Grief & Bereavement: A Practical Approach
Grief & Bereavement:A Practical ApproachIan Anderson Continuing EducationProgram in EndEnd-ofof-Life Care Ian Anderson Continuing Education Program in End-of-Life Care
Module Objectives!!!!!1.2.3.4.5.Define grief & bereavement.Describe some of the models of grief.Describe factors influencing grief.Describe complicated grief.Describe a practical approach in themanagement of grief. Ian Anderson Continuing Education Program in End-of-Life Care
Introduction to Grief!!!Grief is a normal phenomenon common toall of us.As we go through life, we experience awide variety of losses for which we grieve.It is not possible to go through life withoutsuffering losses. Ian Anderson Continuing Education Program in End-of-Life Care
Introduction to Grief!Grief is the response to any loss and is therefore acommon human experience.!!!a common but often unrecognized part of life cyclechanges.often seen as interfering with life, rather than beingintrinsic to life. SubsequentlyWe do not mentor our children concerning thisaspect of life.!we tend to protect them, not only from death, butoften also from the little losses that happenthroughout our lives Ian Anderson Continuing Education Program in End-of-Life Care
Introduction to Grief!!!A terminal illness or indeed any chronicillness is replete with successive losses andconsequent grief.Losing your own life i.e. dying isassociated with grief.Losing a loved-one is also associated withgrief. Who feels the grief – all ages, allpersons and often care providers. Ian Anderson Continuing Education Program in End-of-Life Care
Introduction to Grief!!Grief starts with the symptoms of illnessand the diagnosis of any illness.Good end-of-life care has incorporated theconcept of good grief (i.e. a healthyexpression of our life force) as part of agood death. Ian Anderson Continuing Education Program in End-of-Life Care
Grief is:! a life experience to be lived.! a mystery to be entered.! a stimulus for compassion and kindness.! a reminder of who and what we have loved.! a longing for relatedness. Ian Anderson Continuing Education Program in End-of-Life Care
Definitions!GRIEF is the process of psychological, social &somatic reactions to the perception of loss.!!MOURNING is the cultural response to grief.BEREAVEMENT is the state of havingsuffered a loss.!GRIEF WORK is the work of dealing withgrief, requiring the expenditure of physical andemotional energy. Ian Anderson Continuing Education Program in End-of-Life Care
Grief Models!!No one accepted model.Grieving tivesocial Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Compounding of Losses!A single loss will precipitate other losses.!e.g. the physical loss of a breast through amastectomy for breast cancer will causelosses in the areas of body image, sexuality,role, good health and independence. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!!Inconclusive evidence that men do morepoorly than women but there aredifferences in the way grief may behandled.There are more consequences in childrenespecially if grief is not managed well. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!Older persons in general may have lessintense & fewer reactions but this dependssomewhat on the relationship to thedeceased.!Often overlooked is the intense griefsubsequent to the loss of adult children. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!!Poor physical health may limit the abilityto expend the necessary physical andpsychic energy to integrate grief into ourlives.The use of drugs such as psychotropicagents. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!!A previous history of psychiatric problemsor addictions like alcoholism.There are few conclusive studies about theinfluence of personality variables and thecourse and outcomes of grief. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!!!!Patterns of coping.Past or current experiences with grief.Current other psychological or socialproblems or crises.Culture, ethnicity & religion. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Bereaved!!!!There is a unique nature to eachrelationship.The role that deceased had in family e.g thepower authority in the family.The amount of unfinished business in therelationship.Dysfunctional families will react in theirusual patterns – they will be dysfunctional! Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:The Nature of the Death!!!There are no studies indicating significantdifferences between acute vs. chronicdeaths as far as outcomes are concerned butmany of studies have not been done inpopulations receiving good palliative care.Violent deaths such as those secondary tocrime or accidental deaths.Suicidal death. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Characteristics of the Deceased!!!The age of the deceased particularly ifyoung will affect the course and outcomesof grief.The type of person the deceased was.The timeliness (e.g. at retirement, aroundthe time of an important event such as thebirth of a grandchild, a marriage of a child,etc.) may influence the course and outcomeof grief. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:The Adequacy of Social Support!!!Persons lacking or withdrawing fromsupport may have worse outcomes.Remarriage or other close or intimaterelationships protect.Culture. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Gender Issues!Men may have different coping styles thanwomen:!!!!!To remain silent.To engage in solitary mourning or “secret”grief.To take physical or legal action.To become immersed in activity.To exhibit addictive behaviour. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Children & Grief!!!!Children of all ages grieve & grief isparticular to age groups.Children should not be protected fromgrief, funerals or issues of death & dying.They need to be educated in terms they canunderstand.Parents must be involved in the education. Ian Anderson Continuing Education Program in End-of-Life Care
