Obvious life changing opportunities are fate
Abysses, human fate, hardship and suffering are part of everyday life in a hospital. Sometimes more, sometimes less dramatic. But often it is the caregivers who deal with and endure the mostly life-changing situations. What helps in such situations?
The word crisis comes from the Greek and means: opinion, judgment, decision or turning point. In medical parlance, a crisis usually means that the apex of an illness has been reached. The pendulum swings either in the direction of life or in the direction of death. In any case, a decision is made in one direction or the other.
Help to get through the crisis
The life crises of the bereaved also resemble a pendulum. The previous stability is no longer there, and one's life has been shaken to its foundations. Everything has been done for the patient. Now carers stand in front of the bereaved and have to help to survive the acute crisis. Attention, mindfulness, eye contact and communication without words are a bridge that the relatives may reach when it hits the doctor's message with full force.
The basic requirement is that as a caregiver you are relatively "stable" yourself. Because if something is out of balance in your own personal environment, it is understandably more difficult to provide support. And that's exactly what the bereaved need.
Time is another important factor. Crisis intervention knows no second hand. When a nurse has other patients to care for, she tries to organize her time. A short consultation in the team can help. If an acute situation cannot be addressed immediately, it can be helpful to offer someone else who is available. It also always makes sense to ask the relatives whether they would like a clinic chaplain. This professional group is responsible for crises “qua office”.
When dealing with people in crisis situations, a caregiver should always be binding with statements such as “I'll be right back”. Trust and stability are particularly important for the relatives now. There may be special quiet or retreat rooms for long, difficult conversations. In this way, uninvited, curious eavesdroppers can be avoided.
How to help relatives?
But how can a carer help relatives when it comes to getting through the initial shock? Here is a case study: A woman in her late 40s is stabbed by her husband at home with a kitchen knife. The deed takes place in an argument, in front of the 13-year-old son and the two grown daughters. The emergency doctor who is called can stabilize the woman for the transport to the emergency room, but she dies from her serious injuries on the way to the operating room. The children of the deceased are treated with severe shocks in the emergency room.
This is certainly not an everyday occurrence, but unfortunately it is also not uncommon. As a rule, the treating doctors deliver a death notice. The first important preparation for a crisis intervention is - as already mentioned - to find a quiet room, to avoid nosy eavesdroppers and to allow time. Because possible reactions are difficult to predict. Crying, silence, screaming, running away, physical shock reactions or paradoxical behaviors such as aggression, not wanting to be true and repression are all conceivable.
In the case study, it must be taken into account that the siblings are of different ages. Because children and young people have their own language. To make matters worse, they are victims themselves, since they saw the crime and their father is the perpetrator. So your entire family environment breaks away. What offered them security, security and protection has just been turned into the opposite. Now they have also lost their mother and their own future is uncertain. All of these aspects are important for crisis intervention.
Empathy is essential
The facts that need to be expressed are also significant. Family members often want to know exactly what the type of injury was, what was done and why no rescue was possible. Empathy for the right words is essential, as is commitment. Repeating the words "died" and "dead" sounds terrible. But they are also important so that the relatives really understand what happened.
In the case study, very practical things also need to be clarified because the underage boy, if he does not have to be treated as an inpatient, must be handed over to the care of relatives - for example the sisters or other relatives - or a youth or social service. In the event of an act of violence, the criminal police often want the witnesses to be questioned as soon as possible. The doctor decides whether this is possible from a medical point of view.
Sometimes the relatives want to see their deceased. That should be made possible. In our case, the deceased is “confiscated” by the police as it was an unnatural cause of death. This means that nothing may be changed on the corpse and that a forensic autopsy is carried out. If the relatives insist, the police allow it and the corpse is "viewable", this request should be granted. Accompaniment should be offered - the police will also be present. All of this is part of crisis intervention - understanding the facts.
Back to the case study: Here other family members were informed in order to find accommodation for the children. Her home was blocked by forensics as a crime scene. Sometimes it helps if those affected can take action themselves. You suffer from the loss of control that such a situation brings with it. It can help here, provided that the state of mind of those affected allows them to take on tasks themselves. That conveys security. In the case study, for example, the oldest sister called an aunt with the help of a carer, who immediately went to pick up the siblings. In this way, safe, family accommodation could be guaranteed; the crisis intervention that had begun by the caregiver ended here. The offer to call a hospital chaplain was rejected in the case study.
Crisis intervention always relates only to the acute situation. Long-term therapy may later be necessary for those affected. The three steps of a crisis intervention are, as explained in the case study:
- Inform and provide orientation,
- Stabilize, allow and endure reactions and emotions,
- Activate resources, show possible options for action, but do not “persuade” them.
Leave personal opinion aside
It should go without saying that personal opinion has lost nothing in the crisis intervention. An evaluation of the event - no matter how obvious at first glance - does not help anyone. And most of the time not all the facts are known.
A final important aspect for nurses is mindfulness with oneself. Even the most experienced nurses will not leave a crisis intervention unaffected. In the focal points of a hospital, interdisciplinary supervision, collegial advice or case discussions are often offered. It is not a sign of weakness to participate. A conversation with a colleague or the hospital chaplain, who is also available to the employees, can also help to cope with the next shift with all its new challenges.
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