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Leaning In and Holding On: Team Support with Unexpected Death

Kobler, Kathie MS, APN, PCNS-BC, CHPPN

MCN: The American Journal of Maternal/Child Nursing: May/June 2014 - Volume 39 - Issue 3 - p 148–154
doi: 10.1097/NMC.0000000000000028
Feature: CE Connection

Integral to the care of medically fragile infants and children is the sobering reality that not all will survive. Supporting children and families through the dying process requires knowledge, skill, compassion, and a willingness to be present to the suffering of others. As healthcare professionals journey with a dying child, they experience an ongoing dual nature of their own grief, shifting between focusing on the loss at hand or avoiding the loss and refocusing their attention elsewhere.

This internal conflict may be potentiated with the sudden, unexpected death of a patient, which affords little time for caregivers to process their own experience of the loss. When an unanticipated death occurs, a palpable grief ripples through the entire unit, impacting caregivers, the bereaved parents, and other patients and families. Such an event holds the potential for either team disorganization or growth. This article presents a case study of one unit's response to the unexpected death of a long-term patient, which caused caregivers to lean in to support each other. Using a case study approach, the author identifies strategies to best guide teams when death arrives without warning, and provides ideas for cocreating ritual to honor relationship in the midst of tragedy.

Dealing with the death of a patient is always a challenge for the health care providers involved. These nurses show us how they helped each other to cope.

Kathie Kobler is an APN, Pediatric Palliative Care, Advocate Children's Hospital, Park Ridge, IL. She can be reached via e-mail at

The author and planners have disclosed no potential conflicts of interest, financial or otherwise.

For 2 additional continuing nursing education activities on the topic of grief and 24 activities on end-of-life topics, go to

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