Grief Support


Article Author:
Shawyon Sedaghati


Article Editor:
Jeff Baker


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
9/11/2019 7:27:28 PM

Introduction

Physicians frequently deal with the loss of a patient in the emergency department and in intensive care units. These deaths are often due to unforeseen violent circumstances, such as gunshot wounds, motor vehicle accidents, suicides, and homicides. Only after extensive, failed resuscitation attempts will the emergency department team end their efforts. This harrowing experience takes not only a physical but emotional toll on the providers, as they are the last hope of survival for the patient. The loss of a patient’s life reflects immense personal and professional stress and anxiety on the emergency physician. However, they must put aside their grief to disclose the bad news to family members of a patient who has died unexpectedly. The physician likely lacks a prior intimate relationship with the family. This lack of familiarity makes it important that health professionals are aware of and ready for various emotional reactions from the family so that he or she can alleviate extended grief and bereavement.[1][2][3][4][5]

Function

Death Notification

Having a planned approach to the unforeseen circumstances in the ED or hospital is useful for both the family of the deceased and health professional in charge. The GRIEV_ING mnemonic provides an organized method for concise and accurate death notification; it delivers all the necessary information to the family and is simple to remember for clinicians. 

  • Gather (G): Gather the family members and place them in a quiet, private environment. Assist the family and give information to everyone at one time, allowing for optimal support within the family. [6]
  • Resources (R): Call for additional support resources available to assist the family (e.g., chaplain services, family ministers, additional family. and friends).  
  • Identify (I): Identify yourself. Identify a deceased individual by name. Identify the family's state of knowledge, for example, are they aware of the situation? Will news of death be unexpected? Identify a level of open communication, for example, ask the family members to sit and sit as well.
  • Educate (E): Briefly educate the family about the events that have occurred in the emergency department. Educate them about the current state of their loved one. Educate in thoughtful language and do not use technical terms.
  • Verify (V): Verify the death of the family member Be clear by using the words death, died, or dead. Do not use religious phrases to avoid offending family members.
  • _ (Space): Stop talking and give the family personal space and time to comprehend what you said.
  • Inquire (I): Ask if there are any questions or how you may help.
  • Nuts and Bolts (N) Inquire about organ donation, funeral services, and personal belongings. Offer the family the opportunity to view the body. 
  • Give (G): Give the family your card and contact information. Offer to answer any questions that may arise later. Always return their call.

Issues of Concern

Reactions to Expect

Reactions of grieving family members often differ. Some common emotional reactions observed during times of grief are feelings of numbness, sadness, anger, hopelessness, irritability, denial, guilt, fear, and anxiety. Some common cognitive reactions are difficulty concentrating, confusion, difficulty making decisions, and disbelief. Some common behavioral reactions are blaming others, avoidance of the situation, and acting out. Stay calm and be respectful of the family of the deceased as individuals express their emotions. If you choose to touch a grieving family member, the shoulders are the most appropriate location.[7]

Clinical Significance

When notifying the family members of patients who died suddenly, it is necessary to provide complete, correct information about the death. An accurate death notification may diminish the tendencies for survivors of the deceased to develop complicated health conditions, such as prolonged grief disorder (PGD) or posttraumatic stress disorder (PTSD).[8][9]

Proper death notification protocols are not only vital for family members but may also reduce adverse physiological and psychological responses experienced by clinicians in such stressful situations. Faced with delivering the difficult news of a patient’s death under their care, clinicians and nurses commonly experience the following: excess cortisol upset and irregular heart rate, combined with feelings of sadness and disappointment resulting in insomnia. This hindrance to attention and concentration will negatively affect the high quality of care expected.

Other Issues

Special Situations

Long Distance Notifications

Proceed with the aforementioned GRIEV_ING mnemonic. If the family of the deceased feel inclined to come to the hospital, request that they are accompanied and make certain someone is accessible to answer any of their questions.

