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Nurse as Advocate Elizabeth Roe, RN, PhD Saginaw Valley State University.

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Presentation on theme: "Nurse as Advocate Elizabeth Roe, RN, PhD Saginaw Valley State University."— Presentation transcript:

1 Nurse as Advocate Elizabeth Roe, RN, PhD Saginaw Valley State University

2 Presentation Objectives Describe the role of the nurse as an advocate for survivors of patients who have died or experienced a serious injury. Identify evidence-based interventions useful in advocating for survivors of patients who have died or experienced a serious injury. Respond to case scenarios of nurses in advocate roles for survivors of patients who have died or experienced a serious injury.

3 Nurse as Advocate ANA Scope and Standards of Practice – “Patients and families give nurses permission to enter their lives and share their most intimate life experiences. Registered nurses remain in nursing to promote, advocate for, and strive to protect the health, safety, and rights of those patients, families, communities, and populations” (p.17)

4 Actions of a Nurse Advocate Speaking, fighting, and standing up for patients (Chafey, Rhea, Shannon, and Spencer, 1998) Speaking out (Hanks, 2008) Nurse being the patient’s voice (Filey, Minnick & Kee, 2000) Acting as a guide or liaison (McSteen & Peden- McAlpine, 2006)

5 Actions of a Nurse Advocate Protecting patients (Sellin, 2000) Preserving personhood (Foley, et al., 2000) Empowerment of patients (Chafey, et al., 1998) Communicating at a “human level” (Martin, 1998) Caring, respect (Watts, 1997) Educating and informing (Hellwig, et al., 2003)

6 Advocating for Survivors

7 Common Reactions Sadness Fear Anger Helplessness Denial Confusion

8 Factors that Influence Reaction of Survivor Notification itself Circumstances of the event Characteristics of the survivor and notifier. Personal characteristics of both the victim and survivor Quality of the relationship Physical and psychological problems of survivors – Gamino, Sewell, and Easterling, 1998

9 Advocating in a Crisis Situation Early experience following crisis event or death influences long-term outcomes Needs of family members (CCFNI, Leske, 1991) – Support – Comfort – Proximity – Information

10 Support Facilitate the use of familiar support persons (Lehman, Ellard & Wortman, 1986; Williams & Frangesch, 2001) Be compassionate and humanistic (Hart & DeBernardo,2004; Scott, 1999) Be aware of individual factors that may contribute to complicated grieving(younger age, relationship to victim, history of mental health problems, physical characteristics, manner of death )(Gamino, et al., 1998; Merlevede, et al., 2004)

11 Support Remember that individual responses vary greatly; constantly monitor for emotional and physical support needs (Leash, 1996; Von Bloch, 1996) Allow catharsis/ventilation of emotions (Olson, Buenefe & Falco, 1998; Williams & Frangesch, 2001) Assess for spiritual needs; allow customs and rituals (Li, Chan & Lee, 2010)

12 Comfort Provide practical support for basic and comfort and a private, comfortable environment (Janzen, Cadell & Westhues, 2004; Lehman, Ellard & Wortman, 1986) Choose appropriate individual to do notification (e.g. someone who is knowledgeable about victim, professional, sensitive, caring and confident), utilize team concept if possible (Williams & Frangesch, 2001; Davidson, et al., 2007) Make sure survivor is greeted on arrival, allow for privacy, and a comfortable, safe environment (Leash, 1996; VonBloch, 1996)

13 Proximity Allow significant others to be with patient (Eberwein, 2006; Olson, Buenefe & Falco, 1998) Prepare survivor for what they will see (Leash, 1996; VonBloch, 1996)

14 Information Be aware of specific facts about victim and death(chronology of events, circumstances of death, treatment) (Merlevede, et al., 2004; Williams & Frangesch, 2001 ) Do notification in person and as soon as possible (Hart & DeBernardo, 2004) Avoid telephone notification of death, instead have survivor come to the hospital (but do not lie if they ask if patient is dead) (Scott, 1999; Collins, 1989) Give chronology of events, have facts available, give news of death gradually (Janzen Cadell &Westhues, 2004) Use words such as “dead” and “died” (Leash, 1996; Eberwein, 2006)

15 Information (con’t) Use clear, understandable language (Von Bloch, 1996; Fraser & Atkins, 1996) Use victim’s name (Olson, Buenefe & Falco, 1998) Make survivor has adequate information (Leash, 1996; Von Bloch, 1996) Provide written information (Li, Chan & Lee, 2010) Provide anticipatory guidance (Von Bloch, 1996) Inform of available resources (Merlevede, et al., 2004) Do follow-up contact (telephone) (Williams & Frangesch, 2001 ) Facilitate follow-up with law enforcement and viewing of reports (Hobgood, et al., 2005)

16 Common physical reactions include: – Nausea/vomiting – Hyperventilation – Fainting – Palpitations – Chest pain – Heart attack/Shock – Other

17 Reactions of Health Professionals Understand situations that may lead to greater stress such as the death of a child or coworker and own experiences and attitudes towards death (Stewart, Lord & Mercer, 2000) Provide adequate education of professionals about death and death notification (Stewart, 1999) Provide opportunities for debriefing after critical incidents and death notification (Burns & Harm, 1993; Eberwein, 2006)

18 Case Scenarios

19 References Burns C, Harm, N. Research emergency nurses’ perceptions of critical incidents and stress debriefing. Journal of Emergency Nursing, 1993;19: Collins S. Sudden death counseling protocol. Dimensions of Critical Care Nursing, 1989;8: Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force Critical Care Medicine,2007;35: Fraser S,Atkins J. Survivors’ recollections of helpful and unhelpful emergency nurse activities surrounding sudden death of a loved one. Journal of Emergency Nursing, 1990; 16: Gamino LA, Sewell KW, Easterling LW. Scott and White grief study: an empirical test of predictors ofintensified mourning. Death Studies, 1998;22: Hobgood C, Harwood D, Newton K,Davis W. The educational intervention “GRIEV_ING” improves the death notification skills of residents. Academic Emergency Medicine, 2005;12: Hart CW, DeBernardo CR. Death notification: 224 considerations for law enforcement personnel. International Journal of Emergency Mental Health, 2004;6: Janzen L, Cadell S, Westhues A. From death notification through the funeral: bereaved parents’experiences and their advice to professionals. OMEGA, 2004;48:

20 References Leash RM.Death notification: practical guidelines for health care professionals. Critical Care Nursing Quarterly, 1996;19: Lehman DR, Ellard JH, Wortman CB. Social support for the bereaved: recipients’ and providers’ perspectives on what is helpful. Journal of Consulting and Clinical Psychology,1986;54: Merlevede E, Spooren D, Hendrick H, Portzky G, Buylaert W, Jannes C, Calle P, et al. Perceptions, needs and mourning reactions of bereaved relatives confronted with a sudden unexpected death. Resuscitation, 2004;61: Olson JC, Buenefe ML, Falco WD. Death in the emergency 201 room. Annals of Emergency Medicine, 1998;31: Rutkowski A. Death notification in the emergency department. Annals of Emergency Medicine, ;40: Scott BJ. Preferred protocol for death notification, FBI Law Enforcement Bulletin, 1999;68: Stewart AE, Lord JH, Mercer DL. A survey of professionals’ training and experiences in delivering death notifications. Death Studies, 2000;24: Von Bloch L. Breaking bad news when sudden death occurs. Social Work in Health Care, 1996;23: Williams M, Frangesch B. Developing strategies to assist sudden-death families: a 10-year perspective. Death Studies, 2001;19:


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