1. WHY WE UNDERTAKE VIEWINGS OF DECEASED PERSONS IN HOSPITALS

2. Why we Undertake Viewings of Deceased Persons in Hospitals Presented by: Phill Capra Cairns Base Hospital

3. The role of undertaking viewings of deceased persons in the hospital setting has been identified as a task of social workers. Death in the last few decades has become more sanitised and exposure to deceased persons less common. There is little empirical evidence to suggest that viewing of deceased persons “improve” grief outcomes, or decrease incidence of depression related to grief (database search on terms “viewing”, “bereavement”, “deceased, “death”, “depression”, “grief” in various combinations used on database searches including (SocIndex, Emerald & PsychInfo). However intuitively and morally social workers are aware of the importance of families viewing their deceased relative. Social Workers are also aware that this process may assist in bereavement. In an outcome driven health industry, consideration of evidence and theory in practice in validating this essential service is required.

4. Why Research? Personal interest, validate personal experience and perceived practice wisdom both at an individual and collective level To ensure that we are not in fact doing harm To validate an intervention To ensure the continuation of viewings within the hospital system To seek best practice

5. Literature Very little research into benefits or outcomes of viewings Research relates more to the area of trauma Theory and ideas about viewings and grief, with limited or no documented evidence. Often descriptive of viewing process. Funerals and death rituals have been researched extensively in multiple fields Bereavement and grief extensively researched Field of thanatology is growing, but research still more focused on bereavement, grief, funeral rituals

6. History Since circa 1900 increase in hospitalisation, death in facility and not in the home. Since 1920 life expectancy has increased by over 30 years Less exposure to death as dying becomes more medical and people hospitalised Death rituals performed within the family or close community have become lost skills Many people have not seen a dead body Increase in the reliance of health professionals and Funeral Directors in regards to the practical aspects of death Slight evidence this trend is reversing thanks in part to hospice and community palliative care movements

7. Theory Historically viewings are beneficial as they assist family & friends; to ensure the deceased is dead, to ensure the deceased stays dead, to provide an opportunity for individuals to reflect/mourn/say goodbye to physical form. Viewing ensures “reality” of the death, in particular in sudden and unexpected death (McKissock, 1992) Provides an opportunity to “speak” with the deceased. Note: Also some theory in regards to PTSD, or suggestions could impact on grief process in trauma situations.

8. What is Happening Currently Benchmarking exercise in 2006, of various hospitals showed many similarities. Preference for ward viewings, during business hours, coronial processes. Social Workers utilising viewing process as described by McKissock, usually learnt on the job. Push to encourage viewings to occur at Funeral Directors Viewings at Funeral Directors can cost hundreds of dollars, and some FDs do not offer viewings

9. Evidence From the Trauma Field Need to re-establish sense of control (self-determination) Regret and remorse, people are more likely to regret not viewing (Mowll, 2005; McKissock, 2002*) Need to view deceased to see death has occurred (Goodall, 2000*) Most beneficial intervention in a sudden and unexpected death, (Li, Carmen & Lee, 2002; Fanslow, 1983; Ashdown, 1985) People who viewed had improved physical and mental health outcomes, compared to those who hadn’t post-disaster, Granville train crash 1981 & Zeebrughe ferry disaster (Singh, Raphael, 1981; Hodgkinson, 1995)

10. Evidence Importance of ritual and creativity (Glassock, 2001; Bolton & Camp, 1989; Hyland & Morse, 1995) Concept of post-mortem harm, psychological harm to the bereaved, as a result of actual or perceived harm to the deceased body (Tomansini, 2009; Scanlon,1998) Importance of individualising grief therapy, client focused (Neimeyer, 2000). Cultural appropriateness

11. Problem with Evidence Alone In considering grief outcomes, the primary measure is depression. Too many variables Funding source Ethics Simplification of complex emotions and processes Researcher bias

12. Art Building of relationships most important thing we contribute (Duncan, Miller & Hubble, 1999) Social Workers best placed to advocate for individuals and families in the health system Power of empathy Doing what is right, respect for the individual. Empowering/ Enabling/ Facilitating a process that is likely to help. Being aware of science/ evidence and utilising this

13. The Future Unknown? Decrease in hospital viewings, as push to view at Funeral Directors? Core business of social work verse core business of pathology? Is there a need to prove outcomes? Please email phillip.capra@health.qld.gov.au for full list of referencesphillip.capra@health.qld.gov.au