Autopsy and Medical Examiner Cases

Depending on state laws, deaths meeting established criteria must be promptly reported to the medical examiner and coroner. Some examples are unexplained or unusual deaths, homicides or suicides, medical procedure deaths, pediatric deaths, accidents or unnatural deaths. If a medical examiner and coroner case, resuscitative lines, and tubes must not be removed from the deceased. If the death is not a medical examiner and coroner case, the physician is still obligated to present the family with the opportunity for an autopsy.

Organ Donations

It is not the responsibility of the emergency physician to discuss organ procurement with the family of the deceased. The Joint Commission standards on organ procurement require specific hospital procedures and protocol. This entails the collaboration with organ and tissue procurement organizations. Allow a member of the organization to discuss all information relating to organ and tissue donations with the family of the deceased.

Witnessed Resuscitation

Clinicians should develop procedures that facilitate safe family-witnessed resuscitation efforts. Allowing family members comprehensive, real-time observation on the patient’s situation may provide families with closure, leading to less complicated grief responses. Family members should be escorted out if concerns emerge of them posing a risk to the safety of the healthcare team. [10]

Pediatric Deaths

Pediatric deaths are one of the most taxing situations faced by the team. Protocol for pediatric deaths is different from other deaths, in which clinicians and nurses are to provide a family-centered and team-oriented approach. The family should be allowed to be with child during resuscitation efforts. The family should also be provided with appropriate resources and family planning. Clinicians should get in contact with the child’s pediatrician and disclose the circumstances of their death so the pediatrician can further support the deceased child’s family. Pediatric deaths meet the criteria to be reported to the Medical Examiner and Coroner. [11]

Enhancing Healthcare Team Outcomes

Complications with the grief and bereavement of family members of the deceased can be minimized with team-oriented care efforts. Physicians collaborating with nurses, social workers, and chaplain enables comprehensive death notification delivery; This interprofessional knowledge sharing provides family members with the additional support and resources needed to ensure proper communication and improved grief support outcomes.  [12]      

Nursing Actions and Interventions

Nurses should assist the family by:

  • Acknowledging their feelings. Don’t pretend you understand as the family will appreciate your honesty about how devastating their loss can be.
  • Ask questions about their loved one or ask them to tell you a little about their loved one.
  • Ask them how you can help and what they may need. Most of the time they will not know but this gives the family the option to open up to you.
  • Ask if you can help them connect with those who will provide support.
  • Ask if they want to speak with the clinicians and arrange for a time for the family to speak with them.
  • Ask if they would like to speak to a pastor or social worker.
  • Ask if they would like to be with the deceased and say their goodbyes and do your best to make this time comfortable.
  • Ask if they would like thumb prints, hand prints, or hairlocks.
  • Ask if they have any questions about arrangements with the funeral home.
  • Ask if they have any other questions.

Acknowledge that you may not know what to say. Families understand that you can't fix the situation. Give the family as much attention as they need but provide private time if needed. Remember to give them additional contacts after they have left the hospital as many are overwhelmed and may not have questions for several hours to days later. Don't be judgemental, remember that different religions and families have a variety of views on death and they may be very different from your own personal views.[13][14][15][16]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Grief Support - Questions

Take a quiz of the questions on this article.

Take Quiz
What is an appropriate response to a tearful family after hearing the distressing news that their son has been newly diagnosed with AIDS?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which one of the following patients is at high risk of mental distress after the loss of a loved one?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What should be done if a patient is crying?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A therapist is working with a patient whose spouse recently died. The therapist responds by paraphrasing the patient's statements. What is the purpose of using this technique?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is the best way to offer emotional support to a patient and family during an abortion?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents for mental health care. She is tearful and reports that she lost a job where she had worked for many years. Select the most appropriate response.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 27-year-old female with Down syndrome lives in a group home and works as a dishwasher. Her mother recently died of lung cancer and her grandfather is ill. She was recently diagnosed with hypothyroidism and has been having menorrhagia. Which of the following would not be a support goal for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is seen in the emergency room after a motor vehicle accident in which the driver of the other car died. After a thorough assessment, she is found to have no physical injuries. What is the most appropriate management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 35-year-old patient arrives by ambulance to the emergency department and is shortly pronounced dead after extensive resuscitation efforts. The family has just arrived and wants to know the status of the patient. What is the first thing that should be done?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best description of the grieving process?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Grief Support - References

