Counselling skills : Counselling a relative about sudden cardiac arrest and death of their husband

 Counselling a relative about sudden cardiac arrest and death of their husband

You are a junior doctor in the cardiac arrest team.

Mr X a 80 year old man was admitted with end stage Cardiac failure 5 days ago.

He suddenly suffered a cardiac arrest and resuscitation attempts ere not successful.

The charge ward sister wants you to speak to wifeof Mr X that he has died

Key principles :

Quiet room

No disturbance

Take nurse with you.

Leave your bleep and turn off the mobile phone.

The room should ideally be in the ward with accessibility to a landline phone.

There should be supply of tissue papers

Introduce yourself to the patient”s relative / wife and also the member of the staff & confirm her identity as well.

Also explain your role in the care pathway of the patient ie Junior doctor of Cardiac arrest team.

Exact relationship to the patient should be sought ie wife or daughter.

Be very elaborative in explaining exactly what has happened 

The patient had been doing poorly recently and then suddenly suffered a cardiac arrest.

Resuscitation was attempted but was futile and patient has died.

As this could be traumatizing and unexpected for the patient , hence let the information sink in and let the patient asks any questions .

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Introduce

Ask her what she knows about her husband already.

Poor state at time of admission.

It could be that the nurse might have not told her that her husband has actually died and only phoned her that he is doing poorly and she should come to the hospital immediately.

So it is very important to explore from her , how much she knows already or why she has been called to the hospital in order to take it from there.

After the wife understands, she may have some questions to ask

Why did this happen

Explain that his heart had been weak since he had advanced CCF

As a result his heart had not been able to pump efficiently and was unable to pump blood to the vital organs of the body and itself had grown weaker over time.

Wife may ask : What did you do to treat it

Explain when a cardiac arrest call was made , we gave him Oxygen and performed a cardiac massage and gave intravenous medications to try to help the heart back to its normal function and rhythm.

We also pressed up and down on the heart / chest to ensure blood keeps pumping blood to vital organs of the body.

Apart from that we gave  an electric shock called defibrillation to the heart to try to get the heart its electrical activity.

But all these measures proved futile and unfortunately his heart could not start to function again and he passed away and we are very sorry about it.

Wife may ask : did he feel any pain during the resuscitation

Answer : He became unconscious and it is unlikely he would have felt any pain at all.

Wife may ask : The resuscitation shown on TV is usually very successful

Explain in real life the figures are very low.

Heart beat inly returns to normal only in 30 % of pateints  who have cardiac arrest inside hospital and  resuscitation is successful.

And out of these 30 % only half actually survive and are fit enough later for a discharge.

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