Background Issues and Factors in Grief:Children & Grief!Children cope with grief according to theirdevelopmental stage & may re-visit agrieving situation as they reach newdevelopmental stages.!for example, a death witnessed as a toddlercan resurface & need to be addressed again ina 7-year-old. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief!Need to be interpreted not necessarily assequential but more likely concurrentprocesses through much of the griefexperiences that change and remit overtime until healing occurs. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of Normal Grief:Acute or Self Protective Phase!!!!Initial shock, denial and disbelief.May feel dissociated from the world around themIf family well prepared, there may not be thesame amount of shock or avoidance.Sometimes initially see an intellectualizedacceptance without an emotional component asan initial denial of the loss, rather than anecessary self protective mechanism. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation:!!Most intense experience of grief.Emotional extremes common.!!an emotional “roller coaster”.Rapid and large swings in emotion oftencause fear & more anxiety. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation:!Anger is a common component includinganger that may be directed towardsphysicians and other health care teammembers. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation:!Guilt, inwardly directed anger, confrontsthe bereaved with questions of :!!“What if I had .?”, “Did I do enough?”,“What did I do wrong?” “What did I do todeserve this?”Guilt around so- called survivor guilt.!“Why wasn’t it me?” Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation:!!!!!Sadness & despair.Inability to concentrate or processinformation.Preoccupation with the deceased.Over time the extreme emotional swingslessen.Intermittent denial may also occur. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation!Social manifestations of this phase include:!!!!Restlessness & inability to sit still.Lack of ability to initiate & maintainorganized patterns of activity.Difficulty completing or concentrating ontasks at work.Withdrawal from the very people who may beable to help. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation!Physiological or somatic manifestations ofgrief are common:!!Often these complaints bring the bereavedinto physicians’ offices.The elderly bereaved are a groupvulnerable to illness and physicalsymptoms must be addressed appropriately. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Confrontation!Spiritual issues:!!!!The basic search for meaning and value inlife, i.e. “who am I?”The feeling of abandonment & anger.Fear of the unknown.Finding a secular framework to face theunknown – the mystery of death. Ian Anderson Continuing Education Program in End-of-Life Care
Psychological Phases of NormalGrief: Reestablishment:!!!Grief gradually softens to an “acceptance”of the reality of the loss.Gradual decline in symptoms as griefbecomes integrated into life.Grief is compartmentalized but periods ofgrief may arise at specific times such asholidays, birthdays, etc. Ian Anderson Continuing Education Program in End-of-Life Care
Complicated Grief1.2.3.4.5.Delayed or absent grief.Conflicted grief.Chronic grief.Psychiatric disturbances associated withgrief.Physical illness associated with grief. Ian Anderson Continuing Education Program in End-of-Life Care
The Four Tasks of Mourning(Worden)!!!!To accept the reality of the loss.To experience the pain of grief.To adjust to an environment in which thedeceased is missing.To withdraw emotional energy and reinvestit in other relationships. Ian Anderson Continuing Education Program in End-of-Life Care
Grief Counseling Goals!!!!To increase the reality of the loss.To help the bereaved deal with both experienced& latent affect.To help the bereaved overcome impediments toreadjustment.To encourage the bereaved to make a healthyemotional withdrawal from the deceased &reinvest energy into other relationships Ian Anderson Continuing Education Program in End-of-Life Care
Management: Basic Issues1.2.3.Begin grief counseling if possible whilethe patient is still alive.The family is the unit of care.Grief is a normative process and requiresmuch listening and often not a lot ofintervention on the part of the counselor. Ian Anderson Continuing Education Program in End-of-Life Care
Management: Basic Issues4.Allow sufficient time to grieve.!!!!Most people resolve to a level of functioning aroundone year.Some individuals and families will accomplish thetasks of grieving in two years.Advocate for sufficient time off from work for thebereaved especially in the first few weeks ofbereavement.Discuss the fact that grief spikes continue for lifethrough events, holidays and “anniversary” reactions. Ian Anderson Continuing Education Program in End-of-Life Care
