The Complex Crisis Grief Response is a protocol that provides assistance to UWHC health care professionals as they provide care for Emergency Department and inpatient patients, family and friends during a difficult crisis grief response. This protocol should be considered if there is a situation which involves a group of family/friends with 10 or more people. It should also be considered for implementation if a smaller number of people are involved but the situation is unstable or may draw media attention. UWHC has created a protocol and a complex crisis grief response team to respond to these events. The team enlists appropriate resources and communication tools, and provides effective support to patients, family, and friends in unique crisis situations. The ultimate goal is to ensure that patient and family are well cared for, well informed, and feel that their needs are recognized and supported.
Health professionals address crisis and grief on a daily basis. However, family and friends of patients do not have the same exposure to tragedy and grief. With each crisis grief incident the response will be unique and varied. The patient/family response to a patient situation is more extreme at some times than at others. Culture, the age of the patient, life events and many other factors impact on the response to unexpected events and to tragedy.
Indications for Activating the Complex Crisis Grief Response Team
The Complex Crisis Grief Team may be activated when any of the following clinical situations occur:
- Traumas when some or all of the following conditions may occur and there is potential disruption to the ED or the specific unit:
- Multivictim traumas with five to ten or more family/friends present and agitation, aggressive behavior, and/or other extreme emotional behavior are manifested
- Multiple victims’ families present with an element of discord among the groups
- Traumas where there is a large family response and the family’s grief response is very vocal, displaying outward emotions and high intensity of feelings
- Patients/families who may be public figures or serve in a capacity where there may be a large scale media response.
- Crime victims or other events where it is anticipated that there may be a large family/friend response, multiple law enforcement agencies, and/or a media presence.
The team should not be activated for multivictim, individual grief or smaller-scale situations in which the Primary Nurse and Social Worker, along with the health care team, have assessed the situation and are comfortable in managing the response.
Crisis Grief Team
The team responds to both adult and pediatric events, both inpatient and in the Emergency Department.. The team should not be activated for individual grief or small-scale situations which are managed by the Primary Nurse and Social Worker along with the health care team.
Members of the Grief Crisis Team include:
- Primary Nurse (PN)
- Social Worker (SW)
- Clinical Nurse Manager (CNM)
- Physician (MD) or Medical Director as appropriate
- Nursing Coordinator(s)
- Manager of Social Work and Spiritual Care Services (MSWSC)/ Director of Coordinated Care
- Director of Nursing Operations Support (DON-OS)
- Psychiatric Liaison Clinical Nurse Specialist (PL-CNS)
- Psychiatry, as needed
- Chaplains, as needed
- Health Psychologists, as needed
Emergency Department Procedure
When a situation begins in the Emergency Department (ED), the Primary Nurse (PN) notifies the ED Social Worker (SW) and Security. The PN and the SW consult with the physician, the care team leader/nurse manager, and the nursing coordinator. In the absence of the regularly scheduled ED SW, the nursing coordinator notifies the on call SW as needed. The nursing coordinator or SW contact the MSWSC/or Director of Coordinated Care, the DON-OS, and/or the PL-CNS for guidance. These individuals can help to activate the protocol, mobilize additional staff, and serve as contact persons.
Inpatient Unit Procedure
When a situation begins on an inpatient unit, and there is potential activation of the protocol, the PN or Team Nurse notifies the SW assigned to the service and consults with the physician, the CNM/care team leader and the nursing coordinator. An alert is also sent to Security. In the absence of the regularly scheduled SW, the nursing coordinator notifies the on call SW as needed. The SW or nursing coordinator calls Security, MSWSC/or Director of Coordinated Care, the DON-OS, and/or the PL-CNS as noted above.
ED/Inpatient Unit Activation
Upon activation the SW and PN collaborate to provide support and facilitate communication with the patient family/friends. They coordinate with Security. The SW takes the lead in monitoring and supporting family needs. This is done with assistance from the MSWSC/Director of Coordinated Care, other SW’s, the PL-CNS, chaplains and health psychologists as necessary. Patient Relations and Public Affairs should also be included for informational purposes. The SW identifies the key family member(s) who is to receive information updates and determines who will be the decision maker if the patient is unable to make his/her own decisions, and lacks an Advance Medical Directive. Community resources are considered and brought in as appropriate.
If the protocol is activated it is recommended that the SW or designee contact the following persons in the order given:
- Nursing Coordinator(s)
- CNM/Director for Unit/Service
- Security (if not already informed)
- Patient’s Physician and/or Medical Director (if not already involved)
- Director of Nursing Operation Support
- Manager Social Work /Spiritual Care Services or Director of Coordinated Care
- Patient Relations
- Psychiatric Liaison CNS
- Health Psychology Supervisor
- Nursing Administrator on Call (as needed)
- Public Affairs (as needed)
Roles of Director of Nursing Operations Support
The DON-OS monitors the situation while the protocol is activated, consults with the MSWSC/Director of Coordinated Care and PL-CNS regarding any additional resources that are required, and updates administrative personnel as needed.
Role of the Psychiatric Liaison CNS and Manager, Social Work/Spiritual Care Services
The PL-CNS and MSWSC assist with patient and family needs, determining additional resources that may be needed. They may provide supportive family interventions via small group. (Grief crisis response debriefings and evaluation with the staff will be conducted by the PL-CNS after the event.)