ABC of Major Trauma by David V. Skinner & Peter A.Driscoll

Author:David V. Skinner & Peter A.Driscoll
Language: eng
Format: epub
Publisher: Wiley
Published: 2013-01-27T16:00:00+00:00

Box 17.5 Some immediate grief reactions

Numbness—that is, acceptance but no feeling.

Disbelief.

Acute distress.

Anger, including against the medical professions.

Blaming themselves, others or even the deceased.

Guilt.

Acceptance.

A sensitive nurse is a great asset after bad news has been broken (Figure 17.3).

Figure 17.3 Sensitive nurse.

Encourage and be prepared for questions to be asked during the interview. They may disclose any misunderstandings and present a chance to re-emphasise the message. The question of pain and suffering is common and should be discussed routinely, with reassurance as appropriate. The prognosis may be unknown initially, and you should say so. If death or serious disability is possible, however, then it is only fair to be honest and warn the relatives. It will be a worse shock later if they have been protected from this knowledge.

Do not be afraid to say that you do not know the answers to medical or philosophical questions such as ‘Why me?’. Other difficult questions may arise from feelings of guilt or when a relative was involved in but not injured in the same accident. Special problems may arise if the relative feels directly responsible—for example, as the driver in an accident. Other complications may include a recent squabble before the accident, with subsequent self-recrimination. The ‘If only…’ rumination can be a type of guilt response that is fruitless and should be understood but discouraged at the outset. Just listening may be all that is needed.

If death has already occurred, the same principles as above apply. It is important to use the word ‘death’ or ‘dead’ early and avoid euphemisms such as ‘passed on’ or ‘lost’, which can be misinterpreted. The news is usually hard to accept and so it must be as clear as possible, abrupt as it may seem. People usually need an explanation as to the cause of death of a loved one. It may be helpful to explain the inevitability in the light of the known injuries and that ‘everything possible was done’. Worries about their own first aid at the scene of the accident may need talking through.

Children should not be excluded from the proceedings in the mistaken belief that they need protection. They will be afraid and may have fantasies and feelings of guilt, and need more information and listening to rather than less. Parents and carers may need support and explanation about a child's or teenager's reaction.

Staff actions during the interview with the bereaved are summarised in Box 17.6.

Box 17.6 Staff actions during the interview with the bereaved

Allow:

time

the bereaved to react

silence

touching

questions

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