Sudden Death in the Hospital: the Bad news to the Family
Death DR team

Abstract

When informing the family about the sudden death of a loved one. It requires special skills from Medical profession to break the tragic news to mourning families. A comprehensive, phased action plan based on literature has been presented here to minimize the impact of distressing news and grief.

The guidelines outlined in the article are solely recommendations for healthcare providers and should not be considered as any form of protocol. Consideration should be given to incorporating this content into undergraduate medical curricula. By doing so, we hope to prepare junior doctors to better handle the unique yet highly crucial aspect of dealing with medical therapies.

The experience of doctors who face extreme pressure when informing family members about the sudden death of their loved ones. Providing bad news to grieving families requires special skills from medical practitioners. Unfortunately, there is very little guidance available on this highly sensitive matter. Doctors often rely on their own experiences rather than any formal training from medical schools.

DEATH
Death declarer

A well-trained doctor in this field will be in a better position to handle the challenging task of breaking bad news to bereaved families. It is time to include this topic in the undergraduate medical curriculum. Generally, regardless of the diagnosis, in a hospital setting, there are two scenarios in which death can occur. Firstly, it can be an expected death, where the patient’s family is already aware of the serious nature of the illness, and death is anticipated. In such cases, informing the family about the death may be relatively straightforward as they are mentally prepared for it.

However, in the second scenario, it is a sudden and unexpected death. In this case, informing the family becomes much more challenging. In the face of bad news, they may struggle to cope, especially when the death is sudden and unforeseen. They might find it hard to believe that their loved one has passed away. In this situation, relatives may become highly emotional and charged. In such cases, the team responsible for the patient’s care should demonstrate empathy and compassion, as a lack of it can lead to a hostile and grieving reaction, and Anger could be aimed against the medical staff.

Potential responses of those who have recently lost a loved one

Sudden news of death often triggers intense reactions, and the healthcare team should be prepared to handle various emotional explosions. The response to sudden death is culture, society, and race-dependent. Expressions of grief can range from silent tears to loud cries, lamentations, and physical gestures. The reaction to sorrow is unique and may differ from one individual to another. Bereaved relatives may perceive sudden death as ‘untimely’ and ‘unfair’ and may subsequently exhibit signs of sadness.

Initial Shock Response:

Denial 

This is the initial defensive mechanism after the shocking and destructive news, and it should be acknowledged and accepted. Acceptance can be facilitated by helping loved ones, especially those who weren’t present when the deceased passed away, to accept the truth of the death.

Anger 

After the sudden death of a loved one, anger is a common initial reaction. The expression of this anger can vary from mild irritation to intense aggression. It can be directed towards oneself, healthcare professionals, or others. After expressing anger, it may gradually subside. Blame – This is more than just anger and self-blame. Compassionate words from the healthcare team providing care can help alleviate these emotions.”

Health care Team

“The medical staff in charge of the patient’s treatment has a responsibility to inform the family members of the details surrounding the patient’s unfortunate demise. Studies have shown that The medical staff in often find these situations overwhelming and are prepared to adopt experimental approaches.

Whenever a patient becomes severely ill unexpectedly in a hospital, the healthcare team will make every effort to save the patient’s life. However, all these efforts take place behind the closed doors of the ICU.  The healthcare team should use any available time to mentally prepare the family for inevitable news through brief conversations. These short conversations will give the relatives some time to calm their nerves and brace themselves for the bad news.

Hospitals worldwide have adopted various protocols and guidance principles to break the devastating news and provide initial support to the grieving family when an unexpected death occurs to a loved one.

Based on the foundation of literature, a comprehensive, phased action plan has been developed to reduce the impact of tragic news and grief.”

Initial contact with the family

Death
Doctor and bereaved family

If relatives are in the hospital, bring them to the ICU immediately if possible. However, this becomes an issue when no one is around. A senior member of the healthcare team should call the family to inform them that the patient has suddenly become ill, and immediate treatment has been initiated. Requesting the family member to visit the hospital right away is necessary.

If the patient has already passed away, ensure that the news does not arrive over the phone until the family members are far away. However, if death is expected, the person receiving the call should only break the news and note the person’s identity and their relationship to the deceased. If we want to break the sad news over the phone, make sure that someone is with the person receiving the news.

Receiving Relatives in the ICU: 

  • A trusted member of the healthcare team should admit the relatives to the ICU and verify their identity and relationship with the patient. Prefer to talk to someone who is already familiar with the healthcare team.
  • For talking to family members, there should be a comfortable room available near the ICU.
  • If the patient has already passed away or is alive and being revived, handling family members will be different.

During the patient’s life Family members should be made aware of the risk of death.

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Team bad news
  • First, a relatively senior and trusted doctor should introduce themselves and then start the conversation. Predict bad news by saying, “I’m sorry, but I have bad news.”
  • Explain to family members how the patient’s condition was previously and how it suddenly deteriorated. The healthcare provider should make an effort to clarify the possible reasons for the sudden Deterioration. They should be patient and encourage family members to ask questions and express their emotions, being most prepared to respond.
  • Among the family members, someone who is relatively confident and familiar with the hospital should be given the opportunity to witness the revival process in the ICU. The senior clinician in the team should explain the revival process and show signs of life, such as taking an inactive breath on the cardiac monitor or the movement of organs, in a heartfelt manner. Confirming all of this to family members will help reassure them of the situation.

Afterward, the family member should be taken back to the discussion room and the senior cleaner so that the possibilities of diagnosis and survival can be explained clearly.

