Chapter 1: Strategies for intervening in anticipatory grief and trauma


 “In the rush to do everything we can to save the patient from dying, we sometimes lose sight of the big picture. Sometimes the line is very thin between desperately trying to save someone and taking them off life support”. - ICU Social Worker

Many ICU staff describe heightened intensity and extraordinary measures to try and reverse an impending death. However, when death is inevitable the goals of care change. ICU staff may sometimes resist these critical transitions—from cure to comfort— for various reasons, such as:

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Insufficient training

Lack of focus in medical and nursing curricula on death and dying and the psychosocial skills needed to support patients and families at the end of life.

Reluctance to confront death

 Difficulty shifting away from a treatment approach. Death challenges everyone to face uncomfortable feelings, such as ambiguity, powerlessness, shame, and despair.

Fear of failing or abandoning the patient

When death is likely, there can be a feeling that your team has failed or is abandoning the patient. However, there are always ways to support the suffering of a patient and family at the end of life.

In this chapter, the transition from a curative approach to an end-of-life approach will be addressed, with emphasis on working with families in anticipatory grief and traumatic distress.