Objectives. Traumatic, Unexpected Death. Grief Conferences Jill Wilke, MS, RN, CPLC

Transcription

1 Grief Conferences Lead Educator Resolve Through Sharing This slide presentation is a copyright of Gundersen Lutheran Medical Founda on, Inc., 2014 All Rights Reserved Objectives Describe two processes in order to determine who should attend the grief conference. Discuss three key components of facilitating the grief conference. Identify three benefits for participation in a grief conference. 2 Traumatic, Unexpected Death Deaths are sudden and unexpected. Survivors have little experience or ability to prepare. Survivors have little knowledge of how to react or what to expect. The experience is not common to most, resulting in a sense of isolation. The aftermath has an unpredictable trajectory. (Thielman & Cacciatore, 2013) 3

2 Traumatic Bereavement Survivors experience a lack of control, increased helplessness, a strong sense of loss, and the feeling that their lives have been disrupted or destroyed. There may be a perception of threat to self or a significant other. The event holds high emotional impact (Thieleman & Cacciatore, 2013) 4 Statistics 5 7% of total annual deaths are sudden, traumatic, violent, preventable, and untimely. Extended grief reactions may occur because it didn t have to happen. There is a frequency of use of the metaphysical to provide a rationale for the loss. Motivational constructions are also created to obtain meaning. (Breen & O Connor, 2010; Johnson, 2010; Rynearson, 2010) 5 Witnessing the Death or Finding the Deceased (Kristensen & Weisaeth, 2012; Rynearson, 2010) 6

3 Family Presence During CPR Seeing that every attempt to save the life was made Having the opportunity to speak to the loved one while there is a chance that he/she can hear Having the ability to opportunity to touch the loved one while he/she is still warm 7 Why People Choose to See the Body Seeking confirmation, the reality of the loss Feeling obligated Wanting to make sense of what happened Needing to care for the body, to see if it is ok Wanting to say goodbye Believing that imagined images could be worse (Chapple & Ziebland, 2010) 8 Phases of Bereavement 9

4 Grief Intensity Congruence of the actual loss experience with one s standard of the desirable Ability to confront others when incongruence exists (Hutti, 1992, 1998) 10 Grief Intensity High Grief Intensity Low congruence actual experience is not like the person would want it to be Low ability to confront feel powerless to do anything about it Low Grief Intensity High congruence loss experience is unfolding as the person perceives it should High ability to confront able to tell others what they need, want, and do not want (Hutti, 1992, 1998) 11 Signs of Complicated Grief Persistent inability to perform acts of daily functioning for many weeks or months Abuse of drugs or alcohol Symptoms of major depression and/or PTSD Medical neglect Failure to thrive engagement in high risk and self destructive behaviors Suicidal ideation and intent (Harrington LaMorie, 2011; Worden, 2008) 12

5 Grief Conferences Memories of traumatic events are often hazy. Families may need to revisit every detail with the people who were there. Limit the conference to one hour. Ask the family who they would like to be present. Review the medical chart. (Wilke & Limbo, 2012) 13 When to Initiate a Grief Conference The Bereavement Coordinator should be notified when The family indicates a lack of understanding or memory regarding what happened, or they have questions that require others input The family has experienced a traumatic, unexpected death The risk management department receives call from a family member asking questions or asking to view the chart The situation has required the legal department and/or risk management to be involved 14 Preparing for the Grief Conference Read the medical chart. Talk with the family: Listen to their story. Identify the issues that are concerning to the family. Identify who the family wants to be present at the conference. Communicate the details of the conference to the risk management and legal departments. Identify the appropriate staff to participate, and coordinate so that the staff who will be most effective in meeting the family s needs can be present (e.g., paramedic, physician). 15

6 Preparing for the Grief Conference Notify the appropriate managers of the staff involved. Limit the conference timeframe to one hour. Reserve a room for the conference: Preparing the Family Talk with the family to find out what their needs are. Identify whose presence is most important for the family. Let the family know who will be there. Let the family know that the Bereavement Coordinator will facilitate the conference. Let the family know how the conference will go (i.e., one hour, staff will speak in chronological order, time for questions). 18

7 Preparing the Family Designate a meeting place. Offer to help them write down questions ahead of time. Invite them to bring someone who can take notes. Find out who will be attending. Invite them to bring photos of their loved one to introduce the person to the staff as the family knew him or her. Remind them that the conference s purpose is to help them to remember what happened and to ask questions to help them grieve. It is not to place blame or to look for litigation opportunities. 19 Preparing the Staff Discuss the agenda: After each person has had a chance to share, the family may ask more questions, depending on the time. Discuss what questions you expect the family will ask. Let them know that you may interject to ask or clarify questions for the family. Encourage them to answer honestly using simple language and using the person s name. Discuss how the conference will end: the Bereavement Coordinator will wrap up and allow for goodbyes. 20 Grief Conference Video 21

