Loss

1. Loss Physical (loss of something tangible) Psychosocial: (loss of something symbolic or intangible)

2. Change: always constitutes loss • Developmental change • Normal change and growth • Competency-based loss

3. Secondary loss • A loss that coincides with or develops as a consequence of the initial loss. • (examples: loss of income when spouse dies, loss of concept of self as healthy when serious illness occurs)

4. Grief & Mourning • Grief: the process of experiencing the psychological, behavioral, social, and physical reactions to the perception of loss. • Mourning: the work of adapting andchanging as a result of the loss

5. Grief • Experienced in four major ways: psychologically, behaviorally, socially, physically • A continuing development • A natural reaction • Expected with all types of loss • Dependent upon the individual’s perception of the loss

6. Mourning • Reacting to separation from the deceased • Modification of roles, skills, identity • Learning to live in a healthy way without the deceased

7. Myths & Misconceptions • Grief declines steadily over time • The mourner must put the loss out of mind • Intensity and length of mourning are a testimony to love • Grief involves only the loss of the person • Mourning is complete in a year • Time is a healer

8. Danger: don’t rigidly apply grief theory • Commonalities exist • Idiosyncratic variations occur • It’s not a static state, but rather a process of many changes over time

9. Kubler-Ross’ Stages • Denial • Anger • Bargaining • Depression • Acceptance

10. Why think about death? • To give meaning to human existence • To encourage productivity & enjoyment of life • To prepare for ultimate acceptance of death

11. Ways to prepare: • Be close to someone who is facing death with inner peace • Plan financially • Develop solid support • Incorporate religious beliefs into life

12. How can we help??? • Denial: support without reinforcing • Stay physically present • Offer regressive care (food, drink, safety)

13. How can we help??? • Anger • Provide anticipatory guidance • Don’t take it personally • Meet needs that precipitate anger

14. How can we help??? • Bargaining • Provide information for decision-making • Offer resources and referrals

15. How can we help??? • Despair • Supportive listening • Touch • Avoid cliches • Assess risk of harm to self

16. How can we help??? • Acceptance • Assist in planning • Utilize cultural practices • Allow expression of feelings • Accept changes in feelings • Support groups for patient & families

17. Hospice Care • A philosophy of caring for the dying • Curing vs. Caring • Criteria for moving to hospice care

18. Helpful hints: • Don’t ask whether I’m ‘over it’. I’ll never be ‘over it’. • Don’t tell me he’s in a better place. He isn’t here. • Don’t say “At least he isn’t suffering”. I wonder why he had to suffer at all. • Don’t tell me you know how I feel unless you have had the same experience. • Don’t tell me ‘God doesn’t make mistakes’; you mean God did this on purpose??? • Don’t tell me ‘God doesn’t give more than we can handle’. I don’t feel like I am “handling” it.

19. Please just say: • That you are sorry. • That you miss him too, if you do. • That you will listen.

20. As we learn to help: • “Birds make great sky circles of their freedom. But how do they learn it? They learn by falling, and by falling they’re given wings.