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.