Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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9 Roles of Health Professionals and Institutions
9 Roles of Health Professionals and Institutions
Pages 215-238
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From page 215... ...
The widespread perception of hospitals as bureaucratic, impersonal institutions gives people the impression that the psychosocial needs of dying people in hospitals are often underserved, that families are provided no regular help in understanding and coping with cleath, and that the capacity for compassion has been lost in a technologically oriented, strange worId.is 42 A recent editorial in the British Medical [oumaIi° pointed out that the failure of care-givers to respond to families' needs for reassurance and information has been fostered by increasing fears of malpractice actions as well as by physicians' inabilities to deal with their own failures. However, several concrete, helpful suggestions were made: First, .
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From page 216... ...
the failure of health care institutions to acknowledge their responsibility for bereavement follow-up, the stress that caring for dying and bereaved persons puts on their staff, and the need for sufficient staff time for these activities; and i31 the financial constraints imposed by the current structure of th~rd-party reimbursement arrangements. Despite currently inadequate therapeutic guidelines, however, it is necessary for health professionals to formulate some approach to the bereaved because, whether they are trained or untrained, those who interact with a bereaved person will have an impact-negative or positiveon that individual.
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From page 217... ...
Families usually turn to both physicians and nurses for information about tne illness and its management and for assurances that "everything has been done." Because of the many professionals actively involved in the care of gravely ill patients, relationships with any one health professional doctor, nurse, or social worker are often poorly defined. In the committee's view, it is important that there be one identifiable health professional who the family knows is responsible for overseeing care and to whom they can turn for support and information.
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From page 218... ...
Clear explanations of the cause of the death may prevent misconceptions and selfblame by the bereaved. Although an institution's responsibility to provide the family with information on the patient's condition is clear, doing so has often proved difficult because the general public is so unfamiliar and health professionals are so very familiar with hospital routines once the intricacies of medicine.
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From page 219... ...
Although a family's needs may, on occasion, intrude in the care of a dying patient, physicians, nurses, and social workers must set new goals that include the well-being of the surviving family. Where the outcome is uncertain, as in high-risk myocardial infarction, conflicting responsibilities may be more difficult to resolve.
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From page 220... ...
Some die in the operating room, in the recovery room, or on the ward following surgery. The special care or intensive care unit, coronary care unit, and the emergency room are sites of maximal available technology for critical patient care, yet usually have minimal "technology" for emotional support.
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From page 221... ...
To provide support for both family and staff, some hospitals and many hospices conduct periodic nondenominational memorial services to which both the family members and the hospital personnel who care for a patient are invited. Social workers are available in many hospitals and nursing homes to discuss legal, financial, or household problems and funeral arrangements with families.
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From page 222... ...
Since it may be assumed that when a child is brought to an emergency room either dead or dying, the family in crisis cannot be expected to take care of itself, some members of the staff take responsibility for informing and supporting the parents while others attend to the child.8 The clear delineation of responsibilities for patient care, coordination, and parental support helps alleviate staff stress and confusion. Although many sudden deaths take place in institutions, many do not.
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From page 223... ...
Although these services were designed primarily to aid family and friends through the emotional and practical stresses of bereavement, the impact on the rescue workers at the site, the hospital staff, and the psychiatric support teams was acknowledged at a debriefing meeting held to share the stress of the long hours, the large numbers of people dealt with, the intense level of commitment, and the unusually large number of dead and mutilated bodies. Autopsy Requests Probably the most controversial and sensitive post~eath issue for health care institutions is the request for autopsy.
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From page 224... ...
The committee believes that health care professionals should not withdraw from this process but rather should remain involved. Because of their familiarity with death and dying, their experience with each particular dying patient, and their opportunity for a special closeness with the family, the hospital staff is in a unique position to allevi
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From page 225... ...
Social workers regularly encourage communication among the family members most directly involved, refer people for services, and provide indirect service by fostering the establishment of support groups. The social worker may provide valuable help in locating relatives, making burial plans, notifying next of kin, and referring the bereaved to public welfare, visiting nurse, homemaker service, and other community agencies.
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From page 226... ...
They provide a concrete demonstration of concern, present further opportunities for families to raise questions, and enable a quick assessment of how the survivors are coping. Such calls may give the health professional hints of difficulties in the bereavement process or the presence of gross dysfunction.
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From page 227... ...
Social workers at the tertiary care Institution are usually able to provide referral to social agencies in the home community when that is necessary. Often the most effective way of assuring the continued care of the family is to ask them whom they wish contacted.
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From page 228... ...
However, persistent somatic complaints and enduring depressive symptoms usually signal a need for help. In bereaved children, the need for help may be expressed through repeated aggressive or hostile behavior, a drop in school performance, continued regressive behavior, and somatic complaints.
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From page 229... ...
Working with dying patients and those who grieve for them presents a challenge that requires special training, adequate support systems, and a considerable amount of professional and personal maturity.3234 48 As Raphael's study27 suggests, any initiative on the part of an institution to take more responsibility in aiding the bereaved must begin with an acknowledgment of the effects of death and dying on its own staff. The choice of staff and volunteers is particularly important in highstress areas such as emergency rooms, intensive care units, and hosrices.
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From page 230... ...
Indeed, Beszterczey,s in reporting his experience as a psychiatrist responsible for both patient and staff care on a palliative care unit, suggests that changing expectations to gain a more appropriate view of the situation demonstrates a successful adjustment to highly stressful patient-care responsibilities. He notes that this may produce an increase ~ self-confidence that frees professional staff to experience the satisfaction of being able to attend to "the nuances of psychological support." A sense of esprit in the group also helps each member faced with a trying situation.
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From page 231... ...
In the same way that information helps the bereaved to understand what is happening and what to expect, concrete knowIedge about bereavement assists health care providers.222 Similarly, health professionals who have an opportunity to explore their own feelings regarding death prior to having to help others cope with it are more likely to provide effective and compassionate care. ~ 45 Thus, health professionals should be prepared to deal with the realities of their role in bereavement through training that gives them both the necessary knowledge base and the clinical skills, adapted to the personal characteristics of both the clinician and the bereaved.
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From page 232... ...
of care most often found in hospitals may provide a disincentive for even the best-trained health professional to exercise those skills that are most appropriate to meet the needs of the bereaved. Because of this, health and social service professionals including physicians, social workers, nurses, psychologists, and clergy may need additional training to acquire the specific knowledge and skills necessary to work with the bereaved.3i In summary, the education of health care professionals should specifically enhance the development of skills in an effort to attain the following goals: · Attentive listening.
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From page 233... ...
Physicians, nurses, and social workers must be alert to the "red flags" for children and adults discussed in this report that signal the need for mental health intervent~on. Clinicians should recognize the boundaries of their own professional competency and personal tolerance for the care of bereaved individuals.
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From page 234... ...
. ,: , ~, ~ ~ The hospital's responsibility to aid the bereaved includes an acknowIedgment of the stressful effects of death and dying on hospital staff and of the impact management and organizational practices can have on staff functioning in such settings.
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From page 235... ...
and Fox, R Clinical nurse specialist and social worker.
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From page 236... ...
The self image of the physician and the care of dying patients. Annals of ache New York Academy of Sciences 164:822, 1969.
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From page 237... ...
Bereavement Intervention Programs
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From page 238... ...
support programs, and some hospitals offer support to families facing the loss of one of their members. They encourage all the members of the family, including children, to remain involved with the dying person.
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