  • If the family members wish, permission should be granted for a priest or another spiritual counselor to perform the last prayers The staff should keep informing the family about the progress of reviving the family with regular updates.
  • Telephone access should be provided for the family members to communicate with other relatives.
  • These steps will give the family enough time to mentally prepare themselves for extremely challenging circumstances.”
Informing family about the death
  • And finally, if recovery is not successful, the senior clinician responsible for the patient should sit down with the family members to break the bad news.
  • Once again, as before, try to involve only one or two family members from the household. Friends and Family should be asked to wait outside the room.
  • It is preferable to talk to the same person who was informed earlier about the patient’s delicate condition. Speaking and explaining to a familiar person is always easier than dealing with a stranger. Furthermore, delivering this distressing news to someone who is already well-acquainted with the ongoing treatment and the patient’s issues, rather than a completely new person, will make it much easier.
  • Use simple English like “he has passed away” or “he’s no longer with us” instead of using elaborate phrases like “he has transitioned” or “he has left us, no more.” This will help avoid misunderstandings.
  • Easing Grief Reactions: After delivering the bad news, the next responsibility of the doctor is to assist the family in coping with the grief process.
  • Encourage relatives to express their emotions, such as crying or mourning loudly. Boost their morale to talk about the patient’s illness, and if they are willing, explain the efforts made to save and the inevitable outcomes. Silent gestures like holding hands or placing a hand on the shoulder of a crying person can be tried as well.
  • Appreciating the efforts made by the family in getting the patient treated can help reassure them that there was no lack of effort from the healthcare team or relatives. In some cases, especially when the patient is in a deep coma, clarify how peaceful the death was. This can help them believe that their loved one did not suffer much. Such assurances can also reduce feelings of guilt.”
  • Using this translation in a human-friendly tone can help in conveying the message effectively while being sensitive to the emotions of the family members.

Aspects of religious

Some aspects of religious philosophy, such as ‘Ultimately, everything depends on God’s will’ or ‘Life’s duration is determined by God,’ etc., can provide solace to grieving relatives, and again, this is contingent on cultural and religious perspectives.

  • If relatives accuse the healthcare team or hospital of negligence in caring for their loved ones or make comments, do not engage in argument or reply.
  • They will realize their mistake, and when emotions settle, they will surely seek forgiveness.
  • Whenever there are medical-legal implications or other situations where a post-mortem is needed to determine the cause of death, relatives should be informed in advance about the possibility of a post-mortem.
  • Handle the viewing of the deceased with care.
  • Prepare it for further presentation before allowing the relatives to see the body.
  • Cover the body with appropriate bedclothes.
  • Disconnect all life support, such as the endotracheal tube, cardiac monitor, ventilators, etc.
  • Cleanse the face to remove blood and other moisture.
  • Clean the jelly on the chest used for DC shocks.
  • Emotionally charged or weak relatives should refrain from viewing the body as they may collapse inside the ICU.”
  • Note: This translation has been done while maintaining a human-friendly tone and ensuring clarity in the English language.
When the family arrives and the patient has already passed away

Please arrange for relatives to be informed in the ICU, as previously mentioned, and verify their identification. Place them comfortably in the furnished room as previously instructed. Once again, prioritize informing the healthcare team familiar with the patient’s condition. Introduce a relatively senior and trusted doctor first and then begin the conversation. Prepare relatives for bad news with a gentle warning, ‘I’m sorry, but I have bad news.’ Break down distressing news in simple language and avoid using harsh terms like ‘passed away’ or ‘we lost them.

Make grief reactions easier as previously mentioned. Assist the family in viewing the deceased. Help the relatives navigate through official government procedures. Assign one of the hospital staff to assist relatives in filling out the details for obtaining a legal death certificate. If a post-mortem is required, guide the family through the different procedures. Lastly, ensure the smooth and timely transfer of the deceased’s valuable and personal belongings.”

Guide the relatives to go through the official formalities

One of the hospital staff members should assist the bereaved in completing the necessary paperwork, such as filling out the deceased’s details to obtain a valid death certificate, etc.
Inform the family members of the numerous steps to take if an autopsy is required.
Last but not least, see to it that the deceased’s body, jewelry, and other belongings are delivered promptly and without incident.

Conclusion:

Therefore, every effort should be made to enable the family of the deceased to accept the death of their loved ones in a peaceful manner.. Regardless of the final outcomes, the determination of the healthcare team to provide care should be heartily appreciated by the family. The expression of kindness when needed will undoubtedly strengthen the doctor-patient relationship. A compassionate attitude from the hospital staff towards grieving families not only benefits the bereaved but also safeguards the hospital from potential disputes related to a patient’s demise.

A sense of achievement should be felt if any member of the bereaved family of a terminally ill patient in the hospital shows interest in seeking medical care within the same hospital within a week. Proper healthcare for patients not only provides exemplary comfort to grieving families but also gives reassurance to treating doctors. Unfortunately, most healthcare providers are inadequately trained for this task.

Just as pilots gain experience with flight Simulators, medical students should also be trained in this art of communication. This skill can be taught as an essential but highly important aspect of medical care.

In this regard, this article highlights the importance of formal training for all healthcare providers in delivering bad news to grieving families and mitigating possible communication gaps. The suggested guidelines in the article are only recommendations for healthcare professionals and should not be taken as any form of protocol.

INFO: Bees for Humanity

By Sara Alex

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