Presentation is loading. Please wait.

Presentation is loading. Please wait.

Clinical Aftercare Specialist OneLegacy Family Services Michelle Post, MA, LMFT The One That Counts: Working with Grief & Loss and Organ Donation.

Similar presentations


Presentation on theme: "Clinical Aftercare Specialist OneLegacy Family Services Michelle Post, MA, LMFT The One That Counts: Working with Grief & Loss and Organ Donation."— Presentation transcript:

1 Clinical Aftercare Specialist OneLegacy Family Services Michelle Post, MA, LMFT The One That Counts: Working with Grief & Loss and Organ Donation

2 Tell me and I'll forget. Show me and I'll remember. Involve me and I'll understand. - Confucius The One That Counts… What does that mean?

3 Today’s Agenda Grief as the Great Equalizer Personal grief and loss Codename: Simon and debriefing about Normal Grief What’s happening during the donation & communication between hospital, OPO, and Donor Family How to talk to kids, teens, and adults

4 Elizabeth Kubler-Ross Hearses vs white vans Underused hospice Is Death a Universal Truth?

5 Who Do We Turn to? MDs (some see death as failure) Clergy good & bad Funeral Homes Crisis Response Teams Police & Firefighters Is Death a Universal Truth?

6 Who Do We Turn to? Professional Counselors: Training? DSM Code for Bereavement gives timeframe? 2 months (numbness wearing off) kids (23years old and under): 6-12 mo Is Death a Universal Truth?

7 If Death is a Universal Truth, Grief is the Great Equalizer… Everyone is Affected!

8 Grief Statistics: 1 in 5 kids will experience the death of someone close by age 18 (Kenneth Doka, Editor of OMEGA Journal of death and dying) Quick survey…

9 Grief Statistics: 1 in 20 kids will experience the death of one or both parents by age 15 (Steen, 1998) Quick survey… Close to 2 million children receive death benefits from a deceased worker (Social Security Administration, 2007)

10 What Does Grief Do? Children of parents who die suddenly (suicide, homicide, accident or natural causes) are 3 x more likely to develop depression and are at higher risk for post-traumatic stress disorder (PTSD) than non-bereaved children (Brent & Melhem, 2007 University of Pittsburgh School of Medicine)

11 Possible Pitfalls for Those Who Do Not Reconcile Their Grief: Avoid love as a way to avoid pain Inability to acknowledge the pain of others Avoid risks

12 Inability to express love for their own children Experience a sense of ‘searching’ for that which was lost Resisting school or work projects which demand long-term commitment Possible Pitfalls for Those Who Do Not Reconcile Their Grief:

13 Vicarious Trauma Compassion Fatigue Practitioner Decay How Does This Affect Me?

14

15

16 Symptoms? How Does This Affect Me? Fatigue Sadness Sleep Disturbance Irritability Frustration Weight Change

17 Exploring Your Own Grief ~ See Handout Adapted from J. William Worden, Ph.D.: Grief Counseling & Grief Therapy: A Handbook for the Mental Health Practitioner Where to Start?

18 Family Service’s Philosophy Adopted Dr. Alan Wolfelt’s idea of “companioning” a bereaved family –NOT experts on grief; we will take cues from the family to understand what we can do to support them –We will not lead the family in any direction, but be with them through their journey Dr. Worden’s research and tasks of mourning

19 Philosophy Adopted Dr. Alan Wolfelt’s idea of “Responsible Rebels”: –NOT agents of conformity to ‘get the child over grief’, but instead foster growth in the child. –DO NOT assume that the friends and family members will support them in their grief journey. Parents/siblings can be too overwhelmed. Friends project feelings of helplessness by ignoring the subject entirely. From: Healing the Bereaved Child

20 He’s an undercover agent. You have to keep his secret. DVD available for purchase or see CODENAME: SIMON

21 DVD available for purchase ~ see Michelle or CODENAME: SIMON WHAT DID YOU NOTICE?

22 Symptoms? Emotional Social Physical Spiritual Behavioral/ Psychological Grief is… See Handouts: Normal Kids/Teens Grief and Potential Symptoms of Grief

23 So…. What Can ONE Do to Help? #1 – Foster #1 – Foster communication between hospital, OPO, and Donor Family But 1 st – Know your stuff. What’s happening during the donation?

