need help with bereavement committee

Pediatric Critical Care Columnist · Oct 19, 2007

Our unit has a well-developed bereavement package. Everything is contained in a Rubbermaid storage bin. We have two sizes of bin to accmmodate the different things appropriate to the age of the child. Each bin holds a quilt and a memory box to hold things like a lock of hair, the child's name card (our nursing assistants make decorative name cards for each patient using scrapbooking materials, which are then laminated and taped to the monitors), hospital bracelets, get well cards, and any other items that might be desired. There's a booklet on grief written for parents and another for siblings. We will make footprints of infants, and handprints of all others. One teenager with severe, chronic problems even had a mold made of her hand clasped in that of her sister's. If the parent wants photos, we have a Polaroid camera, and access to a high-quality digital camera and printer. The nurse caring for the child at the time of death writes a note to the family to be included in the package. All the contact information for our grief counsellor, chaplain, social worker and the nursing staff are included as well, so that the family can call for support at any time. And many do. We have a sympathy card that sits at the nurses' station for all who wish to to record their feelings for the family; it is mailed out about 2 weeks after the death. Then we do a follow-up at six months. We also have semiannual memorial services for the children who have died in the preceeding six months. Families, friends and staff are invited to attend; there is a small reception afterward so the families can reconnect with the people they bonded with and every single one of these services is well attended. If you like, I can get you an itemized list of what's in the box and the rest of the process. Just let me know. Bless you for taking this on!

oupedsrn · Oct 21, 2007

I would love an itemized list or whatever more info you can give me. Thank you so much for your help.

Pediatric Critical Care Columnist · Oct 21, 2007

I'll email our chaplain and see what I can get from her.

kessadawn, BSN, RN · Oct 21, 2007

Our unit has a well-developed bereavement package. Everything is contained in a Rubbermaid storage bin. We have two sizes of bin to accmmodate the different things appropriate to the age of the child. Each bin holds a quilt and a memory box to hold things like a lock of hair, the child's name card (our nursing assistants make decorative name cards for each patient using scrapbooking materials, which are then laminated and taped to the monitors), hospital bracelets, get well cards, and any other items that might be desired. There's a booklet on grief written for parents and another for siblings. We will make footprints of infants, and handprints of all others. One teenager with severe, chronic problems even had a mold made of her hand clasped in that of her sister's. If the parent wants photos, we have a Polaroid camera, and access to a high-quality digital camera and printer. The nurse caring for the child at the time of death writes a note to the family to be included in the package. All the contact information for our grief counsellor, chaplain, social worker and the nursing staff are included as well, so that the family can call for support at any time. And many do. We have a sympathy card that sits at the nurses' station for all who wish to to record their feelings for the family; it is mailed out about 2 weeks after the death. Then we do a follow-up at six months. We also have semiannual memorial services for the children who have died in the preceeding six months. Families, friends and staff are invited to attend; there is a small reception afterward so the families can reconnect with the people they bonded with and every single one of these services is well attended. If you like, I can get you an itemized list of what's in the box and the rest of the process. Just let me know. Bless you for taking this on!

This sounds very similar to what our PICU does when a child dies. In addition, I helped initiate a program we call "Huggy Bears." It's to assist siblings in the grief process. When a child passes, each sibling recieves a small, soft, very huggable teddy bear with a tag that reads something like:

"Hi, my name is Huggy Bear. I know you miss your (brother/sister) very much, and I want to help you feel better. Anytime you need to talk to him/her, you can whisper your secrets in my ear, and I shall pass the message along. I also carry tons of hugs from your sister/brother in my tummy, and you can have one anytime you want, I will never run out! I hope we can be good friends!"

Feel free to use this idea, I borrowed it from an ingenious preschool teacher who was very concerned for one of her young pupils after the loss of an infant sister. That pupil is almost 12 yrs old, and still sleeps with her bear every night. We started the program in ouer PICU intending to assist the younger sibling, but I have given them to teenage sibs who seemed to respond to it.

