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INTERACTION WITH THE FAMILY AFTER DEATH - SPECIFIC CONSIDERATIONS Section 8 of 10

Violent reactions from survivors are rare. However, be aware of this possibility and protect yourself. As with a potentially violent psychiatric patient, do not allow your access to the room exit to become blocked. If possible, arrange for another health professional to accompany you.

Often, survivors already suspect that their loved one is dead. When interacting with the family after death, consider the following suggestions:


Use the child's name when speaking with survivors.

Speak in short sentences. Use plain language—avoid medical jargon.

Avoid euphemisms for death (eg, "gone to a better place"); use the word dead.

Try to make eye contact and speak to all survivors, not just the most vocal ones.

Look for nonverbal communication from survivors and remember to use it as a health professional. Be aware of your body language. Try to sit. Touching an arm or shoulder can be appropriate.

If expressions of anger are directed at you or other health professionals, try to accept them without fighting back. The survivor may just be venting. If survivors have gross misconceptions, attempts at education are reasonable. If resistance is encountered, it is probably wise to return to the subject at another time and place.

Do not "hit and run." If you say something hard, remain with survivors long enough for them to absorb it emotionally.

Try to be comfortable with silence. Sometimes doing nothing is actually doing something. Your presence alone can help survivors.

Accept the family's discomfort. You can support survivors in their pain, but removal of the pain is not within your abilities as a health professional.

Do not speak philosophically or attempt to find a silver lining in discussing the death.
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SELF-CARE FOR HEALTH PROFESSIONALS Section 9 of 10

Physicians need not be embarrassed if a pediatric death produces strong feelings within them. What kind of person is totally dispassionate in the circumstances of a child's death? Do not hesitate to seek assistance from family, friends, clergy, and other professionals.

Emotional defenses are a natural reaction to a stressful situation. Physicians who are aware of their defenses are less likely to take actions that may be harmful to survivors (first do no harm).

If physicians feel frustrated or uptight over failure to save a patient, it may be wise to reset one's perception of success. Although the goal of resuscitation (and the physician's role as a health professional) is to give the patient the best opportunity for recovery, the outcome is beyond the physician's control.

If physicians feel angry because the death is due to abuse or neglect, it may be helpful to remember the limits of the physician's role. Health professionals have heard only one side of the history. Others (ie, police, courts, juries) have the responsibility to conduct an investigation, adjudicate, and assign guilt. Directing anger at the situation, but not at any individual, can avoid the possibility of causing great harm by placing guilt on the wrong person.

A health team debriefing after a death can have many benefits. Strengths and weaknesses of the resuscitation can be assessed with the goal of improving future patient care. Each team member can have an opportunity to ask questions or offer comments.
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