Traumatic loss

When the bereavement debriefing session is a response to a traumatic or difficult death, it’s essential to create a safe environment in which staff can ask questions, exchange information, and share thoughts and feelings. A traumatic death debriefing session often works best when the patient care manager arranges it and attends. Using an open-ended format allows staff to share what needs to be shared, and it’s helpful to have a staff member facilitate the session.

Although all staff should be encouraged to attend, their attendance is voluntary. Those who need debriefing in a group setting will be there. But be sure to identify staff who are unable to attend and may need individual debriefing at a later date.

A traumatic death debriefing usually starts with a welcome that states the purpose of the debriefing and then encourages each person present to introduce themself and identify if they had cared for the deceased. A brief summary of the death or situation follows, and the stress and grief experienced as a result of the death are acknowledged. You can use the following questions to guide the rest of the session:

• What else would you like to know about what happened while the patient was dying or at the time of death? (Caregivers who have been involved in the patient’s care may not have been present at the time of death, or for other significant moments in the patient’s care, and may want a complete picture of what happened.)
• How has this person’s death affected you? (It’s important to clarify that there are no right or wrong reactions. Staff are human beings who are touched by the people they care for and need an opportunity to process their losses like everyone else. Encourage them to listen respectfully to each other and to avoid trying to explain away or “fix” others’ emotional responses.)
• What aspects of the care provided to this patient do you feel good about? (Encourage staff to “pat themselves on the back” and to give each other “bouquets” for the things that went well and made a difference.)
• What distresses you about the situation? What do you wish could have been different? (Staff may be distressed for many reasons. They may have had difficulty controlling the patient’s symptoms. They may have experienced conflict with the patient and/or the family, and had disagreements about the patient’s care or treatment. They may also have identified with the patient’s and family’s suffering, while feeling a lack of appreciation for the care they provided. Sometimes staff are distressed about the ethics of care or treatment. Encourage them to voice their concerns, but suggest that they seek additional discussion or consultation at another time to work through the ethical issues.)
• What can we learn from this situation and what can be done differently in the future? (The most challenging situations often offer the greatest learning opportunities.)
• What have you been experiencing since the death (physically, emotionally, socially, spiritually)? How are you taking care of yourself? What have you found most helpful in coping with this death? (By sharing different coping methods, staff can expand each other’s repertoire of coping skills.)
• What do you need from the team or other staff to help you cope with this death? (If a staff member seems overwhelmed by the death, and has few resources to cope with it, follow up to arrange appropriate supports. Often the facilitator or patient care manager is the best person to do this.)
  

The facilitator may close the debriefing session with a reaffirmation of the staff’s intent to provide the best possible care for each individual and family, and reinforce the importance of their commitment to continued learning and self-care.

Reference

Keene EA, Hutton N, Hall B, Rushton C. Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatr Nurs. 2010;36(4):185–9.