Ten-Finger Exercises

Grievances and the Candy Factory

Today's meeting came as a result of a discussion our staff had several months ago on the topic of grieving.

As you might guess, hospice work is not always easy. Some of our nurses are new to this specialty, and they, particularly. are finding it hard to let go and go on. I've heard some comments before, but heard them more clearly today.

We have tried several things in the past to help deal with our own grief. We've had memorial services quarterly, remembering the people who died and their families. That was done before I came to hospice last year, but evidently was not felt to be very effective, or even very well attended by staff. One social worker tried presenting a short piece about the patients who had died that week at the end of each weekly interdisciplinary group, but some didn't want to stay any later so that practice was abandoned. One of the staff, who had worked for a hospice in another state, mentioned the regular groups their staff held, facilitated by a professional outside the hospice system. A committee was formed, a date set, a psychologist booked, and we met today for the first time.

Right off the bat I could see there was a mixed agenda. Several people wanted help with their own grief, and several wanted our office to change the way we do things, somehow. Several, in other words, had grievances about the way we do bereavement for families and the way we assign new patients without regard to the feelings of the nurse who just lost a patient.

Management was not invited to this, but had made the contact with the psychologist, who did a good job given his limited instructions. He volunteered his time, as he has before with our annual camp for children who have lost a family member. He gave more of a presentation than some of us expected, but it was a good one, filled with personal experience and emotion. He did less facilitation of the group that we expected. I think that the "grievance" part of the picture had come as a surprise to him too.

People had their only real chance to talk at the end of the meeting, in the third hour. One nurse described her difficulty with new admits the same day a favorite patient died. I suppose it stands to reason that if you lose a patient, you're the next one up for a new one, but it presents problems.

As she talked, I had the picture of Lucy and Ethel in the candy factory; except instead of just wrapping paper around the candies, we're talking about real people. That is a bizarre comparison, but it helped them find the word they needed to lodge a complaint about how we do things. Everything is too mechanical. They don't have enough breathing time to honor someone. It becomes dehumanizing, jumping from one nice (or not nice) family to another, trying our best to make their last days meaningful but not allowing those days to be meaningful to staff as well. This is particularly true for nurses, who spend so much more time with patients and families than the other staff.

To give you a little break from all this heavy stuff, here's the famous candy factory video. Maybe we should show it at staff meeting.

http://video.google.com/videoplay?docid=-2151128672389072724

I have two suggestions to present. One is that we use a small room for a memory room, a quiet room where we have a list of the patients who die, with maybe a candle and flowers, (battery operated candle, of course,) and a bulletin board where we can post the obituaries and funeral leaflets.

The second is that, where we usually have a prayer before our interdisciplinary meeting, that I make sure to mention at that time any patients who have died and their families. Sometimes we don't hear about the deaths until we notice their name is omitted in the listing of current patients, or people are ripping their pages out of the notebooks of patients, or shredding the pages. As rituals go, the shredding of the cardex page is pretty unfeeling.