Transcript Working with and Identifying the
Death and Bereavement: Somebody’s Gotta Talk About it
Indiana University School of Social Work Alumni Conference
Why Do I Think It’s Important for Social Workers to Know These Basics?
• I had patients die before and was lost • We’re all going to encounter it in some way regardless of setting • Now that I work in hospice I think EVERYONE should know this stuff!
Why Are We So Hesitant to Discuss Death?
• Cultural taboo • Forces us to face our own mortality • Fear of offending, scaring or angering our clients and families • What the heck are we supposed to say?
• Lack of expertise
The Needs of the Dying
• David Kessler • “The best way to treat a dying patient is to remember that he or she is still a living patient” • Focus on cure often ignores the spiritual, physical, emotional and cognitive aspects of dealing with a terminal illness/injury
The Needs of the Dying
The need to be treated as a
living
human being
The Needs of the Dying
The need to maintain a sense of
hopefulness,
however changing it’s focus may be
The Needs of the Dying
The need to express feelings & emotions about death in one’s own way
The Needs of the Dying The need to participate in decisions concerning one’s care The need to have all questions answered honestly & fully The need for continuing medical care
The Needs of the Dying The need to be free of physical pain The need to be cared for by compassionate, sensitive & knowledgeable people
The Needs of the Dying
The need to express feelings & emotions about pain in one’s own way
The Needs of the Dying The need to seek spirituality The need to die in peace & dignity The need not to die alone The need to know that the sanctity of the body will be respected after death
Spiritual Realm
• Is there an afterlife? If so, what is it?
• Deathbed visitations, hallucinations, hauntings, angels • Near death experiences
Symptoms of Dying
• Increased sleeping • Decreased eating • Memory loss • Decreased urine • Difficulty with or changes in breathing • “Death rattle” • Agitation or restlessness • Involuntary sounds or movements • Skin color changes
Suffering
• Can it be alleviated?
• Is it valuable to the patient in some way?
• Emotional, spiritual, mental or physical • Unfinished business “Suffering, if it is accepted together, borne together, is joy.” – Mother Teresa
Legacy Projects
• Tailored to the patient • Patient directed • Often the role of the social worker • Can help with symptom control for some • Wide variety in size, scope, focus
Professional Interventions & The Power of Presence
• Concrete Interventions • Assessments • Clinical Interventions • Presence
Death Ideation vs Suicidal Ideation
• Both can occur • Both require attention • Are not the same and should not be handled as such
What is Normal Grief?
Physical Symptoms
• Hyperactivity or under active • Chest pain • Headaches • Stomach pains/nausea • Change in appetite • Weight changes • Fatigue • Sleeping problems • Restlessness • Crying • Sighing • Shortness of breath • Tightness in the throat • Changes in coordination
What is Normal Grief?
Emotional Symptoms
• Numbness • Sadness • Anger • Fear • Relief • Irritability • Guilt • Longing • Anxiety • Meaningless • Apathy • Vulnerability • Abandonment • Loneliness
What is Normal Grief?
Social Symptoms
• Being overly sensitive • Becoming more dependent on others • Becoming withdrawn • Avoiding others • Lack of initiative • Lack of interest
What is Normal Grief?
Behavioral Symptoms
• Forgetfulness • Searching for the deceased • Slowed thinking process • Disturbing dreams • Sensing the deceased presence • Wandering aimlessly • Avoiding talking about it in fear of making others uncomfortable • Needing to retell the story of the loved one’s death
Grief Theory
• Freud – pathological, get over it • Kubler-Ross – five traditional stages • Bowlby and Parkes – four phases + attachment theory • Worden – four “tasks” not stages • Wolfet – companioning the bereaved • Neimeyer – narrative and constructivist • Maciejewski et al – recent Yale Bereavement Study
Primal Response
• Grief served an evolutionary purpose • Fight or flight • Reactions trigger by reptilian parts of brain as with other traumatic experiences
Complicated Bereavement
• When grief gets in the way of one’s ability to accomplish required tasks of daily life • When symptoms of grief are severe and persistent • When one is unable to cope with the loss after an extended period of time.
