Focus Expand Think through the following two scenarios and how you might respond: 1. All attempts at resuscitating a child have failed and the parents are waiting in the bereavement room. What do you actually say to the parents? a) Ask them some general, caring questions about how they are and use a gentle approach, eventually trying to help by telling them that the fatal accident was not their fault. b) Tell parents their child (name) has died and leave them alone to absorb the news, explaining that a nurse is making them some tea and will be with them soon. c) Tell them immediately how sorry you are that their child (name) has died and that everything possible was done. 2. When a child under your care has died, you feel you want to say “sorry”. Should you? a) Yes b) No
Presentation Expand Give parents the opportunity to talk about their feelings, to be how they need to be You will need to create a non-rushed space where you listen with sensitivity. Allow the parents to say whatever they need. Never say you know how they feel – you don’t. As a professional, showing your emotions if you are truly sad is something parents appreciate. Don’t hide your feelings to protect them. You are in a position of authority and your permission (and modelling) gives their own feelings validity.wome Some parents are understandably unable to accept the traumatic news and may cope by disbelieving what you tell them. Do be patient with parents, as disbelief is a form of emotional protection which will disappear when an individual is ready. Everyone is on a different timetable. There is no right way to grieve. Very often initial feelings of shock inhibit the expression of feelings – withdrawal, anger and many other emotions are also normal in grieving. Parents’ reactions are a normal response to an event which feels totally abnormal. Useful research (next section below) shows us that, in grief, partners may react differently. Explaining this to parents and seeing them together is helpful. Key points Give parents the opportunity to express their feelings Parents appreciate your honest emotions You are seen by parents to be in authority. You can give parents’ feelings validity Disbelief is a form of protection. It will end when the person is ready There is no right way to grieve Partners may react differently to grief Refer to their child by name – especially after death Reassure families that everything possible has been done. They won’t automatically know or assume that. Keep on reassuring them that no measure was left untried in the attempt to save their child’s life. An opportunity to discuss this at a later meeting should be made possible for families, with a follow-up appointment. Assure the parents that they will have an opportunity to ask questions at that appointment. It can be helpful to suggest to parents that they write down their questions in preparation for such a follow-up meeting. Recognise that sometimes there is a need to repeat the same explanation or information several different times. Parents in distress may only absorb a little of what you have explained. Allow enough time for parents to ask questions. Ask them to tell you what they have understood from you. In this way, you can take responsibility for communication and be sure that what the parents heard was correct. Key points Refer to their child by name Families may not always assume that everything possible has been done. Reassure them You’ll sometimes have to repeat the same explanation several different times Allow time for parents to ask questions Communication is your responsibility. Check that parents have understood you by asking them to tell you what they have heard you say Suggest that parents write down their questions for the follow-up meeting. Touch, for some people, can be a form of comfort and communication. Check with the parents that they don’t object If you want to say “I'm sorry” don’t be afraid to do so. The more self-aware you are as an individual, the more likely you are to provide parents with care appropriate to their needs. If you break sad news, do not rush away. Allow parents time to absorb what you have said, check they have understood, and allow them the opportunity to ask questions. Please make sure that parents know who you are and give them a card or write your name down for them, and inform them that there will be a follow up appointment. When parents leave the hospital, offer for someone to accompany them to their car (this could be a role for a trained volunteer). Tell them you will be letting the community professionals know about their child’s death and that they will be contacted by their GP or health visitor. Speak directly to a member of the primary healthcare team as soon as possible and inform them of the circumstances surrounding the death – this all helps with the continuity of care. Enquire about the parents’ beliefs, what they need and what may be available. Parents who never go to church may still be comforted by seeing the Chaplain and receiving a blessing for their baby/child. Others who have a deep faith may choose to have nothing to do with a God who they feel has allowed their child to die. Resist any need to talk about your own beliefs. Key points For some parents touch may be comforting but do check that it is appropriate Do not rush away after breaking bad news Agree with parents when and where they will see you again When parents leave the hospital, give them the choice to have someone walk with them to their car Tell them they will be contacted by their doctor or health visitor As soon as possible, brief a member of the primary healthcare team on the circumstances of the death Enquire about the parent’s beliefs, what they need, what may be available Resist any need to talk about your own beliefs.
Grief theory Expand The second research-based model is the Dual Process Model of Stroebe and Schut. (Stroebe & Schut 1995) The first model from Worden was presented in Module 2. Grief is solitary – even when other people are grieving, the parent is alone and normal patterns in relationships may be disrupted. For couples, there is often an inability to communicate with one another, to express the awfulness of their feelings. One parent's response to the loss of a child may be frequently different from the other's. To illustrate the differences Margaret Stroebe et al Margaret Stroebe et al 1995 proposed a dual model of grieving in which people engage in both loss-oriented and restoration-oriented grieving, and oscillate between the two reactions. Women can tend to be loss-oriented and are very much concerned with their feelings. They may focus more on their loss and the emotions they are experiencing. They may need memories and to constantly recall and be reminded of the child who has died. Remember the section on creating memories earlier in this material. In contrast, men can tend to be more restoration-oriented – they may want things to return to normal as soon as possible. Traditionally, men are not encouraged to show feelings and so they may instinctively try to suppress them and endeavour to be strong. Men may adopt practical forms of behaviour – wanting to do rather than feel. This response may be misinterpreted by their partner as not caring about their child. These different ways of dealing with grief can put a significant strain on the parents’ relationship and it is helpful for each to understand that their partner’s response to grief is natural, and to find ways of sharing their feelings and reaching out to one another. When people engage in either activity to the exclusion of the other it can cause added difficulties. Women may need help to develop some form of restorative response to enable them to move on from the intensity of the pain. Men may need to be helped to allow themselves to face up to and explore their painful feelings. This help may be needed later when the family is at home. It is helpful for you to be aware and observe that at the time of the death men and women can behave differently, and that is not unusual.
Review and reflection Expand Returning to the section called 'Focus' above, do you feel differently about any of these situations now? Reflection Did anything in this module surprise you? What is your key learning from this module? Are there any questions you want to follow up either at your place of work or on the training day? Make a note of anything you would like to raise within the training course. Return to menu