Come Grieve With Me

1. Come Grieve With Me

2. MOURNING BEREAVEMENT GRIEF

3. MOURNING • The way we show grief in public. Our outside behaviors, which are affected by beliefs, religious practices, and cultural customs. • The process of integrating the loss into our ongoing life. • Considered the outward expression of grief. The behavioral manifestation.

4. GRIEF • The psychological and physiological reactions to what is happening now in your mind and in your body. It can be a long, lonely, and agonizing process. As a process grief provides time to reflect and find strength. The responses can be spiritual, mental, social, emotional, and physical. Grief includes many stages or tasks that bring about changes in all of us. Each experience is unique.

5. SPIRITUAL… • Awareness of fragility of life • Searching for meaning in the loss • Appreciation of lessons from the person who died • Challenge to one’s faith • Experiencing the presence of the deceased

6. MENTAL… • Concentration problems • Memory problems • Continuously thinking about the loss • Difficulty accepting the reality of the loss • Feeling nothing is real

7. SOCIAL… • Withdrawal • Aggressiveness • Over protectiveness • Separation anxiety, fearfulness • Disinterest in others • Change in school performance

8. EMOTIONAL… • Anger • Blaming • Hopelessness • Panic • Anxiety • Guilt • Sadness and depression • Relief

9. PHYSICAL... • Appetite change (up or down) • Sleep disruptions • Upset stomach, headaches • Restlessness • Crying • Sighing • Lethargy

10. BEREAVEMENT • What a person goes through when someone close to them dies. The state of having suffered a loss. The period of in which grief and mourning occur, the sadness after losing a loved one through death.

11. AMBIGUOUS LOSS • The person loss is physically present but not psychologically available (severe dementia, severe brain injury, or by choice estrangement…). • Other examples are when the person is gone, but the person grieving maintains an ongoing, intense psychological attachment, never sure of situations reality (kidnapping, prisoner of war, imprisonment…). • These types of losses are particularly difficult to process because of the lack of finality, closure, and unknown outcomes.

12. ANTICIPATORY GRIEF • The unconscious process of “letting go” or disengaging before the actual loss or death occurs. This is the experience found in situations of predicted and prolonged loss. • This type of grief extends over a long period of time. The loss may be absorbed gradually and preparation for its inevitability may take place. • The response experienced is intense; shock, denial, and tearfulness before death. Relief, guilt, and anger after death. • There is mixed feelings about the forewarning or cushion that gives people time to prepare or complete the tasks related to the impending death. While this may offer a buffer for some, the stress is increased for other, creating emotional highs and lows.

13. DISENFRANCHISED GRIEF • Unsupported or Marginal Grief. • Relationships that are not socially sanctioned; openly shared; or appears as being of lesser significance. • The individual’s loss and grief does not meet the norms of acknowledged grief by that person’s culture; this means not socially supportive, and the sympathy is given to other persons with more “legitimate” loss. • The grieving individual often questions whether it is a true loss (an ex-spouse; gay partner; pet; death from a stigmatized illness (alcoholism), a miscarriage…).

14. EXAGGERATED GRIEF • Persons are usually conscious of the relationship of the reaction to the death, but grief response is often excessive, disabling, self-destructive or maladaptive behaviors, obsessions, or psychiatric disorders. Suicide is a risk for these individuals.

15. DELAYED GRIEF • The grief response is postponed, delayed, suppressed, or inhibited; often because the loss is so overwhelming. • The individual usually avoids full realization of the loss, which is frequently triggered by a second loss that is usually not as significant as the first loss.

16. MASKED GRIEF • The grieving individual behaves in ways that interfere with normal functioning, and is unaware that their disruptive behavior is the result of a loss and ineffective resolution.

17. RELIEF GRIEF • The feeling of relief that some negative aspect has come to an end at the death of a loved one. • The relief experienced is followed soon after with guilt for feeling relieved.

