ICU nurses get help from above’ to get over crises
Support program helps nurses after patient death
Whenever a death occurs in the neonatal ICU of Altru Health System in Grand Forks, ND, a chaplain stands by to visit the unit. The chaplain isn’t called for by the baby’s family, but is asked to meet with some of the nurses who are often grief-stricken and visibly depressed.
"It’s especially hard on the nurses if the baby was well-liked or the death was a tough one," says nurse manager Carma Twete-Hanson, RN, MS, who oversees a 56-member staff.
The chaplain visits are only one of a handful of procedures designed by administrators to alleviate the hardship of ICU work at Altru Health, a not-for-profit hospital that serves a relatively small North Dakota community.
Nurses participate in prayer sessions
When called, the chaplain meets in a special room with a group of nurses. The debriefing is voluntary, but certain rules prevail. The participants must express what they’re feeling, how they are dealing with the loss of the child, and how the experience was for them. They are supposed to avoid technical discussions or the medical facts surrounding the death.
"The meetings last from one to two hours, but are designed to allow the clinicians to purge themselves of the experience," says Twete-Hanson.
Most nurses are much better after the debriefings and are able to get back to work a lot faster than otherwise, says Twete-Hanson. (See chart, below, for a list of personal reactions by nurses after an infant’s death.)
On more difficult cases, the chaplain holds prayer sessions in the hospital’s chapel. Physicians, nursing supervisors, and anesthesia personnel are also invited. Participants do readings and hold conversations about the patient, "in order to put the experience to rest," Twete-Hanson says.
When necessary, do an inservice
Occasionally, unit members hold a formal inservice to discuss a difficult experience. Recently, nurses had to confront a six-year-old patient’s out-of-control father who verbally attacked one of the nurses.
The parent went on a tirade, accusing the nursing staff of thinking he was guilty of abusing his child. The child was badly beaten up and on the verge of death. The father later admitted in court that he abused his son.
Nurses met with each other and other hospital staff to analyze the situation so they could separate their feelings about the event from their professional lives. "They talk about burnout a lot," Twete-Hanson notes.
Personal Reactions to Baby's Death | ||
| Feeling | Perceived level of stress |
|
| Mean | N | |
| Helplessness | 2.71 | 56 |
| Intense sorrow | 2.61 | 51 |
| Depressed | 2.34 | 56 |
| Saddened | 2.33 | 57 |
| Angry | 2.32 | 55 |
| Despair | 2.18 | 54 |
| Discouraged | 2.14 | 57 |
| Hopeless | 2.10 | 51 |
| Alone | 1.82 | 45 |
| Grim | 1.71 | 49 |
| Relieved | 1.61 | 56 |
| Note: 0 score = not stressful; 4 = very stressful | ||
| N = sample size (59 total) | ||
| Source: Downey V, Benjamin, MA, Heuer L, et al. Dying babies and associated stress in NICU nurses. New Netw 1995; 14:41-45. | ||
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