her 30s

Her 10-year-old son was killed in a motor

vehicle collision where his body was burnt

beyond recognition

Eight months ago

Jasmin She was interviewed at a hospital

while waiting for her

appointment as she did not think

that the researcher would find her

home; she is in her 40s

Her son was killed after falling out of a bus;

she was with him at the scene of the accident

and went with him to the emergency

department

Three years ago

Amy Interviewed at her home with her

aunt present for support; she is in

her 50s

Her 19-year-old son was killed in a motor

vehicle collision and her husband died after

a motorbike accident; both of them died in

a critical care unit

Son died four years ago and

her husband 17 months ago.

*Time elapsed is from the time the interviews were conducted.

P Brysiewicz


phenomenon in a full and human sense; to maintain a strong

and orientated relationship with the phenomenon of interest.

The final activity, activity 6, was concerned with putting

everything together by stepping back and attempting to look

at the whole picture and to ensure that the different parts

contribute to generating a complete picture of the phenom-

enon (van Manen 2003).

Hermeneutic reflection

The researcher read the transcribed interviews a number of

times, reflected back to the interviews and asked herself what

statements or phrases appeared to be particularly revealing

about the families’ experiences. These statements or phrases

were then identified as thematic statements.

Hermeneutic writing

The researcher made a diagram of all the thematic statements

and themes and then wrote notes and paragraphs in an at-

tempt to capture them. The findings were discussed at regular

intervals with the researcher’s supervisor to discuss and test if

the themes had been captured appropriately. The researcher

frequently wrote, reviewed and rewrote the findings in an

attempt to uncover the real meaning of the experience as

described by the participants.

Maintaining a strong and orientated relationship to the

phenomenon of interest

By focussing on and using the experience to interpret and

explain the phenomenon, the researcher attempted to main-

tain a relationship of what it meant for the families to lose a

loved one to a sudden death.

Balancing the research context by considering parts and

whole

At a number of points during the analysis process, the

researcher attempted to ‘step back’ and consider the whole

context and the contribution of each of the parts (van Manen

2003).

Findings of the research

Bereaved families interviewed described five themes, namely

‘cold reception’ of hospital staff; lack of closure;

acknowledgement of loss; ‘loneliness of grief’; and helping

others.

‘Cold reception’ of hospital staff

Jasmin described the ‘cold reception’ of the staff, in that,

most of the staff had not been sympathetic and did not seem

to care about her. Jasmin described how she arrived at the

hospital just moments after the ambulance, and as she was

running into the emergency department, she saw that the

floor was covered in fresh blood and she just knew it was her

son’s blood. When she rushed through to the department to

ask about him she was told by the staff to go and fetch his

file. After fetching the file, she was told that he was dead.

Jasmin said that this wasted precious time that could have

been spent with her son telling him that she loved him. She

described the nurses as ‘evasive’, as no one wanted to give her

any details regarding her son’s death or to answer her

questions. Amy concurred and said; ‘they made us fill out

forms and ask for details and run around to the reception

desks and things like that when you wanted to spend that

time with the family (member) that was critically ill’. Amy

was of the opinion that hospital staff uses the excuse of

completing documentation as a distraction to get families out

of the way. Amy felt that the staff in the emergency

department did not appear to see the urgency or appreciate

the gravity of the situation. She said:

That ‘golden hour’ that everyone speaks about was long gone you

know, they were very slow and there was no hurry … it’s not what

you see on TV.

Lack of closure

Not being able to find the answers to the questions they were

asking was emphasized by Jasmin, Amy, Shaun and Carol,

who described how immediately after the death, they felt that

they had to be ‘pushy’ to get any information about their

loved one. This made them feel angry as they felt that during

these difficult times – health professionals should be helping

to make the situation easier and not harder. They mentioned

that in the weeks following the death, they had to go

searching, trying to find people to answer their questions and

that this search took up a great deal of their time and energy.

They mentioned that the staff was difficult to get in contact

with, and that, after eventually tracking them down, they

were often unhelpful and reluctant to provide them with

details. Jasmin felt that the accident scene was not properly

handled, and this made her angry as she was left wondering if

her son would still be alive if he had received different

treatment. She had been plagued by these unanswered

questions:

I still don’t understand up ‘til today why didn’t he (the doctor on

scene) leave the paramedic there and then he go with my son (in the

ambulance) … I kept phoning him … I had to trace him, it was

difficult to get through to him … It was like a terrible thing to do

some detective work when you’re in all this pain.