18. COMPLICATED GRIEF • A prolonged (Chronic) & Unresolved type of grief, has significant difficulty moving forward or resuming life after a loss. • The grief response is so constant and so severe it disrupts daily routines and undermines other relationships. Disruptive yearning and preoccupation for the deceased; trouble accepting the reality of the death; lack of trusting others, excessively bitter, emotionally numb, or anxious about the future. • This type of grief occurs more often when the relationship with the deceased is conflicted, with multiple losses or stressors, with mental health issues, or with lack of social support. Other losses with great potential for complicated grief are losses associated with homicides, suicide, sudden accidents, or the death of a child.

19. SYMPTOMS • Intense longing and yearning for the deceased. • Intrusive thoughts or images of your loved one. • Denial of the death or sense of disbelief • Searching for the person in familiar places. • Avoiding things that remind you of your loved one. • Extreme anger or bitterness over the loss. • Feeling that life is empty or meaningless. • Imagining that your loved one is alive.

20. LIVING WITH GRIEF • Losses and declines experienced by the dying person and their family members may need to be responded to during the course of an illness. • Adjusting to changes brought about by a disease. • Planning for the future. (Stroebe and Schut, 1999)

21. NO MATTER WHAT • IT IS IMPORTANT TO RECONGIZE ALL LOSSES ARE SIGNIFICANT TO THOSE WHO ARE GRIEVING AND SHOULD BE ACKNOWLEDGED.

22. GRIEF OR DEPRESSION • It is not always easy distinguishing between grief and clinical depression because they share many symptoms, but there are ways. • Depression is constant feeling the emptiness and despair, while grief is an ocean of waves that include good and bad days, moments of pleasure, and even times of happiness. .

23. SYMPTOMS SUGGESTING DEPRESSION • Intense, pervasive sense of guilt. • Thoughts of suicide or a preoccupation with dying. • Feelings of hopelessness or worthlessness. • Slow speech and body movements. • Inability to function at work, home, and/or school. • Seeing or hearing things that aren’t there.

24. SEEKING PROFESSIONAL HEALTH • If any of those symptoms were recognizable talk to a mental health professional right away. Left untreated complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. Treatment can help.

25. OTHER SIGNS TO WATCH FOR • Feeling like life isn’t worth living. • Wishing you had died with your loved one. • Blaming yourself for the loss or for failing to prevent it. • Feeling numb and disconnected from others for more than a few weeks. • Having difficulty trusting others since your loss. • Unable to perform your normal daily activities.

26. GRIEF THEORY I • ELIZABETH KUBLER-ROSS (1969) • Denial • Anger • Bargaining • Depression • Acceptance

27. GRIEF THEORY II • WORDEN (1982) Describes active engagement in behaviors by outside interventions to help with grief. Working through grief typically requires a full year. • Task I • Task II • Task III • Task IV

28. GRIEF THEORY III • Rando’s “R” (1993)Describes grief as a series of processes. • Recognizing the Loss: • Reacting to the Pain of Separation: • Reminiscing: An important activity in grief and mourning. Recollect and re-experience the deceased and the relationship. Mentally or verbally reliving, and remembering the person, and past experiences. • Relinquishing Old Attachments: • Readjusting to Life After Loss:

29. “CONTINUING BONDS IN DEATH” • Healthy Adjustment Needs 2 Criteria 1. Recognizing that the person is dead 2. Moving forward adaptively into their new life.

30. THE CONCEPT • Challenges the assumption grief resolution is achieved by severing the bond. • Acknowledges the bond continues. • Is a testimony of the enduring strength of love.

31. OUR POSITION • Is to be respectful, and support the individual, and the ways he/she want to maintain the relationship with the person who has died.

32. IN GRIEF The goal of the grieving person is to find the delicate balance between the past that should be remembered and a future that must be created.

33. ALSO IN GRIEF PEOPLE OFTEN WONDER

34. AM I NORMAL SYMPTOMS OF NORMAL GRIEF FEELINGS • Sorrow • Fear • Anger • Guilt • Anxiety • Loneliness • Fatigue • Helplessness • Hopelessness • Yearning • Relief

35. CONTINUED COGNITIONS (THOUGHT PATTERNS) • Disbelief • Confusion or Memory Problems • Problems With Decision Making • Inability to Concentrate • Feeling the Presence of the Deceased.