24 Tell me and I'll forget. Show me and I'll remember. Involve me and I'll understand. - Confucius The One That Counts… What does that mean?

25 Leaving a donor family waiting for information, can feel MUCH longer to them then it does to us. The One That Counts… What does that mean?

26 #1 Question We Are Asked WHY DOES IT TAKE SO LONG???

27 Donation After Cardiac Death (DCD) Donation After Brain Death (DBD) How Does Donation Occur? DBD vs. DCD Two opportunities… Consent Rate – 50% 30 % of Cases Conversion Rate – 88%

28 DBD vs. DCD – What’s the Difference for a family? DCD – Requires a Decision to remove Life Support & Donate vs. transition to long term care Brain Death is Death – Requires a decision about Donation

29 We are not taking something from the family—we are giving them the opportunity for donation.

30 Effective Family Support Family Healthcare Team Recovery Agency This is where we come together

31 #1 Question We Are Asked WHY DOES IT TAKE SO LONG???

32 Donation Process Summarized 1.Clinical Triggers Met → Call UWHC-OPO 2.Evaluate organ function / Eligibility for donation w/ Transplant Surgeons 3.Brain Death Note (BD) / Futility Note to OPO (DCD) 4.Consent signed and faxed to OPO / Serologies drawn 5.Medical-social history done by OPO 6.Allocate organs to recipients 7.Manage hemodynamics – lab panels every 4-6 hours 8.Set OR time and make transportation arrangements WHY DOES IT TAKE SO LONG??? How Does Donation Occur? Bill Snyder in Donation 101, Friday

33 Step 4 of Donation- Serology Phase Once the patient is deemed an eligible donor and we have verbal interest from a family, we can start serologies. The OPO will fax a serology request form to the RN with specific instructions on how to draw serologies and what to do with them. –This form needs to be faxed back to the coordinator with the bottom portion filled out. After instructions are explained, the coordinator will set up transportation for the serologies.

34 Once blood is drawn by RN it is brought to the ER front desk. A courier will be called and pick up the blood at the ER and then drive it to Madison. The OPO Coordinator will alert the core lab and tissue typing of the blood arriving and they will prep their kits for testing. –Once the lab receives the blood it takes about 4 hours to complete the serology testing and tissue typing. Step 4 of Donation- Serology Phase

35 HBSAg- Hepatitis B Surface Antigen Anti- HBC- Hepatitis B core Anti- HCV- Hepatitis C Virus HIV 1 and 2- Human Immunodeficiency Virus HTLV 1 and 2- Human T-cell leukemia/lymphoma virus RPR- Rapid Plasma Reagin test- Tests for syphilis CMV- Cytomegalovirus (many are positive) EBV- Epstein Barr Virus Step 4 of Donation- Serology Phase

36 Medical/Social History needs to be completed before organs can be recovered/allocated. OPO Coordinator will complete with person who knows the pt best. –May do with multiple people OPO is always available for family support. Step 5 of Donation- Med/Soc Hx & Family Support

37 OPO Coordinator will request the following information to evaluate the donor and enter into our chart: –FACE sheet/Demo Sheet (urgent information) –Copy of blood type (urgent information) –H&P –Chest x-rays, CT scans, EKG –Dictated consults –Daily Nursing Flow sheets with vitals and I&O’s –ER flow sheets –Meds from last 24 hours –Blood Products administered –Consent form (2 if DCD) –Labs since admission –Brain Death clinical exam/apnea test results or DCD futility note PLEASE SEND THIS INFO ASAP AS IT CAN HELP SPEED UP THE PROCESS Step 5 of Donation- Med/Soc Hx & Family Support

38 Placement of Lines The OPO Coordinator will request the RN to place an arterial line and a central line. –Many times they will ask for CVP’s to be measured. –This needs to be done by the MD’s, residents, etc, who would normally place lines. –These are usually done on every case.

