Bereavement Care after the Unexpected Death of a Child in a Pediatric Intensive Care Unit: A Systematic Integrative Review

Background: When a child dies in a pediatric intensive care unit (PICU) from a sudden or unexpected cause such as trauma or sepsis, intense grief felt by the child’s family can cause sustained psychosocial impacts. Supporting unexpectedly bereaved families with evidence-based bereavement care is key to improving grief outcomes, and understanding their specific needs is essential to inform the delivery of bereavement care in PICUs. Aim: To understand what is known about (1) bereavement care needs of families who have experienced the unexpected death of a child in a PICU, and (2) approaches to address families’ needs. Methods: An integrative review was systematically conducted with the protocol registered a priori on the Open Science Framework. Original peer-reviewed research articles relating to relatives of children who died an unexpected death in a PICU were included from OVID Medline, PsycINFO, CINAHL, SCOPUS, and ProQuest, along with guidelines from Google © searching. Articles were critically appraised using Critical Appraisal Skill Program, Mixed Methods Appraisal Tool, and Appraisal of Guidelines, Research and Evaluation II checklists, and data were synthesized using the constant comparison method. Results: Twenty-nine original research articles (15 qualitative, 11 quantitative, 1 mixed method, and 2 secondary analyses) and five guidelines were included in this review. Three original articles focused on unexpected child death exclusively. From the findings of all 34 articles, four linked themes were identified: (1) connection and (2) communication with PICU clinicians, (3) awareness of the impacts of unexpected death, and (4) emotional and physical support for family members. Conclusion: Unexpectedly bereaved family members’ needs included close relationships with clinicians and caring support before and after their child’s death, including ongoing follow-up from the PICU. Further targeted research is needed to better understand the specific needs of unexpectedly bereaved families, gain diverse and representative evidence in this area, and develop innovative, evidence-based interventions to improve bereavement outcomes for the whole family.