Effective Requesting The PROCESS of Helping Grieving Families Begin Remodeling by Becoming Grieving Donor Families Prepared by Rev. Tacuma Johnson, M.Div. Manager of Family Services Carolina Donor Services

What’s Needed at a Time of Immediate Loss / Acute Grief

What Is Needed? Competence Empathy Trust

How Do We Achieve Them? Excellent Communication Timely Communication (competence) Consistent Communication (trust) Patient Communication (empathy)

Mental/Emotional Paralysis Isolation Mental Myopia What’s Going On At a Time of Loss?

Emotional Paralysis Capacity to make decisions is hampered or eliminated. Ability to process information, to assemble facts. Give information slowly, in small increments, and repetitively. Have them verify understanding by explaining back to you.

Isolation Diminished capacity to stay connected to others. Often the people most able to help are pushed away. Self-absorbed. “My pain is so great I can’t deal with anyone/anything else.” Remind them of those present who care about them.

Mental Myopia Ability to see the world as larger than this moment and this incident and this time is hampered. Ability to see or imagine/envision the future is hampered. Remind them of the longer continuum of life that stretches to the past and the future.

So What Is Supportive Family Care at End-of-Life? Practicing Timely, Patient, and Consistent Communication to empower acutely grieving families to use their coping resources to diminish their Emotional Paralysis, Isolation, and Mental Myopia at the time of crisis.

THE DONATION CONVERSATION Must be: »Timely »Patient »Consistent

Which means, it must be... COLLABORATIVE!

Unless we work together, the donation conversation will be ill-timed, rushed, and incongruent with the other information and communication the family has received.

2 Scenarios #1 CDS contacted after final prognosis is given and the family is gathered at bedside ready to withdraw. Family told they have to wait because “you are required by law to talk to some people before we can withdraw care. That’s all I can tell you.” FSC rushes to hospital, hurries to speak to family because they have been waiting. 45 y.o. male, catastrophic brain aneurism, brain dead

2 Scenarios #2 CDS contacted before BD testing. FSC huddles with MD, RN, palliative care and chaplain to be fully informed concerning the end-of-life care plan. MD discusses prognosis and family decides to withdraw support. FSC waits quietly in the room with the RN, chaplain, and others present until MD finishes. FSC joins RN and chaplain to discuss “what happens next,” i.e. options for autopsy, memorial services, donation, hospital rituals, other family not yet present, etc.. 45 y.o. male, catastrophic brain aneurism, brain dead

Effective Requesting Was CDS referred or re-referred in time to be included in the end-of-life family care process? Did we refrain from mentioning donation too soon? Did the CDS Family Support Coordinator and the medical staff collaborate on an end-of- life family care plan, and follow through as circumstances allowed?

The Effecting Requesting Difference

Why is Effective Requesting Important? Because grieving families deserve the opportunity to choose donation as a way of saving others’ lives AND They deserve the opportunity to use donation as a tool to facilitate the work of remodeling their relationship with the departed.

THANK YOU There is no substitute for the care of patients and their families that you choose to provide everyday.