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Good Grief: The Pediatric Care Provider and Patient Death Alexis Winnen, CCLS Program Coordinator Rainbow Babies and Children’s Hospital Rainbow Center for Pediatric Ethics Cleveland, Ohio [email_address] Dena Mitchell, RN, BSN Senior Oncology Nurse University Hospitals Case Medical Center Ireland Cancer Center, Pediatrics Cleveland, Ohio [email_address]
Introduction: Experiencing Pediatric Patient Death ,[object Object],[object Object],[object Object],Bereavement
Objectives ,[object Object],[object Object],[object Object],[object Object],Bereavement
First Death Experiences “ Looking Behind the Mask” Bereavement
Normal Caregiver Grief Reactions HELPLESSNESS Bereavement FAILURE GUILT HURT ANGER SADNESS POWERLESSNESS DESPAIR RELIEF SELF CONTROL DETACHMENT NEED TO CRY NEED TO PRAY WITHDRAW NEED TO SHARE NEED TO ATTEND FUNERAL ONGOING THOUGHTS DREAMS SLEEP DISTURBANCES CAN’T COME TO WORK
Types of Loss Unique to the Caregiver: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bereavement
Contributing Factors to the Grief Experience: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bereavement
Case Illustration ,[object Object],[object Object],[object Object],[object Object],Bereavement
Cope: Derived from the old French word, couper, meaning to slash or strike. To fight or contend (with) successfully or on equal terms. To deal with problems, troubles, etc. Bereavement Webster’s new world dictionary of the American language (2nd college ed.). (1980).
Coping Strategies Bereavement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hellsten, M.B., Hockenberry-Eaton, M., Lamb, D., Chordas, C., Kline, N. & Bottomley, S.J. (2000). Helping professionals care for dying children: Strategies that help. In Texas Children’s Cancer Center-Texas Children’s Hospital, Houston: End-of-Life Care for Children. Retrieved May 3, 2005 from: http://www.childendoflifecare.org/profess/profess20.html
Enhancing a Supportive Work Environment: ,[object Object],[object Object],[object Object],[object Object],[object Object],Bereavement
Paradigm Shift Participation in life completing itself rather than only seeing the loss of a shortened life Bereavement
Case Illustration ,[object Object],[object Object],[object Object],[object Object],Bereavement
Reframing Hope ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bereavement
Discussion To Laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics; To appreciate beauty, to find the best in others; To leave the world a bit better whether by a healthy child, a garden patch, or a redeemed social condition; To know even one life has breathed easier because you have lived. This is to have succeeded. - Ralph Waldo Emerson Bereavement
References  Hellsten, M.B., Hockenberry-Eaton, M., Lamb, D., Chordas, C., Kline, N. & Bottomley, S.J. (2000). Helping professionals care for dying children: Strategies that help. In Texas Children’s Cancer Center-Texas Children’s Hospital, Houston: End-of-Life Care for Children. Retrieved May 3, 2005 from:  http://www.childendoflifecare.org/profess/profess20.html Papadatou, D., Papazoglou, I., Petraki, D. & Bellali, T. (1999). Mutual support among nurses who provide care to dying children.  Illness, Crisis & Loss,   7 (1), 37-48. Papadatou, D. (2000). A proposed model of health professional’s grieving process.  Omega ,  41 (1), 59-77. Rando, T.A. (1984).  Grief, dying, and death: Clinical interventions for caregivers . Champaign, Illinois: Research Press Company. Saunders, J.M., Valente, S.M. (1994). Nurses’ grief.  Cancer Nursing, 17 (4), 318-325. Smith, R. (Ed.). (2000). A good death.  BMJ, 320 , 129-130. Steinhauser, K.E., Clipp, E.C., McNeilly, M., Christakis, N.A., McIntyre, L.M. & Tulsky, J.A. (2000). In search of a good death: Observations of patients, families and providers.  Annals of Internal Medicine ,  132 (10), 825-832. Webster’s new world dictionary of the American language  (2nd college ed.). (1980). Simon and Schuster. Woods, M. (2001). Balancing rights and duties in ‘life and death’ decision making involving children: A role for nurses?  Nursing Ethics, 8 (5), 397-408. Bereavement

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204 d mitchell winnen presentation

  • 1. Good Grief: The Pediatric Care Provider and Patient Death Alexis Winnen, CCLS Program Coordinator Rainbow Babies and Children’s Hospital Rainbow Center for Pediatric Ethics Cleveland, Ohio [email_address] Dena Mitchell, RN, BSN Senior Oncology Nurse University Hospitals Case Medical Center Ireland Cancer Center, Pediatrics Cleveland, Ohio [email_address]
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  • 4. First Death Experiences “ Looking Behind the Mask” Bereavement
  • 5. Normal Caregiver Grief Reactions HELPLESSNESS Bereavement FAILURE GUILT HURT ANGER SADNESS POWERLESSNESS DESPAIR RELIEF SELF CONTROL DETACHMENT NEED TO CRY NEED TO PRAY WITHDRAW NEED TO SHARE NEED TO ATTEND FUNERAL ONGOING THOUGHTS DREAMS SLEEP DISTURBANCES CAN’T COME TO WORK
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  • 9. Cope: Derived from the old French word, couper, meaning to slash or strike. To fight or contend (with) successfully or on equal terms. To deal with problems, troubles, etc. Bereavement Webster’s new world dictionary of the American language (2nd college ed.). (1980).
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  • 12. Paradigm Shift Participation in life completing itself rather than only seeing the loss of a shortened life Bereavement
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  • 15. Discussion To Laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics; To appreciate beauty, to find the best in others; To leave the world a bit better whether by a healthy child, a garden patch, or a redeemed social condition; To know even one life has breathed easier because you have lived. This is to have succeeded. - Ralph Waldo Emerson Bereavement
  • 16. References Hellsten, M.B., Hockenberry-Eaton, M., Lamb, D., Chordas, C., Kline, N. & Bottomley, S.J. (2000). Helping professionals care for dying children: Strategies that help. In Texas Children’s Cancer Center-Texas Children’s Hospital, Houston: End-of-Life Care for Children. Retrieved May 3, 2005 from: http://www.childendoflifecare.org/profess/profess20.html Papadatou, D., Papazoglou, I., Petraki, D. & Bellali, T. (1999). Mutual support among nurses who provide care to dying children. Illness, Crisis & Loss, 7 (1), 37-48. Papadatou, D. (2000). A proposed model of health professional’s grieving process. Omega , 41 (1), 59-77. Rando, T.A. (1984). Grief, dying, and death: Clinical interventions for caregivers . Champaign, Illinois: Research Press Company. Saunders, J.M., Valente, S.M. (1994). Nurses’ grief. Cancer Nursing, 17 (4), 318-325. Smith, R. (Ed.). (2000). A good death. BMJ, 320 , 129-130. Steinhauser, K.E., Clipp, E.C., McNeilly, M., Christakis, N.A., McIntyre, L.M. & Tulsky, J.A. (2000). In search of a good death: Observations of patients, families and providers. Annals of Internal Medicine , 132 (10), 825-832. Webster’s new world dictionary of the American language (2nd college ed.). (1980). Simon and Schuster. Woods, M. (2001). Balancing rights and duties in ‘life and death’ decision making involving children: A role for nurses? Nursing Ethics, 8 (5), 397-408. Bereavement