Center to Advance Palliative Care

1. I agree that timing is a huge issue/challenge. So is the need for nurses to stay in "operational mode" for the rest of the shift, and then their desire to just get home.

2. In our ER, EAP and I have done "Defusings" and "Crisis Management Briefings" (ICISF model). The 7-step CISD really takes a long time, and with budgets being what they are, there is a reluctance to plan for a CISD. What we have seen is that, after a series of - let's say - pediatric traumas - mgt and staff will voice a need for an intervention, and we usually do a defusing. If there is some controversy surrounding a death, we use the CMB, since credible info is the first need before processing. Also, be aware of the appropriate "positive" aspects of processing after a death, i. e., "well, in spite of everything, someone's got to be there for our people...I'm glad that I can be here for them..."

3. Also, look at the December 2008 cover story of RN Magazine - rn.modern.medicine.com - and click through the archives. This is a great program at the Univ of MO Health System that emphasizes training nursing peers and front-line supervisors to give immediate and continuing emotional support to nursing. Granted this is geared towards medical errors and sentinel events, but the concept has a great deal of merit. I am aware, as you are, that most of the support nurses receive is from their peers, not from chaplaincy. This is a research-based program, and I have been in touch with the authors of the article at U of MO for about three years as they have developed it, and there is a lot of input from chaplaincy and the ICISF model.

We are watching the U of MO program and want to bring it to our hospitals in about a year, when U of MO feels more confident about taking it on the road, after their second round of surveys and data crunching.

4. Meanwhile, I've trained a number of our nursing floors' clinical educators in the ICISF Individual Crisis Intervention and Peer Support class/model. These clinical educators tend to be long-time, seasoned, and well-respected nurses who have chosen not to progress through up to the supervisor/managerial ranks. They tend to be the ones who support nurses on their units who experience loss and death. So, they are a natural partner with chaplaincy.

Randy Miota
Manager of Chaplaincy Services
Lakeland HealthCare
St. Joseph, MI