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Smith said that the center has tried to create a less
explosive atmosphere by dispatching a team from the
various service-related departments of the hospital-pastoral
and customer services, for example-to talk with families
who have suddenly lost a loved one. "We want them
to know that the entire hospital community is there
for them and ready to address the many different issues
they may have," he said.
Chichwak added that it helps to develop a good relationship
with the family from the beginning. In comparing the
sudden deaths that she had encountered so closely together
last year, Chichwak said she was much more comfortable
dealing with the family of the stroke victim. "I
had gotten to know him and his family well, and so they
trusted me and the other nurses on staff," she
said. "It was certainly difficult emotionally,
but there was never a sense from them that we had done
something wrong."
It is not only sudden death but a dramatic and unexpected
decline in condition that also can put nurses in the
middle of thorny family situations. When seemingly stable
patients suddenly take a turn for the worse and wind
up on life support, many loved ones insist on continuing
treatment-often against the declared wishes of the patients.
This opens up a host of moral and ethical dilemmas,
which usually engulf nurses as well as doctors and administrators.
"We get caught in the middle of this a lot and
it makes the nursing staff very uncomfortable,"
said Theresa Murray, MSN, RN, clinical specialist for
critical care at Community Health Network in Indianapolis.
Murray explains that because of their position on the
frontlines of the hospital, nurses often end up talking
a great deal about this issue with family members and
trying to help them to do what is right.
"We like to think, at least conceptually, that
we're taking care of the entire family unit when we
care for a patient," she said. "But in the
end, we are really working for the patient. They are
our first priority."
Murray, a veteran of critical care, comes across as
tough and unwavering-even in the face of crises such
as an unexpected death or deterioration. She said that
as a leader of her staff, she needs to remain calm and
collected at all times. "You have to be able to
manage yourself in order to manage events," she
said. Even so, she acknowledges that handling death-especially
death that springs up suddenly and claims those patients
you'd least expect-is extremely trying. "Even today,
I do it better on some days than on others," she
said.
She added, however, that it is important for nurses
to find some way of coping with the range of emotions
and issues that accompany sudden death-whether it be
a good cry or a regular grief session with colleagues
or friends. "We have an obligation to manage it
and carry on," she said, "because the next
day, your patients aren't going to care what you went
through the day before. They need you at your best right
now."
Contact H. Cheever Griffin at cgriffin@chi.syn.net
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