Sudden death: helping bereaved parents in the PICU

Researching people who are bereaved: Managing risks to participants and researchers

Conducting qualitative research, especially in areas considered 'sensitive', presents many challenges. The processes involved in such research often expose both participants and the research team to a vast array of risks, which may cause damage to their personal, professional, social and cultural worlds. Historically, these risks have been considered independent of each other, with most studies exploring only the risks to participants or only risks to researchers. Additionally, most researchers only consider risks during data collection, frequently overlooking risks that might be present during other phases of the research project. We aim, therefore, to bring together this fractured literature to enable an integrated exploration of the current academic discourse relating to risks to participants with the literature exploring risks to researchers across all phases of the research process. This article draws on personal experiences to highlight ethical issues and risks encountered by both participants and researchers throughout all phases of a research project. Beginning in recruitment, we discuss the risk of secondary distress in participants arising from researcher contact and then explore the concept of informed consent during grief and bereavement research. We then focus on risks present during data collection, examining risks for participants, such as emotional distress, and potential safety risks for the research team. Finally, we consider the risks which arise in data analysis, including both confidentiality and the possibility of researcher burnout. Previous recommendations are summarised, with new management strategies suggested based on lessons learned along the way.

Caring for Pediatric Patients' Families at the Child's End of Life

Nurses play an important role in supporting families who are faced with the critical illness and death of their child. Grieving families desire compassionate, sensitive care that respects their wishes and meets their needs. Families often wish to continue relationships and maintain lasting connections with hospital staff following their child's death. A structured bereavement program that supports families both at the end of their child's life and throughout their grief journey can meet this need.

Signs of life and signs of death: brain death and other mixed messages at the end of life

Brain death is a medical, legal and cultural category constructed to fill an important need created by evolving medical technologies and practices. However, managing life and death via organ transplants and brain death criteria is not without controversy; there remains much confusion and ambivalence in both lay and medical populations regarding both organ donation and the diagnostic category of brain death. By way of a case study of cranial trauma taken from a larger study of bereaved parents, this article discusses how, from a parent's perspective, brain death and organ donation are neither morally nor medically straightforward concepts. The case study presented in this article demonstrates the necessity for more research and clinical training in communication issues regarding brain death and end-of-life care with families in critical care situations.

Beneficial effects of a hospital bereavement intervention program after traumatic childhood death

PURPOSE

An investigation of the experiences of parents grieving the traumatic death of their child, the initiatives that helped, and common parental concerns that would benefit from improved education.

METHODS

From January 1, 1995, to December 31, 1998, 81 of 3,501 children admitted to our pediatric trauma center died. An attempt was made to enroll all parents. Interactions included family contact at hospital, home/funeral home visit within 1 month of death, educational meeting with parents and 15 supporters at a restaurant within 2 months of death, follow-up survey to parents/supporters, and final interview/survey with parents in 1999-2000.

RESULTS

Seventy-seven families were enrolled; 59 families completed the educational meeting with supporters, and 245 parental supporters returned surveys. Supporters were likely to use proposed interventions (82%), were more accepting of the duration of grief (94%), and interacted with parents more often after the death (78%). Parents (n = 44) felt the hospital staff was appropriately sensitive to their child (90%), themselves (93%) and prepared them for their child's death (81%). Parents (n = 54) on behalf of 37 children have completed the final interview. Poor conceptualization of aspects of the medical care and brain death, and delayed regret for missing the opportunity to donate organs, were recurring themes.

CONCLUSION

We conclude that parents' unanswered questions or misconceptions regarding brain death, organ donation, and their child's medical care adversely affect their grief; that "normal life" for parents is challenged as they struggle to establish a new sense of normal; and that hospital and trauma service personnel can positively impact the grieving process with appropriate training.

Stressors experienced by nurses while caring for organ donors and their families

OBJECTIVES

To identify the stressors experienced by nurses who care for organ donors and their families.

DESIGN

Retrospective, exploratory, descriptive.

SETTING

Eastern Canada.

PARTICIPANTS

Seventeen nurses who worked in a neurologic intensive care unit were interviewed. All had provided care to organ donors.

RESULTS

The threat of the patient dying, the inconsistent commitment of physicians to organ donation, and returning to an empty space were frequently mentioned stressors. All nurses felt positive about being involved in the organ donation process.

CONCLUSION

To deal with the stressors, nurses recommended more education in the area of grief, crisis interventions, stress, and coping theories. More important, they suggested the need to address their feelings through stress debriefing sessions.

Traumatic childhood death: how well do parents cope?

This study assessed effects of traumatic childhood death on parents. From July 1988 to September 1992, 48 of the 1,954 children admitted to our pediatric trauma center died. Interviews were requested with parents of children who died and were conducted by a chaplain in the homes of 29 parents (20 families). Interview assessments were based on Worden's "Mourning Tasks" and Demi and Miles's "Parameters of Normal Grief." Grieving was uncomplicated in seven parents (five families). Common elements included use of multifaceted non-family support networks to aid grieving, and no parents blamed themselves or God for the child's death. Grieving was pathologic in 22 parents (15 families). Dominant features included: (1) lack of a support network beyond the extended family; (2) an avoidant stance to grieving; and (3) view of God as distant and punitive. We provide nine indices that will enable hospital caregivers to anticipate the outcome of parental grieving, and offer suggestions for the physician who desires to be involved in parents' acute and rehabilitative grief recovery.

Breaking the news: informing visitors that a patient has died

Most nurses working in critical care areas for any length of time will be involved in informing visitors that a patient has died. This paper describes some of the methods which may be used to give this news and some of the means of providing support to visitors at this time.

The organ donor family members' perception of stressful situations during the organ donation experience

The purpose of this study was to determine what the individual organ/tissue donor family members appraised as most stressful during the anticipation, confrontation and post-confrontation stages of the organ-donation process. The Lazarus and Folkman stress and coping theory guided the development and interpretation of the study. Family members who had lost a loved one suddenly and consented to donation in 1988 were interviewed. Data were analysed by means of content analysis. Findings showed that family members appraised different types of stressful situations during the three stages. The most frequently reported stressful situations centred around the threat of losing a loved one, confirmation of brain death, failure of the health professionals to identify the loved one as a potential donor and to approach the family regarding organ donation, and adjusting to the many changes associated with the loss. Significantly, five families requested donation, while two readily consented when approached. All family members reported that organ donation had helped with their grief. The findings of this study contribute to the development of knowledge required to guide nursing interventions to provide sensitive care to donors and their families.