Transcript How to Prevent Harmful Events and Promote Patient Safety

Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Chapter 10
Nurse-Patient Relationships During
Grief, Mourning, and Loss
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Grieve big and small losses throughout
life
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Weddings, graduations; off to kindergarten, college
Divorce
Loss of a job (financial security)
Loss of loved ones
Losses associated with illness (self-esteem, belief
systems, faith, hope, dreams)
 Often producing feelings of guilt
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for Crying
 Use empathy: “I can see you’re upset”
 Allow emotional release through tears and
words
 Raging and crying—allow patient to regain
control (blow off steam); keep silent and
accept response
 Quiet crying—sit on same level, hold hand,
offer tissues
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Encouraging Emotional Release Using
Tears: “ A Good Cry”
 Tears reduce emotional pain levels
 Release of stress-related tensions and hormones in
tears
 Relieve feelings of loss, sadness, grief, frustration and
anger
 Initial release of catecholamines increases heart rate
and blood pressure, followed by parasympathetic
response generating systemic relaxation
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
What not to say…..
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“There’s no need to cry. You’re doing fine.” (stop)
“Please stop crying now.”
“Get hold of yourself.” (stop)
“Think positive.” (advice)
“Think of your family.” (guilt)
“You must be strong.”
“You must be a man about this.”
“It’s time to get on with your life.”
“I know how you feel.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Gender Differences
 Women vent tensions, anger, and frustrations by
crying; across cultures, women cry more than men
 Men more often yell or shout
 Pressure for men not to cry for fear of being labeled
“sissy” or “crybaby”: “You’re a big boy. Big boys don’t
cry.”
 Men generally tend not to express emotions as much
as women
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Why Do Women Cry and Express
Themselves More Freely?
 Socialization? Girls encouraged to express
themselves and cry
 Physiological? Women secrete a hormone
prolactin (30 times more than men) involved
in tear production
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Grief Associated With Death and Significant
Loss
Shock, disbelief, denial
Anger—Lack of control
Guilt and fear—Am I being punished?
Depression and sadness—Nothing will ever be
the same again
Come to terms with loss and make plans
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Before helping others grieve/mourn
losses:
 You must recognize your own vulnerability to loss
and pain
 Acknowledge you can never be in “total” control of
your life
 Acknowledge your own mortality
 Anticipatory grieving—emotional responses to
potential loss
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Grief work: After death of loved one,
intense and painful
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Loss of pet—20 hrs crying
Spouse, parent, friend, child—200 to 300 hrs crying
Talk through tears; review good and bad memories
Restructure and rebuild lives without the loved one
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Grief work takes 1-3 years
 People, events, objects evoke memories of the deceased,
bringing on feelings of sadness, depression, tears
 Holidays, special events
 Dysfunctional grieving: Unsuccessful responses at working
through the process of loss
 Sadness turns into depression
 Emotional depression – unable to function in personal
lives or jobs
 Physiological depression of immune system
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Successful Resolution of Grief
 Never forget but go on without the other
 Become actively involved in meaningful
activities once more; still see purpose in life
 Greater understanding of life, greater
compassion for suffering and the needs of
others
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Emotions are contagious
We feel the same emotions as those
around us
We must acknowledge and accept the
emotions in ourselves and our patients
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Health-Care Providers Cry, Too!
 When caring for patients and families, you will become close
to some and experience grief along with them.
 Crying with a family member or patient is fine, as long as the
other cries first.
 Avoid crying unless the patient cries first. If you are upset, you
may need to excuse yourself and go to a private place.
 Discuss your feelings with a trusted nursing student/ faculty.
 Journaling to express feelings.
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Non-emotional health-care provider doing
tasks, procedures, paperwork comes across as
uncaring, task-oriented, too busy to be
bothered