In his well-known book Memoirs of a Geisha, author Arthur Golden profoundly writes of trauma: "After all, when a stone is dropped into a pond, the water continues quivering even after the stone has sunk to the bottom." Like ripples on the surface of water, the effects of a traumatic event can linger long after an incident itself occurs.
If you or a loved one has ever experienced a traumatic event, such as a serious injury or unexpected death, you are likely well aware of the often lengthy time and effort it takes to heal or recover. Perhaps, during this healing process, you reflect back to the initial shock and despair of learning some life-altering news. You recall who spoke the words that had such a dramatic impact on your life, your first thoughts and how you felt. Was support available to you in that moment and throughout your healing process?
In this blog post, I speak with Dr. Lori Triano-Antidormi, a psychologist who specializes in the effect of trauma on individuals. Dr. Triano-Antidormi knows first hand about trauma. She is the mother of two and a half year old Zachary who was murdered by a neighbor in 1997 (See: After death of her son, it's time to 'make noise'). She speaks from her experience and training about what frontline hospital staff dealing with traumatic events on a regular basis should keep in mind when delivering tragic news. She also suggests ways they can cope with the stress associated with being part of such an overwhelming event.
RV: What are some factors to consider when delivering life-altering news to a family who has been called to the emergency department about a family member?
LTA: Consider that this is likely the worst news they might ever hear; this event could shatter their lives. In that moment, they are trying to make sense of what has happened and they are susceptible to both positive and negative influences. Keep in mind that such information has the potential to overwhelm their coping resources.
Therefore, slow down and remember to treat them with respect, compassion and understanding. It is important to recognize the magnitude of the trauma. Give them your undivided attention. Be genuine. Be patient. Be present.
RV: What are some questions a family might ask or think about after receiving this kind of news?
LTA: It is difficult to anticipate every question you might receive. But, in the moment and state of shock, there may be a number of questions on a family member's mind and be asked more often than not: Can I see my loved one? What happened? What do I /we do now? What/who can help?
RV: In what ways do experiences with frontline hospital staff potentially impact an individual's trauma response?
LTA: Individuals exposed to such life-altering news are at risk for the development of intense psychological symptoms, such as post-traumatic stress disorder, acute stress response, anxiety, and/or depression. Receiving such news can be quite traumatizing. What we experience at the time of a traumatic incident has a significant impact on the path of recovery.
It is important to remember that the face and voice of the person delivering this news may be imprinted in their memories for a lifetime. Help them by remaining as calm as possible and facilitate a sense of safety that is so desperately needed in moments of chaos. Be understanding and supportive given support at the time of the traumatic incident is critical. A lack of support increases the risk for the development of the already mentioned psychological symptoms.
RV: What are some dos and don'ts for frontline hospital staff when working with a grieving family who has learned about the death of a loved one?
LTA: There is no right or wrong way for that individual to deal with, or react to, that trauma. Some individuals will be emotional, others will be quiet or calm, while others may avoid the situation. But there are some general guidelines to consider when talking to people experiencing a trauma.
|Be genuine, present, compassionate, understanding.||Be cold or callous.|
|Work to make them feel safe.||Judge.|
|Listen actively to determine needs (practical, safety, emotional).||Prescribe feelings.|
|Allow them to make their own decisions, with information / options discussed.||Make decisions for them.|
|Provide timely information; simple and straightforward; direct; honest. Families need the truth and need to be kept informed.||Overload them with information or provide information at the incorrect time.|
|Make sure all family members present are attended to and looked after; this may include a friend who is there to support a parent.||Concentrate on a parent only or most vocal member, ignoring other family members.|
|Use the name of the victim/deceased. If someone has died, continue to show respect for them by using their name.||Use an impersonal term such as victim/deceased to refer to the family member who has died. Use clichés (i.e. everything happens for a reason).|
|Use the word died or dead.||Avoid the situation and reality at hand.|
|Work to connect with resources.||Leave the family to find resources on their own.|
RV: What are some support groups and other community-based programs frontline hospital staff may want to let a grieving family know about?
LTA: Each family and family member will require a different coping plan and will undergo a different healing process. For individuals who would like community-based programs, a few suggestions come to mind:
- Bereaved Families of Ontario (affiliates available throughout Southern Ontario)
- Bereavement Ontario Network (members throughout Ontario)
- Friends in Grief (Hamilton-based group)
- Compassionate Friends (supporting a family after a child dies)
- Victim Services Ontario (if applicable)
- Local Homicide Groups, such as The Healing Tree (Hamilton-based group) (if applicable)
For individuals who would like specific information on pursuing legal action or obtaining individual therapy / professional treatment, I would suggest consulting a:
- Personal Injury Lawyer
- Psychologist (Ontario Psychological Association)
RV: What are some resources for frontline staff in terms of grief-counselling education?
LTA: Frontline staff looking to better understand how to deal with grief and improve their skills for dealing with such situations can do self-directed research using libraries and/or on the Internet, or consider attending seminars, conferences or college/university certificate programs. Although it's not reasonable to expect all frontline staff to become trained grief counsellors on top of their other roles, this type of general education can certainly help them with this challenging aspect of their roles.
RV: What are some ways that nurses and other frontline staff can stay healthy when faced with daily episodes of trauma?
LTA: Find out what works for you. Some individuals take on meditation and/or deep breathing. Others get their stress out through physical exercise. While others find activities that boost their mood, such as watching a comedy, reading a funny book, and spending time with loved ones. Whatever you do, it's important to get the stress out of your system in healthy ways.
Don't be shy about seeking professional help in dealing with the daily stress of trauma in the ER. This will not only help your own health but will also make you more equipped to work in the ER and will ultimately allow you to concentrate on your patient in times of need.
It's important to note that the above are tips and not prescriptions to help frontline hospital staff when dealing with families of individuals who have suffered serious injury or who have died suddenly.
The families that we help – whether in the ER at the time life-altering news is 'dropped into the pond,' during therapy in an effort to calm the ripples, and while fighting for their loved one's rights through the legal system – all want one thing: to have their loved one return home safely. In many traumatic cases this is not a reality. It is our challenge as professionals entrusted with their care to help create a sense of security and trust in our ability to help them that leaves room for them to concentrate on healing. This is not an easy feat, but we do it because we care and it is our calling to help.
I would personally like to thank Dr. Lori Triano-Antidormi for her commendable work in the field of trauma, advocacy for victims and for sharing her impactful story with me. You can read more about Dr. Lori's story here.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.