Answer questions of families
Nurses should make every effort to answer questions of grieving family members, 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. "Answering their questions can be very healing for family members," she notes.
Anticipate universal questions. Before you talk to the family, prepare for what they will expect to hear. "There are things you can anticipate and can tell the person before they even ask," says Lenehan. Almost every family member wants to know the following things, she explains.
· Was the patient conscious when he or she came in?
· Was everything possible done, and if something wasn't done, why?
· Were they in pain? Did they suffer?
· Were they alone or was someone with them at the scene or in the ED?
Reassure families when possible. "If somebody has a traumatic head injury, it's truthful to say they were most likely instantly unconscious and didn't suffer," says Lenehan.
Provide contact information. Other questions may come up after the family member has left the ED. "Give them the name of a specific doctor or nurse to call if they have any questions and, ideally, when that person is usually on duty, " says Lenehan. "It's also good to give a more distant relative the same numbers, in case the relative who is most upset loses the information."
Get as much information as possible from prehospital responders. "If it was a car crash, you can also tell the family to contact the investigating officer and give them the number of the police station involved," recommends Lenehan.
Emphasize how other individuals came to the aid of their loved one. "If you know of any detail about others helping, it's always nice to include that," says Lenehan. "Tell them if someone took off their own coat and put it under their head as a pillow or if someone ran over and stayed with them until help came.
Wait a few minutes to see if questions arise. "After you allow for the initial shock or anger, pause and ask them if they have questions," says Kathy Nichols, RN, CFRN, CEN, EMT-P, a flight nurse at West Michigan Air Care in Kalamazoo. "They may not have a question immediately, but if you give them a few minutes, they may have some."
In case of a traumatic event, families are more likely to have immediate questions. When a child recently died from drowning in a swimming pool, the parents were given the news. "They reacted with appropriate grief, then began asking several questions." Nichols recalls. "Although the ED was very busy, the physician walked in the room with them, stood with them and answered every one of their questions. If they have questions right away, spend time to answer their questions then."
Follow-up with a telephone call. Even if you provide family members with the phone number to call if they have questions, most don't call. "It takes a lot of energy to make that call and they may feel like they would be bothering you," says Lenehan. "Most often people just ruminate and are distraught and torn, saying, 'If only I called 911 sooner, it could have made a difference.'"
If you call a week or two after the patient's death, the family member may be grateful for the chance to raise concerns. "Say, I'm the nurse who took care of your husband. I'm just calling to see how you're doing,'" says Lenehan. "Instead of asking what questions they have, it is often most helpful to say, "What is going through your mind the most?' Invariably, a question is apparent: 'If I had brought him to the doctor's office last week, could we have prevented this?' You can get a lot of important information that way."
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