ASSISTING THE FAMILY OF A DYING PATIENT

Families shoulder a lot of burden during terminal illness, and their needs grow and change as their loved one's illness progresses. Early in serious illness, there are the emotional burdens of learning of the illness for the first time, and coming to accept a terminal diagnosis, of giving up hope of cure, etc. As terminal illness progresses, patients often need family members to help refocus hope despite the inevitability of death (Covinsky et al, 1994).

            Patients and families need support, guidance, encouragement and understanding to begin planning for many decisions. 

Although the emotional burden is felt by most family members, families who choose to have their loved one die at home have to deal with the additional burden of providing direct care as well. They therefore, would need additional information and healthcare supplies, including specific teaching of caregiving skills and logistic support. After the death of the loved one, family members also have bereavement needs that require continuous and ongoing support, (Covinsky et al, 1994)

            Clinically, helping people is one thing, but knowing what to say or do when a family has just suffered the loss of someone they love is not something you really are prepared for.  It seems absurd, but the reality is that most physicians have no more than a couple hours training on how to break bad news, or support grieving families, (Covinsky et al, 1994)

            When death eventually occurs, the Physician’s role really is not to comfort, it is to provide support.  What that support will be is different for every family, because each family will have different needs.  But in moments of crisis and shock, helping to meet a family’s basic, practical needs can be the biggest help (Covinsky et al, 1994).

            According to the grief help website What's Your Grief, clinicians should be keen to take cues from the family and also keep the following components in mind when interacting with the loved ones of a dying patient:

a)                  Acknowledge to them that you can’t imagine how they feel.  People usually don’t want you to pretend you understand (because you don’t really, even if you’ve had a similar loss) and they will appreciate your honesty about how unique and devastating their loss is to them.

b)                 Ask them about their loved one. You could ask them to tell you a little about their loved one, or show you photos, if they have any with them.  This is a little easier on units outside the emergency room (ER), but can be tough in the ER setting when you may not have time to build a rapport with families.  You may not push this, only ask them if it feels natural.

c)                 Ask them what they might need.  Now, don’t be surprised if many people are unable to tell you, because they don’t know what they need.  But sometimes too they will, so be sure to ask.  It may be helpful to give them a few options when you frame the question.  “What can I do to support you guys right now?”  I can call another family with a similar experience for you, provide a medical letter for your employer/school, or contact a funeral home.

d)                Help them connect with those who will best support them.  Ask if they might           need help calling anyone and discuss who would be their support in the days, weeks, and months to come.  Determine how they will be getting home from the hospital, especially if it appears unsafe for them to drive.

e)                 Ask if they want to speak with a doctor about any questions that have come up.  Ensure there is a doctor available to actually come speak with them, before offering this!  

f)                  Ask if they would like you to  contact the Social Worker or Pastoral Care.  Again, ensure there is someone available before offering this. 

g)                 Discuss with them if they would want to spend time with the deceased and to say their goodbyes.  Assure them that most families wish to see and spend time with their loved one after death and others do not.  There is no right or wrong, just make sure they feel supported either way.

h)                 Offer ‘memory making’ options, if that is an acceptable practice in your hospital.  Things like hairlocks, thumb prints, or hand prints can be a meaningful way for some families to say their goodbyes (especially if there are children present).

i)                   Answer their questions on what happens next.  Many families have no idea how to call a funeral home or what to tell the funeral home, so go over this with them.  Explain whether they will stay at the hospital morgue, see the medical examiner/coroner, etc.

j)                   Answer other questions with regard to an autopsy, processes involving the medical examiner, requesting medical records, documentation for life insurance, funeral assistance, etc.

k)                 Give them space as they need.  Many families will want private time with each other and with the person who just died, take your cues from the family!

l)                   Don’t judge. This may sound obvious, but you would be surprised how often hospital staff impose their grief style or assumptions on families.  Some families may weep, some may laugh and joke, or may show no emotion at all.  Some may even lay in bed with the person, some may not even want to enter the room.  Whatever it is, give them the time, space, and understanding.

Author: Mabel Boadi

REFERENCES

Covinsky K. E., Goldman, L., Cook, E. F., Oye, R., Desbiens, N., Reding, D., Fulkerson, W.,                  Connors, A. F., Lynn, J., Phillips. R. S. The impact of serious illness on patients' families.                 SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes                   and Risks of Treatment. JAMA. 1994 Dec 21;272(23):1839–1844.
What's Your Grief. (2017, March 28). Supporting Grieving Families: tips for RNs and others on               the front line. Retrieved July 21, from https://whatsyourgrief.com/supporting-grieving-                     families-tips-rns-nurses/