Deal with difficult reactions to grief
Some family members present additional challenges when bad news is delivered. "Every family deals with bad news in it's own way. You need to be prepared for a variety of reactions," says Kathy Nichols, RN, CFRN, CEN, EMT-P, a flight nurse at West Michigan Air Care in Kalamazoo. Here are some examples of some adverse reactions and tips to consider for each:
Physically acting out. The best thing to do is to give agitated family members a space to vent, says Nichols. "You've made a contact with them, so you want to stay near them-but not physically close. Give them enough space to react, because that's their way of dealing with it,"she recommends. "If they run out of the ED, they may just need to go out and scream for a minute. Eventually, they'll come around."
If they become violent, security or law enforcement should be called. "If it's at a point where they are becoming a danger to themselves or other people, you may need to protect yourself and others from injury," says Nichols.
Children. "When giving bad news to children, people tend to hide the truth or not give them a straight story. The intent is to want to protect them, but it just causes more confusion and you lose your credibility," says Nichols. "Kids can easily spot sugarcoating. They can understand bad news more than you think they can-sometimes more easily than their parents."
Denial. Some loved ones refuse to accept the message you are giving. "You may have to repeat the information or give the same information using different words," says Nichols. "You can also elicit help from other family members who might be there. Usually someone there can get the picture."
Dealing with a family member who is more distant from the patient is helpful. "Instead of talking to the wife, speak to a cousin or brother-in-law. You can take them aside and tell them the specifics, so somebody in the family knows the situation," says Gail Pisarcik Lenehan, RN, EdD, CS, a former psychiatric clinical nurse specialist in the ED at Massachusetts General Hospital and Boston City Hospital and editor of The Journal of Emergency Nursing. "You can even contact someone on the phone who is not there, and ask them to come in to be with a family member who is not able to hear the difficult truth."
Communication barriers. Communicating with intubated patients presents a unique challenge. "Look for ways they are trying to communicate with you. Then, give them only yes or no questions," says Nichols.
Language barriers are also difficult. "Everyone understands a soothing touch and human kindness, but if you have factual information you need to convey, you need to find a language interpreter," says Nichols. "If the hospital doesn't have an interpreter available, hopefully a family member can be located to translate."
Guilt feelings. Frequently, family members may feel they could have done more to save their loved one's life. "They may want to know, if I had started CPR earlier would he have made it? Would my child have survived if he was wearing a helmet or if I had called 911 sooner? A parent may explain that a child was having symptoms but they thought it was the flu. They want to know if he would have lived if they had brought him in two days sooner," says Lenehan. "Nurses can do an enormous amount of good by dispelling some of these myths."
Hard facts can often alleviate family members' guilt feelings. "I have told families that if their relative had been in the middle of an ICU in the best of hospitals and had such a massive heart attack, little could have been done," says Lenehan. "It's much easier to resolve a death if it's an act of God rather than a human error."
Explain that their feelings are normal. "Tell them while it's natural while grieving to agonize over the 'if onlys,' no matter how careful you are, no parent can totally protect a child," says Lenehan. "Things can happen in a split second."
Emphasize the consequences that guilt feelings can have on the rest of the family. "Tell the family member not to berate themselves too much," says Lenehan. "If you are too hard on yourself, it might have a damaging effect not only on you, but on your family who needs your support."
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