After such a traumatic event, those closest to the person who died often feel helpless and confused. Confronted with circumstances for which they are probably wholly unprepared, they are in emotional shock. Their lives have been irreparably altered and their priorities for the upcoming period have shifted.
Shock and confusion notwithstanding, the hours after a death require decision making by survivors. Being organized and decisive can be emotionally challenging and disruptive, and can bring repetitive stress for both family and health care professionals.
A period of turmoil calls for emotional First Aid
Immediately after a death, the family often finds itself surrounded by people who—to be blunt—soon have a job to return to. You and the other health care professionals on your team have other patients; you must get back on service and concentrate on their care.
The coroner or medical examiner’s office may need to determine if an autopsy is mandated.
The survivors have work to do, too: notify extended family and friends; make plans for a service; choose a mortuary for the burial or cremation; and care for young children, to name a few tasks.
Some families call for a personal pastor or a hospital chaplain to be present at this time. Well-meaning friends and family members arrive, too, and they often hold strong opinions about what should or shouldn’t be done next.
All of these activities and personalities have the potential to add unwanted emotional turmoil.
5 skills to master. Whether the caregiver who provided the notification of death is a physician, nurse, social worker, chaplain, or trained citizen volunteer, we have determined that five general skills form the basis for providing emotional first aid to survivors (see “5 basic skills for providing emotional First Aid,”).
Sample “Table of contents” for a hospital’s resource manual
We recommend that a comprehensive manual to inform and counsel grieving families contain these key sections. The manual should also contain a chapter on resources for families who speak any language other than English that is spoken widely in the community.
- I. Coping after a tragedy
In considering the purpose of those five skills, however, consider this overarching tenet: A broken heart cannot be “fixed.” Don’t try! What you can offer to someone who is emotionally devastated is a caring presence. Just being there is powerful and will be experienced by survivors as deeply helpful. It is best, therefore, not to “overcare”—to do too much for them.
Benefits of an expanded team approach. We have found that a hospital crisis response team approach, with an identified role for each team member, can be of great value to survivors. In addition to the deceased patient’s attending physician and primary nurse, the team typically includes a social worker and hospital chaplain.
In many instances, however, these professionals have so many responsibilities that they are precluded from assisting survivors and from being present for more than a short time after the death. Furthermore, shift changes mean team members come and go during the hours crucial for the survivors; and few hospitals employ social workers and chaplains around the clock.
That is why our repeated experience supports an essential role for a certified, trained citizen volunteer whose only responsibility is to assist and support survivors at all times of the day, all week. This caregiver serves as a guide and a buffer to enable survivors to act on their wishes, feelings, values, and beliefs—not according to what others think should be done. The volunteer provides this necessary temporary support until survivors are able to depend reliably on family, friends, neighbors, and others.
Want to learn more about TIP? About becoming certified as a TIP citizen volunteer?
As noted, coauthor Dr. Chez is a certified citizen volunteer for the Trauma Intervention Program (TIP), established by coauthor Mr. Fortin in 1989 as a nonprofit organization
The national TIP organization, TIPNational, reports that it comprises 18 regional chapters in the United States that serve more than 75 cities, 100 hospitals, 67 police departments, and 55 fire departments. Mr. Fortin describes TIP as the largest operator of emergency services volunteer programs in the nation.
To learn more about TIP, how to become certified as a citizen volunteer, and other ways to participate in the organization’s work, visit www.tipnational.org/home1.htm.
This model of a trained volunteer was developed by the Trauma Intervention Program (TIP) with which we work. You can learn about TIP in the box, “Want to learn more about TIP? About becoming certified as a TIP citizen volunteer?,” and at www.tipnational.org/home1.htm.