204 d mitchell winnen presentation

Good Grief: The Pediatric Care Provider and Patient Death

Alexis Winnen, CCLSProgram CoordinatorRainbow Babies and Children’s HospitalRainbow Center for Pediatric EthicsCleveland, Ohio

Alexis.Winnen@UHhospitals.org

Dena Mitchell, RN, BSNSenior Oncology NurseUniversity HospitalsCase Medical CenterIreland Cancer Center, PediatricsCleveland, Ohio

Dena.Mitchell@UHhospitals.org

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Introduction:Experiencing Pediatric Patient Death

• Death denying culture

• An occupational hazard

• Unique to the healthcare provider

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Objectives

• Increase a sense of competency and mastery in caring for the dying patient and bereaved family

• Acknowledge the pediatric healthcare provider’s grief

• Introduce coping strategies

• Discuss opportunities for increasing peer support in the work environment

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First Death Experiences

“Looking Behind the Mask”

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Normal Caregiver Grief Reactions

HELPLESSNESS

FAILURE

GUILT

HURT

ANGER

SADNESS

POWERLESSNESS

DESPAIR

RELIEF

SELF CONTROL

DETACHMENT

NEED TO CRY

NEED TO PRAY

WITHDRAW

NEED TO SHARE

NEED TO ATTEND FUNERAL

ONGOING THOUGHTS

DREAMS

SLEEP DISTURBANCES

CAN’T COME TO WORK

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Types of Loss Unique to the Caregiver:

• Loss of a close relationship with a patient/family • Loss due to professional identification with pain of

family members• Loss of professional goals, expectations, self-image

and role• Loss related to personal system of beliefs and

assumptions about life• Losses that are unresolved from the past • Losses anticipated for the future • Loss related to personal mortality being challenged

Papadatou, D. (2000). Omega, 41(1), 59-77.

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Contributing Factors to the Grief Experience:

• Lack of support• Feelings of inadequacy• Fear of failure• Communication gaps• Denying the inevitable• Avoiding reality

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Case Illustration

“J”• What’s the plan of care?• Is everyone on the same page?• Am I in this alone?

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Cope:Derived from the old Frenchword, couper, meaning toslash or strike.To fight or contend (with) successfully or on equal terms.To deal with problems, troubles, etc.

Webster’s new world dictionary of the American language (2nd college ed.). (1980).

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Coping Strategies

• Face death and grief head on• Seek knowledge and apply it• Identify supportive measures in work environment• Briefing• Debriefing• Finding meaning• Separate work and personal life• Take care of yourself• Say goodbye

Hellsten, M.B., Hockenberry-Eaton, M., Lamb, D., Chordas, C., Kline, N. & Bottomley, S.J. (2000). Helping professionals care for dying children: Strategies that help. In Texas Children’s Cancer Center-Texas Children’s Hospital, Houston: End-of-Life Care for Children. Retrieved May 3, 2005 from: http://www.childendoflifecare.org/profess/profess20.html

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Enhancing a Supportive Work Environment:

• Offer a hand • Give positive feedback• Invite and seek informal debriefing• Respect personal limits and boundaries• Consider formal mentoring, debriefing

and education

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Paradigm Shift

Participation in life completing itselfrather than only seeing

the loss of a shortened life

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Case Illustration

“D”• Are we asking the right questions?• How can we work together as a team?• What are we hoping for?

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Reframing Hope

• To be together• To have peace• To have comfort• To have quality of life• To have opportunities for memory making• To have choices• To be treated with honesty• To maintain dignity• To feel supported

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Discussion

To Laugh often and much;To win the respect of intelligent people and the affection of children;

To earn the appreciation of honest critics;To appreciate beauty, to find the best in others;

To leave the world a bit better whether by a healthy child, a garden patch,or a redeemed social condition;

To know even one life has breathed easier because you have lived.This is to have succeeded.

- Ralph Waldo Emerson

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References

Hellsten, M.B., Hockenberry-Eaton, M., Lamb, D., Chordas, C., Kline, N. & Bottomley, S.J. (2000). Helping professionals care for dying children: Strategies that help. In Texas Children’s Cancer Center-Texas Children’s Hospital, Houston: End-of-Life Care for Children. Retrieved May 3, 2005 from: http://www.childendoflifecare.org/profess/profess20.html

Papadatou, D., Papazoglou, I., Petraki, D. & Bellali, T. (1999). Mutual support among nurses who provide care to dying children. Illness, Crisis & Loss, 7(1), 37-48.

Papadatou, D. (2000). A proposed model of health professional’s grieving process. Omega, 41(1), 59-77.

Rando, T.A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Champaign, Illinois: Research Press Company.

Saunders, J.M., Valente, S.M. (1994). Nurses’ grief. Cancer Nursing, 17(4), 318-325.

Smith, R. (Ed.). (2000). A good death. BMJ, 320, 129-130.

Steinhauser, K.E., Clipp, E.C., McNeilly, M., Christakis, N.A., McIntyre, L.M. & Tulsky, J.A. (2000). In search of a good death: Observations of patients, families and providers. Annals of Internal Medicine, 132(10), 825-832.

Webster’s new world dictionary of the American language (2nd college ed.). (1980). Simon and Schuster.

Woods, M. (2001). Balancing rights and duties in ‘life and death’ decision making involving children: A role for nurses? Nursing Ethics, 8(5), 397-408.