36. CONTINUED PHYSICAL SENSATIONS • Headaches • Nausea and Appetite Disturbances • Tightness in the Chest and Throat • Insomnia • Oversensitivity to Noise • Sense of Depersonalization (“Nothing Seems Real”) • Feeling Short of Breath, Choking Sensation • muscle Weakness • Lack of Energy • Dry Mouth

37. CONTINUED BEHAVIORS • Crying and Frequent Sighing • Distancing from People • Absentmindedness • Dreams of the Deceased • Keeping the Deceased’s room Intact • Loss of Interest in Regular Life Events • Wearing Objects That Belonged to the Deceased.

38. KNOWING HELPS KNOWING WHAT IS HAPPENING TO US WILL HELP US HEAL. • There is no right or wrong way to grieve. Grief is not orderly or are there really any predictable stages or tasks. It can be an emotional rollercoaster, with lows, highs, and lots of setbacks. • As unique as we each are to each other so is our loss, how we cope with that void in our life, and how we will adapt. Everyone grieves differently, have patience with yourself.

39. UNIQUENESS OF GRIEF • LINDEMANN (DATE) • How the Loss is Perceived. • Disenfrancised • Intentional vs. Unintentional • Age of the Bereaved. • Age of the Deceased. • Preparedness. • Expected vs. Unexpected • The Bereaved’s Inner Strength (Resilience, Coping Abilities) and Outer Resources. • The Bereaved’s Relationship With the Deceased. • Unfinished Business (Closure, Forgiveness…) • Dependency (Emotional, Financial, Physical…)

40. GRIEF TIMETABLE THERE IS NO SET TIMETABLE FOR GRIEVING

41. BEREAVEMENT & CAREGIVING • Hospice patients are often cared for by family members. • Often caregivers have remarkable resilience in adapting to the death. • Relief from burdens of care giving. • End to the suffering of their loved one. • Absence of guilt over having done the work of caregiving. (Schultz et al. 2003).

42. THE CAREGIVER • 30% Risk for Clinical Depression 1 year Post Death. • 20% Experience a Complicated Death. (Hensley, 2008) • Experience Pre-Bereavement • Anxiety & Depression • High levels of burden, exhaustion, overload, & burnout. • More likely to express depression & complicated grief post-death.

43. CAREGIVERS AT RISK • ASK QUESTIONS • Do you feel overwhelmed by the responsibilities of providing care? • Do you feel competent in providing the care for your loved one? • Do you feel isolated from family and friends. • Do you feel prepared for the death of your loved one? • In the past month have you felt depressed, sad, or anxious much of the time?

44. THE DO NOT’S • Do not downplay the grief. • Do not tell the bereaved how they should handle grief. • Do not assume you know how they feel. • Do not act as if nothing is wron • Do not say: • I would not be so upset if I were you. • You shouldn’t feel that way. • It is just God’s will. • You should have worked through all this already.

45. CHILDREN & GRIEF • Reactions are similar to adults. • Reflective of age, cognitive & emotional development. • Patterns of family interaction & communication. • The relevance of the relationship w/the deceased. • Past experiences w/death. • Resilient coping skills. • Adults need to actively listen & provide support. IF YOU ARE OLD ENOUGH TO LOVE …. YOU ARE OLD ENOUGH TO GRIEVE.

46. THE CULTURAL IMPACT • Critical to Recognize the impact of cultural backgrounds. • Learn specifics, be respectful, least be competent professionals. • Your ability to know yourself enhances your ability to listen to another person whose attitudes & beliefs are different. • Individuals exist & operate w/in their own family unit as part of society & culture. (variations exist) • Consider the values, beliefs, and behaviors of the patient and family members.

47. BEREAVEMENT PROGRAM Is Critical Support Available to the Patients, Family Members, & the Community • Pre-Post Bereavement • Assessment/Referrals • Visits • Phone Visits • Mailings & Cards • Groups (Specific, Drop-In, & Holiday) • Memorials • Help From Volunteers