How nurses can ease families’ anguish in the aftermath of a car crash
A critical care sister explains how a shocking family tragedy gave her unique nursing insight
A critical care sister explains how a shocking family tragedy gave her unique nursing insight
- The pain of losing her sister in a car crash has changed how nurse Elaine Gordon responds to patients and their families
- Road deaths charity wants a stronger relationship with the NHS and ongoing support available to families following road crashes
- Counsellor offers practical tips on how nurses can help to ease people's distress
Elaine Gordon lost her sister Georgina Johnson, a nurse working in clinical governance, in a car crash four and a half years ago.
‘Gina was on her way to a hospital in Walsgrave in the West Midlands when another driver hit her car. He was driving over the speed limit and left the scene. A few minutes later Gina’s car caught fire and we never saw her again.’
Driver’s earlier release
The driver, Nicky Gosal, who had previous driving convictions, was eventually arrested, sentenced to eight years in prison for causing death by dangerous driving and banned from driving for ten years. He was released from prison this month.
‘The fact he hasn’t served the full eight years is very hurtful,’ says Ms Gordon, who is a sister in critical care at University Hospitals Birmingham (UHB) NHS Foundation Trust. ‘Harsher sentencing needs to be a deterrent.’
‘Tragedy gave me new compassion as a nurse’
Ms Gordon has another sister who is a nurse and one who is a healthcare assistant. ‘We are all involved in healthcare because of Gina’s passion for nursing,’ she says.
‘Although it is still difficult for me to come to terms with Gina being killed, her death has given me a new understanding and compassion for my patients and their relatives.
‘We came across the charity RoadPeace and went to a support group. It was there we learned what we were feeling is normal’
When Ms Johnson died, her family did not know where to turn for specific advice and support. ‘Then we came across the work that the charity RoadPeace was doing and went to a support group. It was there we learned what we were feeling is normal,’ says Ms Gordon.
At this year’s RCN congress, a RoadPeace stand generated great interest. The charity spoke to hundreds of nurses across all specialties, many of whom had themselves been affected by road crashes, either professionally or personally.
According to Department for Transport (DfT) statistics there are five road deaths every day in England, Scotland and Wales. The DfT also estimates there are 483,000 unreported casualties a year, of which 57,000 people probably have a serious injury.
Five ways to support people experiencing road crash trauma
Mary Goodchild is a counsellor specialising in therapy for trauma and loss. She is also lead facilitator for RoadPeace North West support group and resilience-building programme. She advises healthcare professionals to:
Give clear information People who have been in road crashes, and their families, are likely to be shocked and traumatised, and therefore unable to process information. Sometimes they are unable to speak. So it’s helpful to them if you:
- Speak slowly
- Repeat information
- Maintain a calm, gentle tone of voice
- Check understanding
- Give opportunities for families to ask further questions
- Provide written, as well as verbal, information
Never underestimate the power of kindness A touch on the arm, a smile, a kind word – these small expressions of human kindness take little time but can leave a permanent imprint
Offer choices, wherever possible Lack of choice and no control over events compounds the trauma
Offer to call someone A grieving relative or person involved in a crash may want someone they know with them at the hospital. In times of trauma we need familiar, safe people around us who can provide social support. This is a crucial resource in recovery from trauma
Signpost to relevant sources of support Local counselling services, support groups and self-help websites
For more on the charity’s support services, visit the RoadPeace website
Ms Gordon has been campaigning with Lucy Harrison, who lost her brother in similar circumstances, for a change to the practice of second post-mortem examinations. Her sister’s funeral was delayed by two months after Mr Gosal's defence team asked for a second post-mortem.
She wrote to all coroners in England to ask about their practices and gathered statements from families who were in similar situations.
Ms Gordon and Ms Harrison contacted victims’ commissioner Baroness Newlove, who arranged for them to meet the chief coroner at the Old Bailey last year. He is developing guidance for coroners on second post-mortem examinations, which he hopes to publish shortly.
Emergency department (ED) lead bereavement nurse Stephanie Winlow works alongside Ms Gordon at UHB. She says: ‘As a regional major trauma centre, we receive many road crash victims, of varying complexities.
‘Physiologically, some patients are categorised as “code red” emergency cases because their haemodynamic status is compromised as a result of major trauma, which requires immediate resuscitation in terms of haemorrhage control and circulatory support. Fortunately, other people are able to be discharged home with minimal intervention.
‘There is a focus on the ED environment and people dealing with the immediate crisis. But what is also needed is ongoing support’
Nick Simmons, chief executive, RoadPeace
‘A large part of our role in the ED is supporting the families of trauma patients. The trust’s bereavement care team contacted me about RoadPeace and I am now responsible for ensuring the ED staff are aware of the charity and how to signpost relatives.’