Amy explained that these details are of vital importance as

‘you just don’t settle until you know all those details’. Several

participants described the lengths they had to go through to

get a copy of the autopsy performed on their loved one,

although once they were in contact with the pathologists,

they found them to be extremely helpful. Shaun mentioned

that after hearing the findings of the autopsy from the

pathologist; ‘that gave us peace because we knew that he

didn’t actually suffer’.

The following participants were very angry when men-

tioning poor policing. Shaun and Carol stated that they had

to do their own detective work to uncover the many

unanswered questions surrounding their son’s death:

I think the policeman actually messed up, I really believe they messed

up. I mean, I had to wait … to get John’s (deceased son) blood

because nothing could happen with the investigation until a blood

sample had come back.

Jasmin agreed that the police had not been effective in

investigating the circumstances surrounding the death of her

son, and as a result, the man who was responsible ‘is still

walking free and my son is not here … he was on the

threshold of his life’.

Acknowledgement of loss

Small simple gestures, such as being offered tea or being

asked if there was anything that could be done to help, were

highly valued by Chantelle, Carol and Amy.

Chantelle said the health professional who broke the

news of her son’s death was extremely sympathetic and

asked her if he could get her something to drink. She

remembers that even though she said ‘no’ he went and

bought her an orange ‘Fanta’ (soda) with his own money.

She recalled how she took it home and that it stood in her

fridge for a few weeks and that whenever she saw it, she

was reminded of his kindness. Carol on viewing her son in

the mortuary said; ‘I just thought he looked so beautiful.

You could see they had combed his hair, wet his hair and

combed it back’. This made her feel that someone had

cared that her son had died:

The tiniest little thing that’s done for you is so important. You’ll

never forget that nurse giving you that cup of coffee – it might seem

absolutely insignificant, but it’s just – it’s important (Amy).

Having someone to offer support was viewed as being

extremely important – whether a health professional or not.

This person should just be there for a period of time, sit

quietly, or offer tea or meals. Amy described how she was

very distressed sitting waiting for news of her loved one,

watching people going past and avoiding any eye contact

with her until a medical student came to her:

She just said ‘could I sit with you, it looks like you are going through

a lot of trauma’ and we’ve like become firm friends since … she just

sat.

‘Loneliness of grief’

Jasmin, Carol and Shaun described how lonely the grieving

process was. Jasmin described how this loneliness was self-

inflicted as she did not feel she could share her grief with her

family, as it was too painful for them:

I found out if you laugh everyone would laugh at you, but if you are

crying people don’t want to … they don’t want to handle other

people’s pain … my friends would want to avoid the subject. My

family knows how devastated I am, they are devastated … they don’t

want to speak about him (her dead son).

Carol and Shaun described how their friends and family

avoided them or the subject of their son’s death, and how

difficult this was, as these were the same people who

they expected to get support from. Shaun also described

how his father told Carol ‘to pull herself together’ before

the memorial service – ‘It was just his kind of way

of trying to say, ‘listen guys I’m trying to help you’,

but actually he messed up a relationship because there is

not really a relationship between her (Carol) and my

father at this point in time – and really after something like

that you really need the family to sort of be together’

(Shaun). When describing responses from friends, Shaun

explained:

You know, that is a very sad thing … we’ve had a lot of people that

just, when they see you walking in a supermarket they actually turn

around and walk away.

Carol and Shaun also mentioned that their religious network

had not been very supportive to them with people from

church saying; ‘oh your son is in a far better place, he’s in

heaven and he’s walking the golden streets’. Carol explained

that this brought her no comfort, as she would far rather have

her son with her.

Jasmin suggested that information should be made avail-

able to bereaved families regarding where to access support

or counselling so that they do not have to spend a great deal

of energy looking themselves. Jasmin said that:

I think it would have been much nicer if there was some pamphlets or

something that says look when you really need someone to talk to

there’s a couple of names you could call up because I used to have

these sleepless nights.

P Brysiewicz


Helping others

Amy, Jasmin and Chantelle mentioned how they are now

driven to help others after experiencing the loss of their loved

one. Amy described how she makes herself available to sit

with families in need of support in the critical care unit. She

said that she goes to the hospital and just sits with the family

and she does not tell them about her own losses until they ask

her. She said that: ‘Sometimes its weeks later that they say

‘how did you know to come?’ but they don’t seem to even

ask, they just accept that you are there for them.’ Jasmin

mentioned that she would like to be available to counsel

other bereaved parents as she felt that you could only start to

understand once you have experienced such a loss yourself.