Good luck, I think death/dying and bereavement is one of the most challenging parts of our job inpediatrics, and I just love it when people really want to get involved when most think it's easier to just ignore it, maybe it'll go away.

FranEMTnurse, CNA, LPN, EMT-I · Oct 21, 2007

if you want to hear god laugh, tell him your plans.

humor is like a rubber sword. you can make your point without drawing blood.

i love this jan.

AliRae · Oct 23, 2007

I helped initiate a program we call "Huggy Bears."

This sounds like such a good idea. I think I'll talk to my child life department about this!

smjb22 · Jun 23, 2008

Thanks for your detailed post! We are establishing a bereavement committee in our PICU and are looking for ideas to make it better. I took notes on your post and will bring them to our meeting tomorrow to share--thank you!!

gal220RN, BSN, RN · Jun 26, 2008

kessadawn: What a beautiful idea for the huggy bears- I am going to pass it on

We also have a very specific process for bereavement, including a lovely memory box. We include hand prints, locks of hair, pictures ( we take them no matter what and then ask after the death multiple times if the family would like us to include them. Sometimes, they will say no, then change their minds later.) We also do hand and feet molds when possible. We have staff sign letters for year memorials. We also include anything in the memory box the family requests, blankets, clothing, etc. Once I had a father ask to take home the pulse ox cable, ECG leads and IV board. I didn't even blink, but included them in the box.

Our problem comes on the weekends or holidays when our PICU chaplain and child life specialist are not there. We have chaplains on call, but they are usually students doing their hospitals rotations, having no idea how to cope with the death of children, the developmental considerations for siblings ,etc. The PICU nurses have had to learn how to deal with the details- calling funeral homes, organizing baptisms. This is hard, especially when we are dealing with the patient, the parents and the actual process of dying.

A GREAT resource, one of my favorite dog-earred books I read from time to time, is Elizabeth Kubler-Ross "On Children and Death." Wonderful information, comforting and strangely uplifting. Purchase a copy, read it and pass it on to your colleagues.

Godspeed, dear friend. There is no more important task than the one you are undertaking.

allnurses Guide · Jul 3, 2008

When we had to withdraw life support from Joseph, the hospital had memory boxes prepared, one for me and one for Joseph's dad (we are divorced). They were very pretty boxes that tied on top with a green ribbon and are made of some kind of soft paper with bits of nature dried into the paper...hard to describe. The boxes are lovely, padded, inside the inner flaps are spaces to put two pictures...frames of a sort. They did handprints, took some of his hair (sporifice due to chemo but still better than nothing) and put it in a little baggie in there, offered to take pictures of our hands with his hands, took pictures of him etc. They gave us a packet of information that included brochures from community resources for grieving families (Compassionate Friends, here in Dallas there is Camp Sol, The Gilda Club, etc) and some poems as well as information on what to expect from the grieving process, both for us and for Joseph's siblings. The staff signed sympathy cards and even took it up to the other floors he'd been treated on during the course of his illness for those nurses to sign as well. We were allowed to touch, hold, spend as much time with Joseph after his passing as we wanted. We were given absolute control over the room at the time of his death (ie monitors off or on, who was in there and who was not, whether to give him morphine prior to turning off the oscillator and probably a ton of stuff I can't remember). Prior to his death, Joseph's brothers were brought in and were told Joseph was going to die by his father and I along with the child life specialist and social worker. And they were given the opportunity to go say their own goodbyes.

The one touch that really stays with me to this day, and I do not know how the hospital organized it, was that when we were leaving for the last time, after having signed all the papers for the autopsy and there was nothing left to do, Joseph was gone.....somehow the parking attendants had been let know we were coming. And they opened the parking gates for every member of our family and let us through without having to pay. We were so numb and so bereft and shocked...but that little touch of kindness continues to impress me so very much. It was very late by the time we left, around 9 PM, but I have no idea to this day how they knew which parking gate we were going out of, what cars we were in etc. It was so so impressive and so incredibly considerate.