She says the information has been well received by families, who know there is a network of support available to them.
Ms Winlow says ED services such as in-house well-being teams offer coping mechanisms for nurses but there could be further staff support in how to signpost people to services and how to deal with families who have been affected.
Variability in ongoing support
RoadPeace chief executive Nick Simmons says: ‘It feels important that charities like ours develop a stronger relationship with the NHS. Whenever I talk to professionals in the health service it’s apparent that after a road crash there is a focus on the ED environment and people dealing with the immediate crisis.
‘But what is also needed is ongoing support and I’m surprised that at the moment there doesn’t seem to be a uniform way of providing that ongoing practical and psychological assistance.
‘What we find is a very familiar journey among people who approach us. There is the initial shock of the crash, but then they have to deal with the way the system, whether it’s the police or justice system generally, fails to support or treat them appropriately.
‘There are many instances where a serious road crash should be treated as a crime and it is not. Even the use of the term “accident” to describe a crash can minimise what has happened. Something that is truly awful becomes even more horrendous.’
Nurses need to know about support services
Last year, IT manager Glen Wall was sentenced to two years in prison after killing university graduate Helena Thurm in a road crash.
During his trial, Manchester Crown Court heard Mr Wall sped through an amber light. He had driven straight ahead in a compulsory left-turn lane and hit pedestrian Ms Thurm, who had believed it was safe to cross. Her mother Sandra Thurm, who worked as a nurse for 42 years, emphasises that ‘unexpected death or injury in a road crash is so different from a long, life-threatening illness’.
‘We should talk openly about the subject of road crashes and not clam up about bereavement’
Janette Marchbank, community learning disability nurse
‘It is difficult to prepare families for the worst tragedy they will ever experience but if nurses have more knowledge during training of the support services available, that would help,’ she says.
Janette Marchbank, a community learning disability nurse at Cheshire and Wirral Partnership NHS Foundation Trust, was 12 when her father was killed coming home from work on his moped.
She is supporting a friend whose 19-year-old daughter died as a passenger when she went out in a car with her boyfriend for the first time. ‘Teaching people about the dangers of the road when they first learn to drive is so important and as a society we should talk openly about the subject of road crashes and not clam up about bereavement,’ she says.
Drop in prosecutions
RoadPeace is concerned that Ministry of Justice data, published in May, show that prosecutions in 2018 for causing death by driving offences were down 18% on the previous year. Additionally, 7% of drivers convicted of causing a death were not given a mandatory driving ban. There was a 67% drop in sanctions for drivers using mobile phones between 2011 and 2017.
In a more positive trend, cities around the world have been committing to a target of eradicating road deaths and serious injuries. The Mayor of London’s transport strategy includes the goal that by 2041 there will be no deaths or serious injuries on London’s transport network.
‘Some may say that a target of no road crashes is naïve,’ says Mr Simmons. ‘While it might be very challenging, at the end of the day no number of road crashes is acceptable.’
Specialist support following a road crash injury
Oakwood, in Greater Manchester, is a residential service run by the charity Leonard Cheshire that provides support to individuals who acquired a disability as a result of a brain injury. Many residents have been injured in road crashes.
They receive specialist treatment from a team of therapists including support and assessment using specialist neurorehabilitation tools. A rehabilitation support worker provides individual support to maximise independence.
Leonard Cheshire head of clinical excellence Sue O'Brien says: ‘We know how important it is to support disabled people to live as full and independent a life as they choose. Our person-centred approach to care and support is tailored to the specific needs of the individual.
‘We understand that particularly after a brain injury there will be a number of everyday challenges that an affected individual will have to overcome, and these will vary from person to person. Our nursing teams are trained to identify, understand and meet these individual needs, treating people with respect at all times.’
‘What patients need most is time’
Sarah Waters is an administrator at a West Midlands rehabilitation centre and an RCN workplace representative. She had to learn to walk again after her car skidded on oil and surface water into the path of a lorry.
‘I was never able to return to the physical level where I could do general nursing, and I chose to do my dental nursing registration to remain clinical while being in a less physical role. Twelve years after being told I wouldn't be able to go back to nursing, I finally retired from a clinical role.
‘Everyone's experience is different. Although there are established treatment pathways, there shouldn't be “one size fits all” and there is no timeline for how recovery happens. Twenty-two years after my accident, I am still in treatment and recovery.
‘Early referral and access to treatment is needed but most of all, give the person affected the time to explain or ask questions about what they have been through and believe the patient without judgement.’
Petra Kendall-Raynor is a health journalist