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  • 1. Good Grief: The Pediatric Care Provider and Patient Death Alexis Winnen, CCLS Program Coordinator Rainbow Babies and Children’s Hospital Rainbow Center for Pediatric Ethics Cleveland, Ohio [email_address] Dena Mitchell, RN, BSN Senior Oncology Nurse University Hospitals Case Medical Center Ireland Cancer Center, Pediatrics Cleveland, Ohio [email_address]
  • 2. Introduction: Experiencing Pediatric Patient Death
      • Death denying culture
      • An occupational hazard
      • Unique to the healthcare provider
    Bereavement
  • 3. 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
    Bereavement
  • 4. First Death Experiences “ Looking Behind the Mask” Bereavement
  • 5. Normal Caregiver Grief Reactions HELPLESSNESS Bereavement 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
  • 6. 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.
    Bereavement
  • 7. Contributing Factors to the Grief Experience:
      • Lack of support
      • Feelings of inadequacy
      • Fear of failure
      • Communication gaps
      • Denying the inevitable
      • Avoiding reality
    Bereavement
  • 8. Case Illustration
    • “ J”
      • What’s the plan of care?
      • Is everyone on the same page?
      • Am I in this alone?
    Bereavement
  • 9. Cope: Derived from the old French word, couper, meaning to slash or strike. To fight or contend (with) successfully or on equal terms. To deal with problems, troubles, etc. Bereavement Webster’s new world dictionary of the American language (2nd college ed.). (1980).
  • 10. Coping Strategies Bereavement
      • 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
  • 11. 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
    Bereavement
  • 12. Paradigm Shift Participation in life completing itself rather than only seeing the loss of a shortened life Bereavement
  • 13. Case Illustration
    • “ D”
      • Are we asking the right questions?
      • How can we work together as a team?
      • What are we hoping for?
    Bereavement
  • 14. 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
    Bereavement
  • 15. 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 Bereavement
  • 16. 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. Bereavement