References

Milman E,Neimeyer RA,Fitzpatrick M,MacKinnon CJ,Muis KR,Cohen SR, Rumination moderates the role of meaning in the development of prolonged grief symptomatology. Journal of clinical psychology. 2019 Feb 22;     [PubMed]
Gamba F, Coping With Loss: Mapping Digital Rituals for the Expression of Grief. Health communication. 2018 Jan     [PubMed]
Newsom C,Schut H,Stroebe MS,Wilson S,Birrell J, Initial Validation of a Comprehensive Assessment Instrument for Bereavement-Related Grief Symptoms and Risk of Complications: The Indicator of Bereavement Adaptation-Cruse Scotland (IBACS). PloS one. 2016     [PubMed]
Oates JR,Maani CV, Death and Dying . 2019 Jan     [PubMed]
Pitman AL,Hunt IM,McDonnell SJ,Appleby L,Kapur N, Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings. Psychiatric services (Washington, D.C.). 2017 Apr 1     [PubMed]
Henoch I,Berg C,Benkel I, The Shared Experience Help the Bereavement to Flow: A Family Support Group Evaluation. The American journal of hospice & palliative care. 2016 Dec     [PubMed]
Harrop E,Morgan F,Byrne A,Nelson A, "It still haunts me whether we did the right thing": a qualitative analysis of free text survey data on the bereavement experiences and support needs of family caregivers. BMC palliative care. 2016 Nov 8     [PubMed]
Eisma MC,Te Riele B,Overgaauw M,Doering BK, Does prolonged grief or suicide bereavement cause public stigma? A vignette-based experiment. Psychiatry research. 2019 Feb     [PubMed]
Killikelly C,Lorenz L,Bauer S,Mahat-Shamir M,Ben-Ezra M,Maercker A, Prolonged grief disorder: Its co-occurrence with adjustment disorder and post-traumatic stress disorder in a bereaved Israeli general-population sample. Journal of affective disorders. 2019 Apr 15     [PubMed]
Johnson C, A literature review examining the barriers to the implementation of family witnessed resuscitation in the Emergency Department. International emergency nursing. 2017 Jan     [PubMed]
Greenwald N,Barrera M,Neville A,Hancock K, Feasibility of group intervention for bereaved siblings after pediatric cancer death. Journal of psychosocial oncology. 2017 Mar-Apr     [PubMed]
Silloway CJ,Glover TL,Coleman BJ,Kittelson S, Filling the Void: Hospital Palliative Care and Community Hospice: A Collaborative Approach to Providing Hospital Bereavement Support. Journal of social work in end-of-life     [PubMed]
Smith-MacDonald L,Venturato L,Hunter P,Kaasalainen S,Sussman T,McCleary L,Thompson G,Wickson-Griffiths A,Sinclair S, Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC geriatrics. 2019 May 6;     [PubMed]
Sawin KJ,Montgomery KE,Dupree CY,Haase JE,Phillips CR,Hendricks-Ferguson VL, Oncology Nurse Managers' Perceptions of Palliative Care and End-of-Life Communication. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses. 2019 May/Jun;     [PubMed]
Martinez AM,Castiglione S,Dupuis F,Legault A,Proulx MC,Carnevale F, Having Therapeutic Conversations With Fathers Grieving the Death of a Child. Omega. 2019 Jan 28;     [PubMed]
Chang WP, How social support affects the ability of clinical nursing personnel to cope with death. Applied nursing research : ANR. 2018 Dec;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.