The uncomfortable truth about death

As a nation mourned the death of Queen Elizabeth II last year, it became apparent that her passing affected many people.?

The outpourings of sympathy, the queues to see her lying in state, the sea of flowers and gifts left at the gates of royal palaces, countless people paying their respects with constant media coverage reminded us of the importance of the bereavement process.

It also brought to the fore memories of those we may have loved and lost.

It is an uncomfortable truth – death will play a part in everyone's lives. Despite this, the western world often struggles with conversations about dying.?

Bereavement does not end with a funeral, of course. It is a process that can be ongoing, often for long periods of time and even resurfacing many years after a death. How we grieve for those we lose varies tremendously from person to person, manifesting in a plethora of emotions and behaviours.

And, whilst some people will internalise feelings and quietly cope with their grief, others will feel compelled to share their story and emotions – even beyond their family and friends.

According to researchers at Cardiff and Bristol universities [1], people bereaved during the first nine months of the Covid-19 pandemic showed high grief and support needs. The age of the deceased had a strong effect, with those dying younger a risk factor for vulnerability in grief and higher support needs.?

Social isolation and loneliness had a medium-large effect, particularly on emotional support needs with people feeling unsupported by health professionals after the death of a loved one among the other risk factors identified in the study.

Navigating the ‘right thing to say’ when this happens can make us clumsy and embarrassed, particularly if the person sharing their story is a work colleague or patient with whom we have little or no physical contact and for whom a hug is out of the question.

Health care professionals are trained to communicate effectively and openly, with many possessing an innate capacity for empathy.?But death can wrongfoot the best of us. How should we respond when patient A reveals his wife died after a lengthy illness, or patient B talks of a child lost shortly after birth? How do we comfort a colleague when they return after the death of a loved one?

Staff bereavement

It may come as a surprise that there is no automatic legal entitlement to compassionate leave in the UK, unless the death is a dependant. A dependant is defined by the Employment Rights Act 1996 as a spouse, civil partner, child, grandchild, parent or someone living in the same household as the employee immediately before their death.

If the death is not of a dependent, there is no automatic right to compassionate leave. However, many employers offer compassionate leave as a matter of policy.

A study in 2020 by charity Sue Ryder, revealed that bereavement in the workplace costs the UK economy nearly ￡23 billion a year.

Additionally, it reported that:

? Nearly a quarter of working age adults knew someone who had died over the previous year

? Bereavement can have longer term consequences for mental and physical health

? Only 30% of employees say workplace leaders have communicated with them about grief or bereavement in the past year with only 32% of employees were aware their employer has a bereavement policy.

A bereavement policy is helpful in any workplace. It sets boundaries and clarifies what staff can expect should they face a challenging time processing a death of someone near or dear.

Employees need time to grieve, so practices must support this with carefully considered strategies, such as paid bereavement leave and time away from work that are consistent across the whole team. And it might be wise to avoid specifics as to who bereavement leave applies to. Someone’s great aunt might be as important to them as another person’s mother.?

Employers should respect privacy and ascertain whether the news is to be shared (or not) with the rest of the team. Any discussions about details of the death should be led by the employee.

Work flexibility, clear communications about the support available and a culture where people are comfortable talking about grief are key to better outcomes for everyone involved.

In essence, policies should balance the needs of the individual with the rest of the staff and the business itself.?

Sarah Buxton is director and solicitor at FTA law. She says: ‘I come across many practices without a bereavement leave policy. So, when a team member has a bereavement, the manager/employer is at a loss as to how to react or what to do.?

‘This often means that if employers do not know what leave and/or pay they can provide to the employee, they can get it wrong from a legal perspective. Additionally, there can be a lack of understanding as to how respond to support the employee’s mental wellbeing. Both are equally important.’

Patient bereavement

Dental professionals must remain mindful of a patient’s needs, requirements or any other social, physical, medical situation in which communication may prove challenging.? So, should a patient confide about losing a loved one, kindness and professionalism must prevail.?

Compassion and active listening (without sharing back your own story of grief) are key. Listen rather than talk, maintain appropriate eye contact and stop what you are doing to give them time to share. Ensure open body language, too, so they feel comfortable with their emotions.?

Respect their feelings, too – their loss may be difficult to appreciate (it might be a pet, for example) but allow them time to share their grief. There is a strong chance of the appointment running over – so it is important to remain patient and calm.

Don’t be tempted to break patient confidentiality. The GDC’s Standards for the Dental Team [2] reminds us that ‘confidentiality is central to the relationship and trust between you and your patients. You must keep patient information confidential.

‘This applies to all the information about patients that you have learnt in your professional role, including personal details…’

If the person who has died is a patient, discreetly make a note to inform reception so records can be amended. Nobody wants to receive a reminder for their loved one who passed away a year ago!

Dr Kathryn Mannix is a palliative care consultant and author of With the End in Mind and Listen: How to Find the Words for Tender Conversations.

She says: ‘Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, often need to tell their story repeatedly, and that is an important part of transferring the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it.’

For dental professionals faced with challenging conversations about death with grieving colleagues and patients, it should be considered a privilege that people are happy to share with them.?

With compassion and a listening ear, it can make a world of difference to those looking for support. Far better to be part of the natural grief process than part of its struggle. As Dr Mannix notes: ‘It's your compassion, not your vocabulary, that makes tender conversations happen.’

Reference?

1. https://www.bristol.ac.uk/news/2022/february/covid-bereaved.html

2. https://standards.gdc-uk.org/pages/principle4/principle4.aspx

Further reading

For more about Kathryn Mannix, visit https://withtheendinmind.co.uk

? This article originally appeared in the November issue of Dental Nursing, the monthly journal for dental nurses, addressing the clinical and professional issues that matter to the profession and supporting their educational development. Subscribe here https://www.magsubscriptions.com/healthcare-dental-nursing