Caregivers in death, dying, and bereavement situations

Peer-Debriefing After Distressing Patient Care Events: A Workshop for Pediatric Residents

INTRODUCTION

When confronted with a distressing patient care event, physicians experience feelings of failure, inadequacy, and self-doubt that negatively impact emotional well-being and have been linked to burnout and premature exit from the medical profession. A need exists within the medical community for improved emotional processing of distressing patient care events, particularly for resident physicians at the beginning of their careers.

METHODS

To encourage physicians to communicate as a means of initiating emotional processing after a distressing patient care event, a workshop was developed for pediatric residents providing training on a peer-debriefing model taken from the bereavement counseling literature. The workshop is designed to take 60 minutes, including dedicated opportunities to observe and conduct debriefing sessions based on the residents' own distressing patient care experiences. Included are the workshop facilitation guide, the adapted peer-debriefing model, hypothetical patient care scenarios, and pre- and postsession survey evaluation forms.

RESULTS

Pre- and posttraining survey metrics revealed statistically significant and meaningful increases in pediatric residents' self-reported comfort with and likelihood of leading a peer-debriefing session in an appropriate clinical setting.

DISCUSSION

This workshop is a well-received, effective intervention that provides pediatric residents with a tool to aid in the timely emotional processing of distressing patient care events. It has been adopted into the standard educational curriculum of our home institution's pediatric residency program. This workshop may be extended throughout the field, helping physicians at all levels of practice process the inevitable distress inherent in caring for the sick.

Empathy and silence in pastoral care for traumatic grief and loss

This paper evaluates silence as a therapeutic practice in pastoral care for traumatic grief and loss. Informed by the history of attachment and mourning theory, its research considers the basic effect that empathy has upon the therapeutic relationship around psychic difference. The study appraises the potential resources and detriments that empathic language may have for the grief process. Offering clinical examples in hospice chaplaincy, it refutes the idea that silence is formulaic tool to be used. It instead offers silence as the acceptance of the limits of empathic language and the affirmation of psychological difference and theological wholeness.

Service of Remembrance: a comprehensive cancer center's response to bereaved family members

Comprehensive cancer centers that offer an array of clinical trials and treatment options often experience significant patient mortality rates. Bereavement resources may not be routinely incorporated into the service delivery model in these specialty hospitals. In response, an interdisciplinary team at one cancer center proposed, planned, and implemented an annual Service of Remembrance. The incorporation of music, poetry, and visual arts was important in designing a program that would provide a meaningful, spiritual experience. A community artist who designed an interactive memorial art piece played a pivotal role. This article outlines the process of institutional culture change and describes future challenges in the implementation of this type of bereavement service.

"A rewarding conclusion of the relationship": staff members' perspectives on providing bereavement follow-up

GOALS OF WORK

Staff members in palliative home care play an important role in supporting bereaved family members. The aim of this study was to explore staff members' perspectives on providing such support.

MATERIAL AND METHODS

Staff members in six units responded (n=120; response rate 58%) to a postal questionnaire with Likert-type and open-ended questions. The responses were analyzed using statistics and manifest content analysis.

MAIN RESULTS

None of the respondents stated that bereavement follow-up was "most often difficult," 23% "most often rather difficult," 52.5% "most often rather easy," and 12.5% "most often easy." Apart from a tendency for age to be linked to perceived difficulty, there were no apparent patterns. Bereavement follow-up was a positive opportunity to support the family member's coping with their bereavement and to get feedback on the palliative care provided. Critical aspects concerned the question of whose needs actually were being met at bereavement follow-up, i.e., the staff members' needs for getting feedback on the care provided versus the risk of burdening the family members' by reminding them of the deceased's dying trajectory. Aspects that negatively influenced the staff members' experiences were complex and related, e.g., to the family member's dissatisfaction with the care provided, to the staff member's perceived lack of competence, and to the staff member's relationship to the family member.

CONCLUSIONS

Bereavement follow-up was perceived as a rewarding conclusion to the relationship with the family member. The findings suggest that meaning-based coping might be an appropriate framework when understanding staff members' experiences with providing bereavement follow-up.

Into the Abyss of Someone Else's Dying

This study was undertaken to better understand family caregivers' perspectives of providing end-of-life (EOL) care to elders facing expected deaths from life-limiting, chronic illnesses, and the study involved understanding the nature of EOL caregiving using caregivers' own words. The study employed a cross-sectional, exploratory descriptive design. The data source was intensive interviews with 27 EOL caregivers. Eight themes were extracted from data that exemplify the core characteristics of EOL caregiving. The themes intersected at a central idea expressed in the voice of one caregiver as “jumping . . . into the abyss of someone else's dying.” Data suggested that caregivers of elders with life-limiting illnesses needed nursing guidance about EOL care earlier than it is usually provided and that all nurses providing care to elders in any setting should be ready to offer early education in the practical, technical, and emotional dimensions of end-of-life caregiving.

Bereavement support in an acute hospital: an Irish model

In the first Irish study to examine a hospital-based bereavement care program, 1 year's cohort of bereaved people was surveyed. A response rate of over 40% provided 339 completed questionnaires from bereaved next-of-kin. The findings suggest that a tiered pyramid model of bereavement care (the Beaumont model) may be functional in a number of ways. The outreach aspect of the service is successful in providing additional support and information through telephone and postal contact to people at a distance or with mobility difficulties. Those bereaved by sudden death are twice as likely to access the service as those for whom death was expected. These, and other findings, are discussed.