Dying and grieving in the 21st century: Exploring the challenges to professional carers

1. Dying and grieving in the 21st century: Exploring the challenges to professional carers 4th November 2008 Linda Machin PhD

2. What shapes our understanding of dying and grieving? • Context • Concepts • Care

3. The Context of Grief - a changing landscape • Changing perspectives on the expression of emotions • Changing social patterns • New possibilities and ethical challenges around life and death issues

4. The emotional expression of grief • Two great wars and the national need to take pride in heroism and not grieve the dead - the ‘stiff upper lip’ • The rise and influence of psychotherapeutic theories as acknowledgement of grief and as a guide to freer emotional expression

5. Changing social patterns • Social mobility • A move in emphasis from community to the individual • Ethnic and religious diversity • Changing values - growing secularism

6. New possibilities and ethical challenges around life and death issues • Creating life - IVF, selecting embryos, cloning etc • Extending life -transplant surgery, life- support machines etc • Ending life - abortion, switching off life-support machines, euthanasia etc

7. Contemporary Concepts on the nature of grief • The concept of the Dual Process model of grief • The concept of ‘Continuing Bonds’ • The concept of ‘resilience’

8. The ‘Dual Process’ model of grief - a challenge to the classic concept of grief work Restoration orientation Loss orientation Grief work Attending to life changes oscillation

9. ‘Continuing Bonds’- a challenge to the concept of letting go and moving on • Role model • Help with decision making • Value clarification • A place in memory

10. The concept of Resilience - a challenge to the primary focus on risk • Personal resourcefulness - flexibility, courage, perseverance etc. • A positive life perspective - hope, optimism, a capacity to make sense of experience, motivation in setting goals etc. • Social embeddedness - availability of support and the capacity to access it.

11. Care - a process of giving and receiving • Who needs care? • What kind of care? -transforming risk into resilience • The cost to the carer • Policy and research

12. Who needs care? • Assessing risk • Appraising resilience

13. What kind of care? Transforming risk into resilience Confronting Appraising the negative the positive balancing the competing elements of grief accessing support

14. The cost to the carer Competence sensitivity availability burn out compassion fatigue renewal self-knowledge self-care support

15. Policy and research issues - the challenge • Practitioners as policy and research followers • Practitioners as policy and research leaders

16. The challenge - to the cared for and their carers To suffering must be added mourning, understanding, patience, love, openness and the willingness to remain vulnerable. Anne Morrow Lindbergh

17. Conference aim: To explore and debate the complexities of loss, grief and bereavement in the 21st century

18. Conceptual challenges ‘….two contradictory perspectives recur in psychology and the social sciences. One perspective holds that humans are basically the same. The other holds that there are enormous differences among people’. (Rosenblatt 1993)

19. Holding the contradictions in balance • Using theory as a template for our general understanding. • applying our knowledge to the variability of individual response to loss.

20. Conference aim: To reflect on our roles as professional caregivers when supporting people who are dying and grieving.

21. Care challenges • To recognise the cultural, social, organisational and personal contexts in which care operates. • To continually update and appraise the state of conceptual knowledge about death, dying and bereavement. • To acquire and maintain practice skill and self-care as central to effective care giving.

22. Some closing thoughts - from a dying man Handle me with care,the wrapper’s worn and held by threadbare string, almost torn apart: gaping edges invite you to look with curious eyes. Worthless, you might think, so old, carelessly parcelled up. Just think before you touch, think where I have been, seen, spoken,listened,touched, hurt, born, and felt. Can’t you feel the passion left within me?

23. Share it (the passion within me), undo the string, slowly please, (I’m so slow now). Undo the hurt (I hurt now), the guilt (aren’t you guilty too?), the hate (as I hate what’s happening now). Undo the love, and let it go, my gift to you. John Smith