39 Lab Values/Blood Cultures Stat labs –ABO/RH Typing and Type and Screen (VERY IMPORTANT TO GET ASAP along with Demo/FACE Sheet!!!) –Blood Cultures x 2 (different sites), Sputum Culture with Gram Stain, Urine Culture and Sensitivity, UA –CBC with diff., ABG, Chem 10, LFT’s, Coags, Amylase, Lipase, Cardiac Enzymes, HgbA1c

40 Organ Evaluation Echocardiogram Bronchoscopy Multiple chest x-rays Cardiac Cath Abdominal CT O2 Challenges Multiple ABG’s

41 Once all of this information is received, entered into our databases, tests are complete, and serologies are done, we can begin allocation ALLOCATION: The process that is used to offer out organs according to the UNOS list of recipients that need an organ transplant. Step 6 of Donation- Organ Allocation Phase

42 All of the information is entered in a database and then lists are run. These lists come up with the recipients that are good matches to the donor –Length of wait time –Antibodies are compared –Status 1A? (Very sick pt) –0 mismatches (PERFECT MATCH) Local, then regional, and then national unless there is a Status 1 recipient listed. Step 6 of Donation- Organ Allocation Phase

43 Each organ is allocated separately. Each transplant center has 1 hour to acknowledge offer Each transplant center has 1 hour from time of acknowledgement to make a decision Can be a very long and tedious process There are many, many phone calls during this period and additional tests may be requested during this time. There is a lot of communication with transplant physicians at this time to determine if the recipient is a good fit for this donor. Step 6 of Donation- Organ Allocation Phase

44 Recipients Once a recipient is selected for an organ, a transplant coordinator calls the patient into the hospital. (Need to always be available by cell phone or pager.) They have 1 hour to respond and make a decision. Need to get to the hospital and get ready. –Labs, x-rays, prepped for OR Step 6 of Donation- Organ Allocation Phase

45 Then, every 6-8 hours we will re-check –CBC, Chem 10, LFT’s, Coags, Amylase, lipase, cardiac enzymes Standing orders are given to replace electrolytes. Changes may be made by coordinator if needed. –If brain dead patient- OPO can give orders –If DCD patient- OPO can give suggestions. Lab Values & Family Support (cont.) Step 7 of Donation- Manage hemodynamics

46 V/S, UOP, CVP, gtts… Measured every hour Use orders/recommendations given by the coordinator. Rule of 100’s –SBP above 100 –PaO2 above 100 –UOP at 100ml/hr Step 7 of Donation- Manage hemodynamics

47 Once Allocation is complete is it time to get our team ready to go! Usually a Surgical Recovery Coordinator, a recovery physician, and an assistant will go on a case. –An OPC will go on every DCD case The coordinator will arrange transportation (flight) to the airport and then transportation from the airport to the hospital. Step 8 of Donation- OR Time & Transportation

48 Recovery Phase: Surgical Recovery of Organs All organs except kidneys need to be allocated to a specific recipient prior to recovery. All infectious disease tests must be completed and confirmed. Some teams will need time to fly in from their location. (Could be multiple teams) Step 8 of Donation- OR Time & Transportation

49 Brain Death Recovery Process Patient is maintained on ventilator throughout the organ recovery Organs are dissected in situ 3-4 hour surgery Heart, lungs, liver, kidneys, pancreas and intestines can be recovered

50 Donation After Cardiac Death Withdrawal of life support in the OR or ICU Cardiac death occurs Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician Rapid recovery with organs procured en bloc 1-2 hour surgery Lungs, liver, kidneys and pancreas can be recovered