She felt that she would have benefited from some counselling

herself and she found the support group for bereaved families

to be a great help. Chantelle has a little boy, a similar age as

her deceased son, from a nearby orphanage that she takes

home for the weekend, and she says, ‘It’s put something back

in my life being able to help someone else’.

Trustworthiness

Trustworthiness refers to the quality value of the final results

and conclusions reached in a qualitative study (Lincoln &

Guba 1985) and is comprised of credibility, transferability,

dependability and confirmability. Credibility is concerned

with the internal validity of the data and their interpretations.

This was ensured by prolonged engagement, as this study

took place over one and a half years. This allowed the

researcher to establish trust and a good rapport with the

participants, thus making it more likely that rich, useful data

were collected. The researcher attempted to develop an early

familiarity with the culture under scrutiny by developing

dialogue with the support group leader and the group

secretary, who were bereaved parents themselves. The

researcher made preliminary visits to the support group to

meet the members and ensure that she became a familiar face

and so help with the establishment of a relationship of trust

(Shenton 2004). All the participants approached were given

the opportunity to refuse to participate in the study so that

those interviewed and included in the study were willing and

interested to take part. The researcher encouraged the

participants to be frank in telling their stories and it was

emphasized that there was ‘no one truth’ (van Manen 2003).

Frequent debriefing sessions were held between the researcher

and her supervisor to discuss the proposed plan of action for

the study and to make changes where necessary. These

meetings also allowed the researcher to discuss the develop-

ing ideas and interpretations in addition to allowing an

opportunity for the researcher to be made aware of her own

biases and preferences. The research supervisor also chal-

lenged the assumptions the researcher was making. Feedback

was provided to the participants regarding the themes

emerging from the data to obtain their reactions and to

explore if these interpretations were a good representation of

the participants’ reality (Polit & Beck 2004, Shenton 2004).

The support group members verified the results and seemed

surprised that the researcher had managed to capture their

experience so well without having experienced her own

bereavement.

Transferability refers to the application of this study’s

findings from the context in which the data were developed

into a similar context. Thick descriptions of the research

process were provided in an attempt to demonstrate that the

knowledge acquired may be relevant to a similar situation or

participants. The researcher endeavoured to provide details

regarding the organization taking part in the study, the

number of participants and details regarding the data

collection methods and interviews. This was done in an

attempt to provide the reader with the necessary information

to allow them to make their own conclusions regarding the

study’s transferability (Polit & Beck 2004, Shenton 2004).

Dependability is concerned with the stability of the data,

and this was ensured by the long time period over which the

data were collected. The researcher also attempted to

describe in detail the decision-making processes of the

research study in addition to the context of the study

(Holloway & Wheeler 2002).

Confirmability refers to the degree to which the data

confirms the findings. The researcher attempted to provide

rich descriptions of the research to give the reader a sense of

‘being there’ so that the reader was able to follow the path the

researcher took and trace how the researcher arrived at the

interpretations. The researcher undertook an audit trail when

conducting this research and it contained fieldwork observa-

tions made by the researcher after interviewing each parti-

cipant or attending one of the support group meetings.

Documentation was also kept regarding any methodological

changes made in the study, reflections regarding the data

analysis and personal reflections during the study (Holloway

& Wheeler 2002).

Discussion

When trying to save the life of a critically ill client, health

professionals are expected to deliver complex physiological

care, and this includes performing a number of medical and

technological procedures. Health professionals in this situa-

tion may view the family as an obstacle and exclude them.



The results can be devastating as the families are neglected

and their presence is barely acknowledged (Chesla 1996).

Flam (1999) suggests that health professionals should strive

to have a ‘high touch’ approach in managing sudden death to

complement the already ‘high tech’ care that is being given. In

South Africa, health professionals are exposed to various

critical incidents, for example, large volumes of clients with

life-threatening trauma; clients intoxicated with alcohol and/

or drugs; threats of violence against the staff and actual

experiences of violence towards the staff. These health

professionals suffer from burnout, which is reflected in the

loss of their ability to feel emotionally involved in their work

and the development of a cynical attitude towards clients and

their families (Crabbe et al. 2004).

