Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
Currently Skimming:
Pages 213-236
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 213... ...
Roles of Health Professionals and Institutions
|
From page 214... ...
1b carry out this role responsibly, they should be able to communicate about sensitiveissues, to understand the nature of normal and abnormal bereavement reactions' and to be knowledgeable about commzmity resources to which the bereaved can be referred for specialized help if needed.
|
From page 215... ...
CHAPTER 9 Roles of Health Professionals and Institutions Although grief is not an illness, health professionals and health care institutions have important roles to play in caring for the bereaved, both before and after the death of a patient. One hundred years ago, most people were born and died at home; now most are born and die in a hospital.
|
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.
|
From page 217... ...
ROLES DURING THE DYING PERIOD More than SO percent of the deaths in the United States occur with at least several weeks' warning, 43 and in most cases health care ~rcife~ic~n _1 ~ 11 ~ 1 · ~ ~ ~ __. ~ ~ ~ alS Will nave oeen 1nvolvect.~ Whether death occurs at home or in an institution, there is a period during which health professionals have multiple opportunities to help the soon-to-be-bereaved.~3 29 Staff members' professional competence and the sincerity and consideration they show toward a patient and his or her family can help the bereaved cope with their grief when the patient dies.33 By ensuring that the patient and family are made as comfortable as possible during this generally difficult time, staff members establish themselves as people who will help the survivors.
|
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.
|
From page 219... ...
The newly bereaved should leave a deathbed with the faith that they and the medical staff have done the right thing for the person who died. Health professionals should help diminish the occasions for survivors to blame themselves or the medical and hospital staff.
|
From page 220... ...
Compared with obligations to a dying person, which may be perceived as boundless, family members may see their own needs as selfish. Health professionals should encourage families to place reasonable limits on what they expect of themselves and on the degree to which they are exposed to painful sights, smells, and sounds.
|
From page 221... ...
Being forewarned may lessen anxiety if such reactions do occur.24 38 In addition, lay offering the family the opportunity for a later appointment to discuss questions that might come to mind, health professionals make it clear that they are not indifferent to relatives' feelings, that they are available for support, and that they are sensitive to the fact that the shock of death may preclude people's ability to express all their questions and uncertainties immediately. Although health care institutions have been thought of as insufficiently responsive to patients' and families' needs around death and bereavement, administrative personnel are beginning to acknowledge their responsibility in these areas.
|
From page 222... ...
In these situations, no clear-cut advice is possible, but parents' desires can be elicited by careful discussion. Talking with the hospital staff who cared for the baby before death is particularly important in confirming for parents that their baby really did exist, especially when other family members or friends may suggest that it would be better for everyone if the pregnancy and birth were simply forgotten.
|
From page 223... ...
Some members went to the city morgue to assist families in identifying the bodies, many of which were grossly disfigured. Attempts were made to learn what social support was available to each family, provide for further contact with and referral to local support groups, and arrange for material aid.
|
From page 224... ...
If permission for an autopsy is Granted it is important to follow through with the family when results become available, to discuss find~ngs and answer any questions they might have.3 ~6 28 This expectation of toilow-up suggests that the institution has a responsibility to mainlain contact with the bereaved for some time; it may also explain why physicians seek to avoid making an autopsy request, with the accompanying necessity of reviewing and remembering what they may have experienced as a "failure" on their part. CONTINUING RESPONSIBILITIES OF HEALTH PROFESSIONALS AND INSTITUTIONS Although medical institutions are not commonly expected to have a continuing responsibility to family members once a patient has died, the fact that there may be no one else to fulfill that function has prompted a range of experiments with institutional bereavement programs.
|
From page 225... ...
Research, therefore, may have psychologic as well as scientific functions. Although interactions between a family and health professionals are likely to decrease in intensity or to end shortly after bereavement, each group of health professionals has special skills to offer in caring for the bereaved.
|
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.
|
From page 227... ...
Part of the continuing responsibilities of health professionals stems from recent changes in the delivery of health care. Very ill patients are increasingly being transferred to regional facilities for care.
|
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.
|
From page 229... ...
Problems for patients, family members, and personnel themseives have been observed when care-givers are psychologically unstable, uncomfortable with issues of death and grief, and unable to recognize their own limits and make referrals when their competencies are exceed. 39 These issues are discussed in Chapter 10 in relation to the screening and selection of lay volunteers to work in hospice bereavement intervention programs.
|
From page 230... ...
Perhaps the most frequent problem to surface in staff meetings is the unrealistic level of self-expectation common among highly skilled indivi~ua~s.39~44 The inevitable failure to live up to these self-imposed expectations often leads professionals to withdraw so that their colleagues will not observe their "failures." This withdrawal results in isolation and severely limits staff members' ability to respond adequately to their patients. Seeing the hostile or demanding behavior of the relative of a patient as part of the bereavement process rather than as a personal attack may relieve the professional of the sense of failure and isolation.
|
From page 231... ...
Coordinated staff activities with clear role responsibilities, regular meetings to discuss problems and staff reactions to them, and adequate back-up from liaison psychiatry are all ways to build a supportive atmosphere for staff. Education of Health Professionals Recognizing that the ability to care for grieving people depends heavily on such personal factors as conscious and unconscious reactions, personality structure, family experiences, and styles of coping, the committee also believes that this capacity can be enhanced through professional education.
|
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.
|
From page 233... ...
The primary tasks for health professionals in the care of the bereaved include providing information and explanations about the medical factors that caused the death as well as legitimization of it by assuring the bereaved that everything therapeutically reasonable was attempted. The symptoms and signs that may be associated with bereavement should be anticipated, including the lengthy nature of the grieving process and the likelihood of differences in the ways grief is expressed in various ethnic groups and even by members of the same family.
|
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.
|
From page 235... ...
Bereavement Care Manual. Boulder, Colo.: Boulder County Hospice, 1979.
|
From page 236... ...
Measurement and management of stress in health professionals working with advanced cancer patients. Death Education 1:365-37S, 1978.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.