51 Recovery Phase

52 So…. What Can ONE Do to Help? #1 – Foster #1 – Foster communication between hospital, OPO, and Donor Family Know what’s happening during the donation & share

53 #2 Develop a Communication Plan/ Introductions Team Huddle –“ Time-out” for all members of healthcare care team to establish a needs and communication plan for family Things to consider: –Ensure family’s emotional, physical and spiritual needs being met –Circumstances surrounding death –Religious/cultural background and rituals –Varying family structures –Patient’s end of life wishes

54 What Can ONE Do to Help? #3– Watch Your Language (reference: Grieving Kids & Teens Do’s and Don’ts & Child Speak documents)

55 Why “Watch Your *#$%&* Language?”

56 Why is language important? It’s okay to say dead… died… death… Let’s practice! Helps with Worden’s First task of mourning – to accept the reality of the death

57 #3 Watch Your *#$%&* Language! Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D DO: Use Truthful and clear information DO NOT: Use colloquial sayings or religious explanations DO: Explain it is not contagious.

58 Suicide: Watch your language! What does the word “Commit” imply? Instead use: Died by Suicide or Suicided The Legal history of Suicide was that it was a crime. Was this person thinking clearly? What disease causes Suicides? Adapted from Didi Hirsch Suicide Prevention ProgramAdapted from Didi Hirsch Suicide Prevention Program

59 #4 Normalize Feelings Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D DO: Acknowledge and validate their feelings. Express Condolences, Acknowledge what they have been and ARE going through. - Their loss is primary—not donation - Bereavement support and crisis intervention skills, including cross-cultural variability - Teamwork to support the family DO: Remember they can only tolerate intense grief in spurts. (10 – 15 min for kids)

60 #5 Address Fear & Anxiety Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D DO: Address their fears and anxiety. For Kids/Teens: DO: Let them know most people live to be very old DO: Develop a plan about who will care for them.

61 #5 Address Fear & Anxiety Make a Worry Doll (Demo Later Today)

62 #6 Encourage Consistency Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D DO: Provide limit setting and consistent discipline DO: Encourage routine activities. DO NOT: Encourage Change in 1st 12 months, Instead: keep home, school, work, relationships the same.

63 To Include or Not to Include Kids in the Hosp/Funeral? Seeing/Touching the Body?

64 #7 Include them!!!! Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D Prepare children & teens & adults for what they will see, hear, feel and/or smell. The Harvard Study Research: The picture in their head is often worse than what is real. - Not being involved is a risk factor for later complicated grief Let them make an informed choice.

65 #7 Include them!!!! Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D Include children in all aspects of information sharing, hospital visits, and family mourning rituals. Debrief with them. In ICU or at a Funeral: Provide a buddy for them (1 adult per child)

66 #8 Learn a Grief Model Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D J. William Worden’s 4 Tasks of Mourning Task 2: To Experience the Pain of the (Death) Task 3: To Adjust to an Environment in Which the Deceased is Missing Task 4: To Relocate the Dead Person within One’s Life and Find Ways to Memorialize the Person Task 1: To Accept the Reality of the (Death)

67 #9 Help with Remembering Help the family start thinking about the “legacy” their loved one will leave Encourage story telling –Opportunity to share a part of their life with you and to introduce you to the person they loved through memories –Help facilitate the process strengthens rapport and trust comforting and reassuring Memory Boxes Hand Molds – demo later today in our workshop

68 #10 Explore Your Own Grief! (see handout) #11 Listen! #12 Develop Self-care and rituals to let go. It’s a mistake not to! What Else Can We Do?

69 Read: Teddy Roosevelt

70 #13 – Understand The Power Of Being The ONE that Counts What Else Can We Do?

71 ...lives are changed forever What Else Can We Do?


Download ppt "Clinical Aftercare Specialist OneLegacy Family Services Michelle Post, MA, LMFT The One That Counts: Working with Grief & Loss and Organ Donation."

Similar presentations


Ads by Google