How do you support the grieving family during and after their loved ones' journey in hospice?
Each patient and families journey is unique. The most beneficial thing is to listen and provide them the education they need to care for their loved one. Praise the caregiver for the care they provide. They are doing the best they can at one of the most difficult times of their lives. Remember as a nurse you are a member of the IDG. Hospice is a team on purpose. Know your own limits, and scope. Don’t hesitate to call a team member when needed.
When I come to pronounce a patient I verbalize that I see someone who appears to be at peace as if in peaceful sleep. I ask about who they were or what fond memories they shared (when I am pronouncing a patient I was not the case manager for).
In short I ask about happier times, help them remember those find memories, and tell them how good of a job they did in caring for their loved one.
- be genuine
During and after the journey Listen, Listen. They will give you clues. 1) Where are they at in their spiritual journey. 2) Are they in denial? What stage of the death and dying process are they in? 3) Is there strife within the family? Is there a struggle or strain with children or other family members? 4) One of the most important things is the person does not feel judged. Their feelings are their feelings. The person that is the patient where are they at in the process?
Of course, if they start to talk about when they are no longer here. 5) Sometimes family does not want the person to take pain medication. The option is does the patient remain awake and suffer or pain medication and sleep more...6) When they are ready give them information about signs and symptoms when they are declining..
Grief is a good question. Many families start grieving well in advance when somebody's in a critical illness ,they are sick for many years, months, days and so the family sometimes grieves in advance so when the person dies they're almost numb and they can't cry they can't express it. They kind of just float through things- it's important to talk about their feelings to acknowledge that their situation and life will change sometimes. Family members have to sell their home with moving to an apartment or with another family member due to finances. it's a lot of major change for those that are left behind. A young mother may have young kids and lose her husband, or you have a brother and sister living together for finances so it's a big adjustment. Following up with support, making calls to make sure the people are okay, a lot of times they ask me about the nurses staying away and about a lot of social work visits to meet with them because it interferes with the grieving process but acknowledging how people feel. Sometimes it's quite cold when people come in and pick up the equipment and it has a finality to it. it's just like a cut and dry situation handling those situations with dignity are so important.
With hospice support comes in many forms it's about explaining and teaching the family so they know what to expect in the end most people revoke hospice when they're have a lack of education like a teaching from the hospice nurse and hospice aid if you explain things in advance reinforce it throughout the journey also support them for birthdays parties for veterans Day for anniversaries allow them to talk about their milestones so things in their life that are important expressing how they feel in the end help those that are left behind with the journey it's important to treat the hospice patient and the family has one unit and making sure they know that you'll be there for them in the end having those emergency drugs available so that when something happens you can talk them through it you can be supportive and come to the home is so very important it's not about money we're a special meal although many hospices do that box of cookies or somebody picking up an egg McMuffin for the wife who's the caregiver when the husband's not eating sometimes it's just all that's needed is somebody to say hey I hear you I see you
Just listen, and be present. It will mean the world and they will never forget it🤍
Active listening, be present for them and don't say everything will be okay. Explain that grief can be very different for each person so help them to understand each family member's grief may appear different than theirs. Help them find ways to celebrate the loved ones life.
You remind the family/caregivers that they did a wonderful job providing their loved one with such loving care. Remind them that they provided their loved one with the ability to be in their own environment surrounded by everything that meant anything to them and to die comfortably and dignified. It is a tremendous gift to give that to your loved ones.
I started the grieving process as soon as a patient is admitted to hospice; with the patient and with each family member. Each person's level of grief and stage of grief was different. My goal was always to achieve the acceptance state of grief; however, that was not always possible. Thoughtful and insightful conversation with the patient and family unit is needed to open dialogue so that you can begin your work of helping them to start to grief. That is as simple as asking how they are handling the diagnosis, how they are doing with each visit. Take the time to pull caregivers aside and ask about them because they are so absorbed in patient care but they need the one on one as well. Get your social worker involved so that she can offer counseling as well. After death, nurses call patients themselves along with the SW to follow up with the family. Everyone in the office signs a "thinking about you card" and is sent after death with cards every three months and calls monthly for 14 months. We also have a grief counseling group which is free to attend and hosted by a grief counselor and finally a Hospice Memoria service each year that all family can attend and honor their loved one.