Management : Basic Issues5.Emphasize the role of the funeral and ofmemorial service.!!Encourage families to bring children to these rites.Consider having memorial services in hospitals,agencies and palliative care programs for bereavedfamilies and for staff.6. Medications, particularly tranquillizers andantidepressants are usually not needed for anysustained period of time. Ian Anderson Continuing Education Program in End-of-Life Care
Management: Basic Issues7. Contact the bereaved at regular intervals.! Definitely monitor any families with high riskfor grief problems.8. Identify concurrent problems that mayinterfere with normal grief. Ian Anderson Continuing Education Program in End-of-Life Care
Management: Basic Issues9. Use resource books that have been writtenon grief to help the bereaved.10. Monitor children at school for griefproblems manifesting as school problems.11. Investigate to see what types ofbereavement programs exist in yourcommunity. Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Worka) Family (friendship) orientated:!The ability to accept loss is at the heart of allskills in healthy family relation.b) Relational:!Opportunities for resolution, forgiveness,gratitude. Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Workc) Intergenerational:!!!!!!!!How we want to be remembered.Legacy work e.g. what are we leaving behind as alegacy.Healthy and effective parenting model.Mentorship re: coping skills with children.Decreasing fear in future generations.Teaching children.Learning from children.People die, relationships don’t. Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Workd) Psycho educative:!!Anxiety about the unknown.What changes to expect.! Forewarned is forearmed.! Physical & emotional.! Changing family dynamics/roles. Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Worke) Harm reductive/preventative:! Identifying destructive coping mechanisms.i.e. alcohol/drug use.f) Community oriented:! Looking at the larger social interaction e.g. inschool or workplace.g) Active:! What we need to do in order to integrate howwe are changed? Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Workh) Narrative:!Richly descriptive in elucidating personalmeaning – ‘Tell me what it is you see deathor this loss as?”i) Supportive:!Facilitating the safe containment of emotionalspace. Ian Anderson Continuing Education Program in End-of-Life Care
Nature of Grief Workj) Intrapsychic:!Facilitating connection to our own deeperwisdom and ability to heal ourselves.k) Spiritually supportive:!We are dealing with the unknown, with life’smysteries. Ian Anderson Continuing Education Program in End-of-Life Care
Summary!!!Grieving is the active way by which weincorporate grief into our lives and discover howwe are changed by it.It is open ended and is continually transformed aswe go through life and experience further losses.As caregivers we need to be self-aware.If we cannot bear our own grief, it will be hard towork in the presence of another person’s grief. Ian Anderson Continuing Education Program in End-of-Life Care
' Ian Anderson Continuing Education Program in End-of-Life Care Introduction to Grief! Grief is the respons
Practice - Focused Training in Prolonged Grief Disorder Therapy Day 2 Prolonged Grief Infographic Accept the reality Bereavement Acute Grief Restore capacity to thrive Defensive coping (Pause Points) Adapt to changes Integrated Grief Changes due to the loss Prolonged Grief Accept the reality Bereavement Acute Grief Restore capacity
Pre-requirement: Completion of RTS Bereavement Training: Perinatal Death or RTS Bereavement Training: Pediatric & Adult Death Advanced Skills in Perinatal Bereavement Care Those who provide perinatal bereavement care often ask about education that will take them beyond the basics. That's what this workshop is designed to do.
Grief is a normal phenomenon common to all of us. As we go through life, we experience a wide variety of losses for which we grieve. It is not possible to go through life without suffering losses. Grief is the response to any loss and is therefore a common human experience. Grief is a common but often unrecognized part of life cycle changes.
Examples of bereavement programs and evaluation of outcomes Site Bereavement Components Evaluation Cardiac ICU A bereavement packet mailed to families at 4 wk with a list of support groups in the area and 7 brochures with information on grief A sympathy card
Wadsworth/Thomson Learning. Worden, W. J. (2009). Grief Counseling and Grief Therapy: A Guide for the Mental Health Practitioner (4 th ed). New York, N.Y.: Springer Publishing Co. Course Content Given the prevalence of grief issues within the fie
Bereavement Training: Perinatal Death Acquire the skills needed to provide gold-standard bereavement care. Learn evidence-based bereavement best practices. Reduce healthcare disparities while supporting diverse grieving populations. Learn strategies to care for yourself and support your colleagues. In-Person Training La Crosse, WI
Deepest Sympathy; Door Card; Gone But Not Forgotten Card; Embossed Note Cards; When Your Child is Dying; Family and Friends (when a child dies and when a loved one dies). RTS 2021-E / RTS 2021-S 19.95 Perinatal/Infant Bereavement Sample Kit The Perinatal Bereavement Sample
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