8 The Day of the Grief Conference Ask the staff to arrive 15 minutes early. Remind the staff of the names of all who are coming. Remind the staff that you will keep track of time and expedite discussion, as needed. Remind the staff to use non medical terms. Have staff sit around the table do not place them on one side with the family on the other side. Have water and tissues available. 22 Day of Grief Conference Meet the family at the designated spot and escort them to the room. Let them know that the staff is waiting. Introduce the family to each staff member. Begin the conference by allowing the family to show the pictures of their loved one and briefly tell his/her story. Guide the discussion by directing the first question. For example: I m thinking that it may be important for you to know how the paramedics get to the scene and what they know before they arrive. Mike, would you begin by telling us how this happens? 23 Exchange Student 24

9 Murder Victim 25 Ending the Grief Conference Do you have any other questions for the staff at this time? and Thank you all for coming. Staff may offer their condolences and do what feels right in terms of touching or hugging the family member(s). Once the staff leave, let the family know that if they come up with other questions, they can call the Bereavement Coordinator. Ask the family if they found the conference helpful. Provide the family with appropriate support materials. Walk the family to the exit. 26 Common Themes for Parents Need to understand what happened before the focus could shift to grief of the one who died: What happened pre hospital? Did my child cry out or suffer? Was my child treated with dignity and as an individual? 27

10 Common Themes for Care Providers Felt glad to be able to answer questions for families Appreciated hearing what other departments did for the patient improved understanding of roles Appreciated being prepared for what to expect Appreciated the conversation being facilitated Felt they helped the family Allowed for reflection on the experience and improved their own coping 28 Kylie s Mom Video 29 Afterwards Within a few days, call or the staff for their feedback: Was the conference helpful for them personally? Did they think it was helpful for the family? What surprised them? What was difficult? Would they participate again? Thank them for participating and point out the specific ways that they helped the family. Within the next week, call the family: Ask how they are doing. Remind them of the parts of the conference that were important to them. 30

11 Grief Conference vs. Care Conference or Family Meeting Focused on understanding what happened for the family to make meaning of the death Family driven: they identify what they want to know and who they want to be present Physician does not have to be present Provides support in the aftermath of trauma in hopes of preventing complicated grief Provides the staff an opportunity to understand and to reflect on their own grief 31 Benefits of Grief Conferences for Families Ability to better understand what happened Opportunity to see who cared for their loved one Opportunity to ensure their loved one was treated respectfully Ability to stop worrying about issues that had been on their minds Ability to decrease grief intensity by having a better understanding of the situation 32 Benefits of Grief Conferences for Staff Acceptance of the family s gratitude Ability to feel that they directly helped the family Better understanding of colleagues roles creation of relationships Ability to express their own emotion Better understanding of grief (which leads to better care) Increased comfort in talking about grief 33

12 References Breen, L. J., & O'Connor, M. (2010). Acts of resistance: Breaking the silence of grief following traffic crash fatalities. Death Studies, 34(1), doi: / Chapple, A., & Ziebland, S. (2010). Viewing the body after bereavement due to a traumatic death: Qualitative study in the UK. BMJ: British Medical Journal (Overseas & Retired Doctors Edition), 340, c2032 c2032. doi: /bmj.c2032 Harrington LaMorie, J. (2011). Operation iraqi Freedom/Operation enduring freedom: Exploring wartime death and bereavement. Social Work in Health Care, 50(7), doi: / Hutti, M. H. (1992). Parents' perceptions of the miscarriage experience. Death Studies, 16(5), Hutti, M. H., depacheco, M., & Smith, M. (1998). A study of miscarriage: Development and validation of the perinatal grief intensity scale. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 27(5), doi: /j tb02621.x 34 References Johnson, C. M. (2010). African American teen girls grieve the loss of friends to homicide: Meaning making and resilience. Omega: Journal of Death and Dying, 61(2), doi: /om.61.2.c Kristensen, P., Weisæth, L., & Heir, T. (2012). Bereavement and mental health after sudden and violent losses: A review. Psychiatry: Interpersonal and Biological Processes, 75(1), doi: /psyc Rynearson, E. K. (2010). The clergy, the clinician, and the narrative of violent death. Pastoral Psychology, 59, Thielman, K, & Cacciatore, J. (2013, January). When a child dies: A critical analysis of grief related controversies in DSM 5. Research on Social Work Practice, 1 9. Wilke J., Limbo R. (Eds.). (2012). Resolve Through Sharing bereavement training: Perinatal death (8th ed.). La Crosse, WI: Gundersen Lutheran Medical Foundation, Inc. Worden, J. W. (2008). Grief counseling & grief therapy: A handbook for the mental health practitioner (4th ed.). New York, Springer Publishing Company. 35