“We Are Not Grief Counselors:” Missing the Point of Opportunity and HealingChristine Merchant BSN RN CHPN Aug 31, 2021
I had a prospective palliative NP shadowing our team to see what our workload looked like. While sitting in my office in the ICU, we heard a woman cry out and continue in distress. The Neuro-intensivist had just declared her 45-year-old husband with brain death. Like many times before the physician came to my office and asked for my assistance in helping this wife with her grief and knowing there were 2 children ages 11 and 14, he himself had tears in his eyes and looked overwhelmed which was unusual for this physician. I quickly listened to the details and said yes I would help. After he left, the NP looked at me and said “We are not grief counselors and that is an inappropriate consult.” While her response took me back, she went off with the palliative SW and I continued to move forward in assisting this family.
Days later this continued to cause me to reflect on her statement and why she had such a different interpretation from my own when it came to palliative or supportive care. That day when I entered the room I found the wife laying over her husband with her aunt close by. They were from the state of Washington and had gone to Mexico for a procedure gone wrong. This wife was all alone in her complicated grief and shock of what had happened. I stood there in silence for quite a bit allowing her to talk to her husband and her aunt. I did not offer her tissues or stand there and rub her back and tell her everything was going to be okay because it wasn’t in that moment. I am trained in the understanding of what it means to give space and the beauty and appropriateness of silence.
We sat and talked about the events, his life prior, their home, their children, and then with trust, entered the discussion of next steps now that her husband was declared brain dead. Her biggest concern at that moment was their children and how to tell them. I discussed engaging the Child Life Specialist from one of our other network hospitals and she was agreeable to that. They did follow up and the help was tremendous for her. She also was very overwhelmed in knowing what to do with the body and getting him back to the state of Washington. Her father-in-law would be flying in from out of state later that afternoon so would serve as her support system. She was so grateful for my support, kindness and understanding, and for having someone that would listen to her when there was no one else.
The patient had been a registered donor in the state of Florida and Washington. I work closely with Donor Network in our state and always try to bridge the family with them when able. Once the patient’s father had arrived I spent a little time with him although more closed off he was receptive to my support. After a bit, the window of opportunity opened up for them to meet with the donor team and their family advocate. Because I had established that relationship I felt comfortable in introducing them and guiding them to our conference room and leave them in their hands. The patient did go on to be a multiple organ donor.
The takeaway from all of this? As a palliative care provider we look at Mind, Body, and Spirit. I found out the NP was solely focused on symptom management and nothing more, that was her practice prior to coming to us. If we only treat the body then how do we tend the mind and the spirit going through a traumatic experience? This whole-body process is what drew me into being a palliative provider and subsequently pursue my Masters. There is also situational distress for the nursing staff and medical providers. This was a young individual with a horrible demise. I played a small but integral part in being that soft place to land if only for a moment. There was no one else to do that and the physician knew it.
Many times as palliative providers we are the ones that the staff seek out to debrief with and talk to. They aren’t equipped to take the downtime of discussion and finding resources. Just as the neuro physician came to me with tears in his eyes, which was my cue that he needed to feel supported in that moment. In an article titled ‘Debriefing after a crisis,’ the author states, “nurses who experience moral distress in their work setting without receiving situational support aren’t able to easily process the experience.” (Hanna, D., 2007).
I recognize that everyone comes from different learning experiences and backgrounds. The work that we do in the palliative care setting is just that, it’s an experience and journey for both the patient, caregiver, family, and provider. After this experience, it just clarified for me that we are indeed grief counselors, it’s part of what we do for both patients and staff, during and after a situational event for that emotional closure and healing. I will always incorporate that into my practice and for others that don’t recognize it as part of palliative care it will remain a learning curve and my contribution will always be front and present to inform and educate.