Loss is inevitable when working in end-of-life care. But the grief that follows is not simply the family’s burden alone. The way care is delivered before, at, and after the death of a loved one significantly influences whether bereavement becomes a manageable process or a complex, prolonged struggle. Qualitative research highlights three influential domains: personal interactions with health-care workers, the quality and timing of information delivered, and system-level functions around death notification and bereavement support.

Understanding Bereavement: Not a Uniform Path

Grief is more than sadness. It manifests as emotional, physical, cognitive, social, psychological and behavioral responses. Its intensity and course depend on many factors: the relationship to the deceased, attachment style, mental-health history, whether death was sudden or expected, the setting of death, and social support available.

Protective factors exist: prior experience of loss, living support networks, strengths identified by the bereaved themselves, and practical support all improve outcomes. The role of healthcare workeris now seen as vital to activating these protective factors or mitigating risk.

How Healthcare Workers Influence the Bereavement Experience

Personal Interactions and Honor-Centred Care

The relational dimension matters: When families observe healthcare workers interacting with their sick family members “as if they are present and conscious”, it conveys recognition of personhood, respect and relational worth.

Conversely, when families experience dismissive language, unfamiliar faces at critical moments, or a change in staff that interrupts continuity, perceptions of care shift negatively: the sense of being “left behind” or disregarded can aggravate grief.

Information, Communication and Narrative Coherence

Families need clear, honest, timely information about prognosis, symptom progression, and what to expect in the dying process. When such information is absent, families report an emotional “hole” in their narrative of loss: “Dad went there, he passed away and that was the end of the story.”

Education about grief itself — helping families understand how different people grieve, what reactions may unfold, and what support is available — can normalize experiences and reduce distress. Healthcare workers who engage in anticipatory planning and family education serve a critical function in preventing complicated grief.

System-Level Issues and Bereavement Continuity

Even when individual clinicians do well, system problems can undermine outcomes. For example, hospital visiting-policy confusion, lack of inter-service communication, inadequate death-notification workflows, and absence of follow-up by care teams can all contribute to complicated grief.

Bereavement support must be embedded structurally and not left solely to goodwill. While many families will navigate grief with community/family supports, a moderate number require non-specialist professional help, and a small but significant minority will need specialist care for prolonged grief disorder.

Implications for Hospice and End-of-Life Practice

Training & Education: Healthcare workers benefit from communication skills training, anticipatory bereavement care education, and guidance in dignity-conserving care.

Protocols & Follow-Up: Organizations should implement clear workflows: condolence letters, follow-up calls, opportunity for family meetings after death, and referral pathways for those at risk of complex grief.

Integration of Bereavement into Care Continuum: Hospice care should explicitly view bereavement support as part of its service, not afterthought. The transition from life into death and then into community/family grief must be managed.

Organizational Systems: Review visiting policies, death-notification systems, documentation handovers, cross-service communication and ensure that families always know what to expect. Community resources and culturally-tailored supports must be flagged especially for vulnerable populations.

Conclusion

The dying process and what follows are inseparably linked. Healthcare workers do more than manage symptoms. They influence how families make sense of loss and build the next chapter of their lives. By prioritising dignified presence, transparent communication, and systemized bereavement support, we honor not just those who die but the ones left behind. The evidence is clear: when care ends, compassion must continue.

References

• A qualitative exploration of the impact of healthcare pre and post death on the impact of bereavement experiences
• Predictors of Complicated Grief : A Systematic Review of Empirical Studies
• Investing in Bereavement Care as a Public Health Priority
• Relationship between grief and coping strategies among nurses dealing with patient deaths
• Nursing care and nurses’ understanding of grief and bereavement among patients and families during cancer illness and death