Managing time for staff to reflect after a resident's death
Singing "Amazing Grace" or playing a ukelele version of "Somewhere Over the Rainbow" may not immediately spring to mind as ways to help staff members grieve after a resident has died, but they were among the musical tributes healthcare professionals shared during a LeadingAge session Wednesday.
Helping staff working with end-of-life patients was the topic of the last session of the LeadingAge convention held in Nashville. Presenters Kristen O'Grady, MA, LCAT, MT-BC, Clinical Director for Creative Arts Therapies and Child Life, and Gordon Hutchen, M.D., medical director, both of Elizabeth Seton Pediatric Center in New York, discussed why it's important to help caregivers grieve, namely that deaths can be unprocessed, staff can be afraid to grieve, or are worried about being stigmatized. The result is feelings of inadequacy and burnout.
The first step when a patient or resident is at the end of his or her life is to have a meeting where the physician and one or two palliative care team members can give straightforward information about the plan of care. This can cut down on rumors and contextulize the wishes of the family, O'Grady noted.
In addition to memorials or services, the center has a specific program called Reflections and Melodic Moments specific for staff, where trained facilitators lead whoever appears in a time to answer questions such as “What will you remember most about this patient?” Anyone on the team can come, and O'Grady noted how meaningful it was when a housekeeper came to one session to share her memories.
The music is used to cue staff for the start and end and can change the quality of the environment. Facilitators can be social workers, pastoral care specialists or, with training, nurses and physicians, Hutchen explained. The challenge is finding a facilitator who can tolerate silence (this is not something, for example, in my skill set) and allow participants to speak when ready, instead of rattling off questions.
Towards the end of the session, which sadly had about 15 people in attendance,one provider posed a question. I'm paraphrasing, but it was essentially how to deal with stoic staff who are reluctant to participate in any type of remembrance. She said when her facility has a memorial service, it's not uncommon for staff to say “oh, that's for the residents,” or “well, that's good for the family, but I don't need that.”
My gut instinct is this is a tangled web of a problem that deals with the culture of long-term care professionals. It's a group that often feels called to work with the elderly, but also knows a skilled nursing facility is often the last place the resident will live. Still, we're making a mistake in assuming grief can be intellectually modulated. The death of a resident at age 85 is logically more expected and “natural” than the death of a pediatric patient, but that doesn't mean we can't do better in helping professional caregivers work through saying good-bye.
The low-hanging fruit in tackling this scenario is addressing workload: If a certified nursing assistant has been close with a resident who has died, there needs to be someone who can cover her shift while she attends a service, or attends a Reflections session. Secondly, administrators and executive leaders have to embrace the idea of allowing the work day to be flexible enough to include this time to mourn. I know this is not time that can be submitted for reimbursement. But making it a priority could well save you money, time and stress in allowing your staff to continue their work and renew their dedication to being in long-term care.
Elizabeth Newman is Senior Editor at McKnight's Long-Term Care News.