The Manchester

Arena Attack

New approaches to bereavement support

only see relatives through a glass, on a metal trolley, under white sheet, you can’t kiss or touch or smell. In this instance the approach was quite different.

The families were transferred from the hotel by police escort and they were brought into the mortuary by bereavement nurses. They had prepared the room and the patient in a bespoke way using the information they had been given. Their favourite music was playing, they were wearing pyjamas in their favourite colour. They were in a bed, with a pillow and a duvet. If possible, their hair had been washed in their favourite shampoo. “If we were told their relative hated cold feet, they would be wearing slippers; all these details are really important.” The families were offered handprints, lip kisses, photographs of favourite tattoos, if they wished – something to create a tangible memory of the relative they had lost.

“This was an incredible piece of work that we were privileged to lead, and it has changed the approach to major incidents. We are now on the national major incident plan because Bereavement Nurses are a rare breed.” In Manchester, they have also started a pilot of having a Bereavement Nurse in the Coroner’s Office, who can respond if there is a sudden, unexpected death.

Security team involvement

Fiona also explained that security played a key role in the support that was offered to the families of the bereaved. “The media had found out where the families were staying and had booked into the same hotel, pretending to be visitors to get stories.” So, protection of the families from the media was critical. “Following this, they kept everyone away, no press intrusion. Having a member of the security team, someone to help us to protect our families and maintain discreet compassionate care was absolutely vital.”

Following the Manchester Arena attack, Fiona now fully understands the benefit that security teams can bring. Across the Northern Care Alliance, which is a group of five hospitals, they have carried out extensive work with the security teams, working with Tony Carter, Head of Security. “I now appreciate that security is not a different service, they are one of us, they want to make a difference. We work really closely with them. This includes all hospital security teams understanding the SWAN model and what it means, in particular communications training, access to the End of Life care team; there is always someone they can call for advice and support. Additionally, there are comfort packs in each of the Control Rooms.”

The SWAN Initiative

The approach that Fiona and her team

took at Manchester followed the model of SWAN – an initiative that Fiona has devised. “The SWAN was a symbol of a happy death in Roman times, and we use it to symbolise our philosophy of how to approach caring for those at the end of life and those dying suddenly and unexpectedly.” Fiona believes we can all contribute to a good dying journey.

“SWAN is a model of care and a symbol to tell staff, whoever they are, from security to porters, doctors, ward clerks, hospital volunteers, if you see a swan symbol in your organisation, that means we have a vulnerable patient and family in the dying phase of their life.”

“This symbol gives them permission to act, to be kind, so if you are a volunteer, you can call behind a curtain or knock on the door, offer a newspaper. If you are a member of the

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catering staff delivering meals, automatically offer that family a hot meal and drink. It is these tiny acts of kindness that show people you really care and make a huge difference.” SWAN is being used in sixty hospitals nationally. “It is really important, instead of us being specialist nurses, we now are enabling the generalists, whoever they are, to do the small things.”

The staff have permission in traumatic death situations, or expected deaths on a ward, to offer a range of ideas that might help the bereaved family. Similar to Manchester, the opportunity to create a tangible last memory like handprints, lip kisses, or a photograph of a favourite tattoo is provided. Or the chance to lie on the bed and give their relative a last cuddle. Dogs and pets are allowed on the bed too. “These are all things we don’t talk about because we want to provide discreet compassionate care. But the relatives will be heartbroken and need support.” They also enable families to dress their relatives in their favourite clothes, perhaps a favourite shirt and use knitted blankets and other similar items: “Not a shroud to wear and not white crisp linen. Anything to de-medicalise the environment when it is not possible for someone to die at home. “

There is an End of Life Resource Room on all sites. This contains put-you-up beds, food, alcohol (so they can flavour mouth swabs with their relative’s favourite flavour) hand-knitted blankets and Comfort Packs (with toothbrushes, soap and other items to help those suddenly away from home).

The objective as health care professionals and linked professions, needs to show "we really care, this needs to shine”.

The work of the Bereavement Nurses continues following a sudden, unexpected death: they follow up every family, with a call: "I am a bereavement nurse, is there anything I can help you with?” They can help deal with worries, such as paying for the funeral and areas where they can provide support.

Everyone can contribute Fiona concludes, “I really do believe end of life care and dying is everyone’s business: we can all do something kind, that helps the experience for that family, helps them to walk into their tomorrow. You might think it is insignificant, a small kindness. But just think first, ‘if I was walking in this person’s shoes, what would I need now?’ Be kind to that person in this vulnerable position. This should part of our normal, it shouldn’t be special, this should just be what we do, as a compassionate community.”

Andrea Berkoff Editor,

City Security magazine >


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