Circumstances - Physician Assistant Education Association2016forum.paeaonline.org/2014/wp-content/uploads/... · Group grief reactions • Inoculation effect • Women may have more

All Rights Reserved, Duke Medicine 2007

Circumstances

•  31 year old female student on surgery rotation –  Known medical issues –  Immediate notification of program

•  31 year old male student on scheduled break between preclinical and clinical years –  No known medical issues –  Complicated death notification


Initial Response

•  Case I: family already notified by facility –  Two faculty members to facility immediately –  Students on site gathered in private space –  SOM administration notified

•  Case II: family notified by police –  Hours between welfare check and

confirmation to program via Duke police and administration


Student’s Loved Ones

•  Case I –  Met with family at hospital –  Communicated by telephone and email prior to service –  Designated family member –  Call to family from Dean

•  Case II –  Communication by telephone –  Designated family member –  Call to family from Dean

•  Ask about their needs from program; provide contact information


Communication

•  How and when people are informed is critical •  Case I: Classmates either told in person or received

a personal phone call from a member of the faculty at their rotation.

•  Case II: Classmates on campus. Communication to group as a whole.


Utilizing Resources

•  Campus police •  Dean On-Call •  Counseling and Psychological Services (CAPS) •  Employee Assistance Program •  Student life/Residence life •  Chaplain


College/university policies

•  Crisis teams •  Dean of Students and student affairs leadership •  Academic Dean •  Policies regarding student death

•  Consider: –  Meeting space arrangement –  Nourishment –  Excuses for affected students –  Alternate living arrangements for impacted students


Funeral and Memorial Services

•  Communicate with designated family member •  Provide information to students, staff and faculty

when known •  Remove any barriers to attendance •  Safe transportation •  Participation in service as requested by family •  Acknowledge emotion •  Understand that some may not be emotionally

prepared to attend


Funeral and Memorial Services

•  Appreciate religious and cultural differences in memorials

•  Family’s service and memorial is paramount •  Memorials by students or university should not

eclipse or conflict with family’s service


Awareness of Perceptions

•  Provide truthful information quickly •  Keep everyone informed •  Expect confusion •  Grief is individual as well as collective

–  Communities of grief •  Anger can be a part of grief •  “Open doors” now more than ever


Condolences

•  Giving and receiving •  Acknowledging students’ loss


Group grief reactions

•  Inoculation effect •  Women may have more severe acute reactions to

peer deaths •  Students who “know” deceased more likely to have

severe reactions •  Prior trauma may exacerbate responses •  Having a large network of friends may reduce

ongoing distress •  Prior loss of close friend or family member may

mitigate acuity of reaction


Individual reactions

•  Can be affected by media exposure to deaths •  Relatively few will take advantage of counseling

offered •  Peer support matters •  Isolation, pre-existing depression cause for concern •  In some, may not be directly related to knowing

deceased •  Nature of prior patient care experience •  Cultural experience


Talking about it

•  Core themes: –  Sadness –  Helplessness –  Guilt –  Thinking about one’s own future –  Already coping with loss –  Helping the family of the deceased


Kindness to one another

•  Simply asking how students and colleagues are faring

•  Accommodating curricular requirements for students •  Understanding that there will be moments of great

sadness •  Updating students and faculty as more information is

obtained •  Anniversaries will be significant


Symbolic remembrances


Enduring remembrances

•  Strivers’ Scholarship –  Begun by a classmate of both students

•  Fiona Lawrence Diversity Scholarship in Public Health Education (UNC-G)


Graduation

•  Acknowledgement of deceased student by classmates

•  Invitation of loved ones •  Honorary certificate


Long-Term…

•  Family may need your assistance or wish to maintain contact

•  Continued work under high-stress conditions may increase student vulnerability after peer death

•  Exposure to high levels of peer loss may be associated with chronic health conditions over life span


References

•  Andersen JP, Silver RC, Steward B, Koperwas B, Kirschbaum C. Psychological and physiological responses following repeated peer death. PLoS One. 2013 Sep 27; 8(9): e75581.

•  Dean on-Call Manual, Academic Year 2014-15, Dean of Students Office, Duke University.

•  Hart H, Garza Y. Teachers’ perceptions of effects of a student’s death: a phenomenological study. Omega (Westport). 2012-2013; 66(4):301-311.

•  Hedman AS. Faculty’s empathy and academic support for grieving students. Death Stud. 2012 Nov-Dec;36(100):914-31.

•  Jelllinek MS, Okoli UD. When a student dies: organizing the school’s response. Child Adolesc Psychiatr Clin N Am. 2012 Jan;21(1):57-67. •  Jiang RS, Chou CC, Tsai PL. The grief reactions of nursing students related to

the sudden death of a classmate. J Nurs Res. 2006 (Dec);14(4):279-285. •  Servaty-Seib HL, Peterson J, Spang D. Notifying individual students of a death

loss: practical recommendations for schools and school counselors. Death Studies. 2013 Oct 29; 27: 167-186.

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In Memoriam

Fiona Lawrence 1981-2012

Marcus Johnson 1981-2012

Documents

Circumstances - Physician Assistant Education Association2016forum.paeaonline.org/2014/wp-content/uploads/... · Group grief reactions • Inoculation effect • Women may have more