5/10/2018 MODULE 9 LOSS, GRIEF, AND BEREAVEMENT. Loss, Grief, and Bereavement. Definitions. America is a death denying society

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1 Curriculum MODULE 9 LOSS, GRIEF, AND BEREAVEMENT Loss, Grief, and Bereavement America is a death denying society Affects the family unit, community and healthcare providers Grief is an individual process Bergstraesser et al., 2014 Definitions Loss is the absence of a possession or person Grief is the emotional response to loss Mourning is the outward, social expression of loss Bereavement includes grief and mourning Strongly influenced by culture Corless, 2015; Limbo & Davies,

2 Models / Theories of Grief Stage/phase or medical models Criticism of these models Grief work theories relearning the world Relinquish attachment to the deceased Adjust to life without the deceased Develop a new relationship with the deceased Kissane & Zaider, 2015; Grief Work Begins before death Task oriented Not orderly or predictable No one gets over it Leads to living with the death Healing occurs when the pain is less Grief as Relearning the World Relearning physical surroundings Relearning social surrounding Relearning aspects of the self Relearning the relationship with the child 2

3 Anticipatory Grief Definition Actual or fear of potential loss(es) Children s responses to the illness is a form of their anticipatory grief Intervention Does not lessen intensity of grief after death Complicated Grief More intense and longer in duration than expected Types of complicated grief Chronic Delayed Exaggerated Masked Risk factors Perinatal and Neonatal Loss Medical management Lactation consultant/postpartum care Genetics counseling Psychological and social care Disenfranchised grief Siblings 3

4 Factors Affecting the Grief Process Individual factors History and relationship Previous experience with death Developmental level Personality and coping style Factors Affecting the Grief Process (cont.) Environmental factors Deceased child s role in the family Family characteristics Social/cultural characteristics Factors Affecting the Grief Process (cont.) Situational factors Characteristics of the child s illness/death Involvement in the illness/death related events 4

5 Circumstances Where Special Care May Be Needed Sudden or traumatic death Suicide, homicide Multiple losses Unresolved grief from prior losses Unique Aspects of Grief in Children Developmental stages Grief in young children Grief in older children Fiorelli, 2011 Effects of Grief The dying child Related to personal awareness Range of feelings Anger Anxiety Sadness Loneliness Fear 5

6 Effects of Grief (cont.) On the family The parent(s): Relationship is like no other Responsible for protecting child Mother and father have unique experiences Special at risk parents Effects of Grief (cont.) On the sibling(s) Loss is 3 fold Sibling needs Difficulty transitioning back to normal life Validation of sibling grief Lövgren et al., 2016; Machajewski & Kronk, 2013; Rosenberg et al., 2015 Effects of Grief (cont.) On the grandparent(s) Source of strength Grief is two fold, for parents and child 6

7 The Nurse s Role in Grief and Bereavement Provide reassurance and validation of feelings Assessment Utilize interdisciplinary team Grief Assessment Who: child, family, significant others When: time of diagnosis ongoing process Grief assessment includes Interdisciplinary approach Assess for factors which affect grief Assess risk factors for complicated grief Corless, 2015; Grief Assessment (cont.) Physical assessment of caregivers Assess psycho/physiologic responses Siblings at risk Corless, 2015; 7

8 Grief Interventions: Family Provide presence Active listening, touch, silence, reassurance Follow up bereavement phone calls Identify support systems Make referrals, as appropriate Normalize & individualize the grief process Actualize the loss & facilitate living without the deceased Grief Interventions: Children Interventions match developmental level Involve/include in funerals, memorial services Address fears, listen/reassure Allow to express grief/validate feelings Model grief behavior Play, art, music therapies Grief Interventions: Schools Preparing students Understand what the bereaved child wants their peers to know Provide guidance of what to say/do Peer death Staff support 8

9 Grief Interventions: Parents Before death Communication Evaluate helpful support Memories Funeral planning ; Meisenhelder & Gibson, 2015 Bereavement Interventions: Parents Follow up by HCPs Bereavement follow up phone calls Meeting with child s doctor Identify support systems Social support Refer to support groups Allow time to talk about feelings, normalize grief The Nurse: Death Anxiety, Cumulative Loss, Grief Death anxiety Defenses Personal death awareness Vachon et al.,

10 Cumulative Loss Succession of losses experienced by nurses May not have time to resolve losses before another loss occurs Caregiver suffering Moral distress and grief Bearing witness to others suffering ; Vachon et al., 2015 I was required to confront my own pain in nursing and the pain of those around me. The challenge was to create some distance from the pain, yet remain caring and human. ~ Beth Perry Black Nursing Differs From Other Professions Competence in caring is widely accepted as a foundational value that distinguishes nursing from other professions. Nurses are gifted healers A nurse s words communicate hope A nurse s touch extends compassion A nurse s presence offers comfort and assurance, even in the most painful of circumstances. Bush & Boyle,

11 However... The labor of healthcare is stressful. Stress is an assumed cost of doing our work and interpreted as the individual s responsibility to counter it Yet, we don t do it It comes so naturally for us to take care of others, yet find it so difficult to nurture ourselves. Interventions For Healthcare Professionals Formal/informal support systems Support groups Post clinical debriefing Needs of the healthcare provider Attend ceremonies/funerals Allow for short break Death notifications Interventions For Healthcare Professionals (cont.) Mentorship Spiritual support Education in end of life/pallliative care Self care activities ; Vachon et al.,

12 Conclusion Nursing care does not end with the death Loss, grief, and bereavement need to be assessed with ongoing intervention Utilize expertise of interdisciplinary team Nurses must recognize and respond to their own grief Find Own Meaning & Purpose 12