Dealing with Yourself
- An "occasionally" death, severe trauma or other aspect of a patient's story will (unexpectedly) upset you
- All the senior staff have personally experienced this and are sensitive to this situation
- Most will have had similar experiences and will be able to help
- There is no loss of face in talking through such problem
Dealing with bereaved relatives
Delivering the News with Compassion
- Deaths in the ED are, by definition, sudden and unexpected
- Breaking bad news therefore has a particular character and urgency
- You must remember that your role is to enable relatives to start the grieving process and come to terms with the news
- Insensitive, impatient or rushed consultation can cause scars that impede this process and may take years to heal
- On the other hand if relatives see your gentleness and empathy it can be an invaluable start to their grieving
- There are also times when you experience immense strength in the people you are talking to and this can be rewarding
| G | Gather all family members |
|---|---|
| R | Resources such as chaplain services, family & friends |
| I | Identify yourself, name of deceased or injured patient and state of family's knowledge of events of the day |
| E | Educate family about events that occurred in ED and current state of loved one |
| V | Verify that loved one has died; use "dead" or "died" |
| - | Give them space and time to absorb information |
| I | I(E)nquire if there are any questions and attempt to answer them |
| N | Nuts & Bolts; ask about funeral services, personal belongings, opportunity to view the body |
| G | Give them a contact number for further information |
Suggestions
The following guidelines are listed to help you develop your own technique. How you break bad news depends ultimately on how you cope with the news yourself.
- Be certain that death has occurred
- Prepare yourself. You will need to switch from a busy problem solving mode (often with many things on your mind at once) to a mode where you give the person you are talking to your absolute attention for the time you are in there
- Leave your phone / bleep with another member of staff
- Take a nurse in with you. Often there has been a "link nurse" who has already met the relatives and prepared the ground
- Know some of the background so you can answer general questions
- When you first go into the room relatives will want to know one thing only and that is whether their loved one is dead or alive, so tell them this
- Then wait to see reaction. Often it is better to sit with relatives and say nothing and/or hold their hand while they come to terms with the news
- When you talk through the story tell the truth but tell it positively, always affirming any attempts that the relatives may have made to care for their loved one
- Avoid such statements as "I know how you feel" because you don't
- Do not be afraid if you yourself are upset and show that, for example, by a break in your voice or shedding a tear. This can be a very powerful show of empathy
- Encourage relatives to go and see the body. This is particularly important in the Emergency Department as it will help them to say goodbye. Explain to them that this is their time and they must feel free to spend as long as they want with their departed, to hold a hand, talk to, hug and/or to kiss. Relatives will need to hear this
- Offer to bleep the hospital priest / chaplain. They are very experienced with dealing with bereavement and can be invaluable when the department is busy. Whatever your own faith may be, you are treating the relatives and you don't know what theirs is. Many people are comforted by a chaplain at times of acute loss
- Discuss the further administration, death certificate, etc. in a separate interview
- You will be asked about post-mortem. All deaths in the ED will have a post-mortem which is a legal requirement so explain this to relatives. Emphasis that it should not delay arrangements for the funeral. If you can, open up the subject of retrieval of heart valves and cornea for transplant. Do not do this however if you feel it to be inappropriate. Sometimes you will find that relatives will mention it themselves
- Debrief yourself with the nurse who has accompanied you afterwards
- Surviving victims of road crashes are advised to read "Finding your way ..."
Dealing with staff
Do not forget that we work as a team. Many of the staff who work with you, particularly your colleagues or junior nurses, may be upset by what has happened. It is important that you create a moment just to check that all is well. This will also help your own process of coming to terms with acute death.