Marrow (1996) suggests that, for the bereaved, uncertain-

ties linger terribly and this makes the bereaved family’s

adjustment to loss very difficult and prolonged. Oppewal and

Meyboom-de Jong (2001) agreed that families often felt

reassured after hearing the results of the autopsy, and that

there was nothing that could have been done to prevent the

death. Families need to be informed of the condition of their

loved one by being given honest and up-to-date information

as frequently as possible (Thayre & Peate 2003). During the

family’s time in the hospital, they may not be able to absorb

much of the information given to them and thus should be

given oral and written instructions (Wright 1996). Health

professionals need to be aware of the importance of caring

for the families and that this caring can be made visible by

very simple and small gestures, for example, giving a glass of

water. Families also need to be involved in the care of their

loved one and be part of the decision making wherever

possible (Thayre & Peate 2003), as this would then help

families feel involved, cared for and reduce the anger and

detachment experienced.

Oliver et al. (2001) emphasized that families may not

share their grief owing to pain or embarrassment, with-

drawal out of fear that another loved one will also leave

them or because they were trying to protect others,

especially bereaved children. The bereaved family’s friends

and relatives are essential in supporting them through their

grief, and it is often surprising which friends and family

emerged as supporters and those who did not. These

authors described that the most disappointing experience

occurred when clergy or the community of faith failed to

meet their expectations of care. The clergy may not view

themselves as grief counsellors, but rather as being necessary

for the grief rituals (funerals, etc.) and that this may be the

reason for the disappointment on the part of the bereaved

families (Oliver et al. 2001). The supporters of the bereaved

families need to remember the loved one and appreciate the

bereaved family’s grief and the need to be available to the

bereaved for a length of time. Raphael (1984) suggests that

when friends and family stop the bereaved from talking

about the deceased and try to orientate them to the future

and deny their affects, a poor outcome is likely and the

mourning is blocked.

Solari-Twadell et al. (1995) describes the bereaved indi-

vidual’s process of rejoining life and reaching out to others

after the death of a loved one. This involves exploring new

experiences and using the strengths gained in meeting and

interacting with new people and new situations. These

authors caution, however, that there are painful elements as

life is different and in rejoining life, the bereaved may be

forced to revisit their own loss, although this should be seen

as a normal part of grief that will continue throughout the

bereaved individual’s life (Solari-Twadell et al. 1995).

Recommendations for nursing practice,education and research

Health professionals need to be educated on how to deal

with sudden death, and the development of protocols to

guide practice could be useful. Formal and informal support

for all health professionals should be encouraged and made

available to the staff. Written information, for example, a

booklet for the family outlining how to register the death

and obtain a death certificate, the bereavement process and

contact numbers of support groups could be extremely

beneficial to the newly bereaved (Wright 1996). This

information should also include the names of health

professionals involved in the care of their loved one so that

the bereaved would be able to contact the appropriate staff

should they have questions. A bereavement coordinator has

been suggested (McClelland 1993), who is able to follow up

the bereaved families and ensure that all is in place to assist

them, and being able to liaise with bereavement organiza-

tions. This person is also responsible for staff development

and in assisting the staff in being able to manage deaths

appropriately. In South Africa, however, resources do not

permit this and the unit manager is expected to fulfil these

needs. Workshops for heath professionals could be very

beneficial in increasing awareness regarding, for example,

issues of breaking bad news and the identification of

strategies which could promote effective clinical practice

(Farrell et al. 2001). The psychosocial implications of

trauma in South Africa is presently an extremely neglected

area of research, and cultural issues regarding these

psychosocial consequences is uniquely South African and

warrants further research to ensure that culturally appro-

priate interventions are developed.

P Brysiewicz


Conclusion

Losing a loved one to a sudden death is a devastating

experience for families, and this can be influenced a great deal

by the way in which health professionals deal with them. The

families highlighted the importance of feeling that health

professionals cared for them and their loved one and that this

caring could be made visible in a number of simple, small

gestures. If health professionals are made aware of the impact

that their initial actions can have on the bereavement

outcomes of families, much could then be done to improve

the situation. The information from this study can be used to

ensure that health professionals purposely direct their inter-

ventions and interactions with the bereaved family to ensure

that they are managed in the most therapeutic way possible.

Acknowledgements

Funding for this study was provided by the University of

KwaZulu-Natal. The valuable contributions to this study

provided by Professor L.R. Uys are acknowledged.

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Documents

The lived experience of losing a loved one to a sudden death in KwaZulu-Natal, South Africa