Organ or tissue donation and autopsy

Organ or tissue donation and autopsy

  • Meaningfulness of acting to benefit another human being
  • Common questions asked by families
  • Sensitive approach
  • Organ donation: Legislated in many states
  • Unexplained or violent death
    • Autopsy may be required by law
  • Grief and Mourning
    • Grief: A process
    • Highly individualized
      • Parental grief
        • Along with experience the primary loss of their child, many secondary losses are felt, such as 
          • The loss of part of oneself
          • Hopes and dreams for the child’s future
          • The family unit
          • Prior social and emotional community supports
          • Often spousal support.
        • Studies with bereaved parents have shown that grieving does not end with the severing of the bond with the deceased child but rather involves a continuing bond between the parent and the deceased child
        • Parental resolution of grief is a process of integrating the dead child into daily life in which the pain of losing a child is never completely gone but lessens
        • A child’s death can also challenge the marital relationship in several ways. 
        • Maternal and paternal reactions often differ
      • Sibling grief
        • Children grieve differently than adults
          • Their understanding and reactions to death depend on their age and developmental level.
          • Children grieve for a longer duration, revisiting their grief as they grow and develop new understandings of death. 
            • They do not grieve 100% of the time. 
            • They grieve in spurts and can be emotional and sad in one instance and then, just as quickly, off and playing.
            • Children express their grief through play and behavior.
            • Children can be exquisitely attuned to their parents’ grief and will try to protect them by not asking questions or by trying not to upset them. 
            • This can set the stage for the sibling to try to become the “perfect child.”
          • Children exhibit many of the grief reactions of adults, including physical sensations and illnesses, anger, guilt, sadness, loneliness, withdrawal, acting out, sleep disturbances, isolation, and search for meaning. 
        • Nurses should be attentive for signs that siblings are struggling with their grief and provide guidance to parents when possible.
    • Supporting grieving families
      • General
        • Stay with the family; sit quietly if they prefer not to talk; cry with them if desired.
        • Accept the family’s grief reactions; avoid judgmental statements (e.g., “You should be feeling better by now”).
        • Avoid offering rationalizations for the child’s death (e.g., “Your child isn’t suffering anymore”).
        • Avoid artificial consolation (e.g., “I know how you feel,” or “You are still young enough to have another baby”).
        • Deal openly with feelings such as guilt, anger, and loss of self-esteem.
        • Focus on feelings by using a feeling word in the statement (e.g., “You’re still feeling all the pain of losing a child”).
        • Refer the family to an appropriate self-help group or for professional help if needed.
      • At the time of death
        • Reassure the family that everything possible is being done for the child if they want lifesaving interventions.
        • Do everything possible to ensure the child’s comfort, especially relieving pain.
        • Provide the child and family with the opportunity to review special experiences or memories in their lives.
        • Express personal feelings of loss or frustration (e.g., “We will miss him so much,” “We tried everything; we feel so sorry that we couldn’t save her”).
        • Provide information that the family requests and be honest.
        • Respect the emotional needs of family members, such as siblings, who may need brief respites from the dying child.
        • Make every effort to arrange for family members, especially the parents, to be with the child now of death if they want to be present.
        • Allow the family to stay with the dead child for as long as they wish and to rock, hold, or bathe the child.
        • Provide practical help when possible, such as collecting the child’s belongings.
        • Arrange for spiritual support based on the family’s religious beliefs; pray with the family if no one else can stay with them.
      • Post Death
        • Attend the funeral or visitation if there was a special closeness with the family.
        • Initiate and maintain contact (e.g., sending cards, telephoning, inviting them back to the unit, making a home visit).
        • Refer to the dead child by name; discuss shared memories with the family.
        • Discourage the use of drugs and alcohol as a method of escaping grief.
        • Encourage all family members to communicate their feelings rather than remaining silent to avoid upsetting another member.
        • Emphasize that grieving is a painful process that often takes years to resolve.

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