Why Assess for Risk
• You may be completely unaware of the losses that your patients are experiencing • Identify if somatic complaints are grief related • Identify supports that can be put into place • Implement appropriate medical interventions • Provide support and education
What Should a Risk Assessment Explore?
• Loss history – divorce, miscarriage, death, moving, job loss, etc.
• Available supports – emotional, spiritual, resources, within the community • Health history – known medical and mental health concerns • Emotional stability – level of dependence, anger, acceptance • Considerations for children • Circumstances surrounding death • Course of illness
When to Assess for Risk?
• Time of diagnosis • When subsequent losses occur • Changes in prognosis or patient’s condition • When death occurs • After initial impact of death has “sunk in” • Frequent updates to assessment is ideal
When is it More Than Grief?
• Diagnostic standards • Practical implications • Overlapping symptoms with depression, anxiety, attachment disorders, post traumatic stress disorder • Wishing for death
How Does Grief Impact Health?
• Grief is stressful!
• Exacerbates existing health concerns • May trigger previously unidentified medical problems • Can intensify mental health concerns • Behavioral implications that impact health
Anticipatory Grief
• But the person isn’t dead yet!
• Can serve a very useful, protective purpose • Can help to identify problems that may be carried over to the typical course of bereavement
What Can We Do to Help the Bereaved?
• Listen to the story – even if you think you know the story • Don’t try to plan solutions – help to identify supports and resources instead • Be with the grieving • Ask meaningful questions • Try to be comfortable when discussing the loss • Be aware of non-verbal communication, word choice and tone of voice
What Can I Say?
• I am so sorry for your loss.
• I wish I had the right words. Please know I care.
• I don’t know how you feel, but I am here if I can help in any way.
• You and your loved ones will be in my thoughts and prayers.
• My favorite memory of him is… • I am always just a phone call away.
• We all need help at times like this. I am here for you.
• I am usually up early and stay up late.
• Don’t talk – Just be with them. Hugs can be very powerful.
What Not to Say
• At least she lived a long life. Many people die young.
• He’s in a better place.
• She brought this on herself.
• There is a reason for everything.
• You can still have another child.
• It was God’s will.
• You’ll get over it.
• She’s better off this way.
• Be strong.
• Aren’t you over him yet? He’s been dead for a while now.
• She was such a good person. God wanted her to be with Him.
• You think that’s bad? My loved one… • It was her time.
• It was just a miscarriage.
• I know how you feel.
• Tears won’t bring him back.
• You’re still young.
Encourage Self Care
• Be patient with one’s self • Ask for and accept help • Talk to others • Recognize that bad days will come • Rest • Schedule fun and rest • Journaling • Eat regularly • Schedule time with others • Exercise • Keep a routine • Engage in old or new hobbies • Welcome new experiences • Take care of something else – a plant or pet for example • Drink plenty of water • Plan for alone time
Grief Impacts Professionals, Too!
• Medical professionals are exposed to death and suffering more often • Loss is cumulative • Impacts personal and professional relationships • Your own self care is important!
What Can We Do To Better Support Professionals?
• Reduce stigma associated with professional grief • Explore systemic changes that understand grief and offer supports • Model appropriate interactions with patients and families for others • Engage in good self care
Struggling and Need Help?
• Natural sources of support – formal and informal mentors, coworkers, family members • External resources – community mental health providers, funeral homes, hospital or hospice providers • Reach out – if you can’t find a group that works for you help to make one. You can’t be the only one!
Bibliography
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Hodgekiss, A. You really CAN die of a broken heart: Surviving spouses have a 66% higher risk of dying in the three months after their partner’s death. Daily Mail; November 15, 2013. www.dailymail.co.uk/health/article-2507829/You-really-CAN-die-broken-heart-Surviving-spouses-66-higher-risk dying-months-partners-death.html
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