Understanding Grief and Loss: Exploring the Journey of Bereavement

2. Learning outcomes Discuss as a group the effect of witnessing death and saying goodbye to people you care for List other losses that may cause grief for people and their loved ones Describe what grief means and explain the difference between grief, bereavement and mourning Explain what may be some of the common responses to loss using the model of total suffering Discuss the journey of grief Describe the factors which affect the way we experience grief Explain what services are available for bereavement counselling As a team explain their roles in helping people, their loved ones and other team members cope with loss and grief Discuss cultural needs and rituals of grief and mourning in different cultural groups

3. Models of care

4. Cultural considerations at the end of life • What are the attitudes, values and beliefs you bring to your practice? • What are your rituals around death, bereavement and mourning? • What is the organisational culture? • Discuss the important role of the family at this time Adapted from Waitemata Palliative Care Education Programme 2011

5. Grief is a journey • "Grief is a journey, often perilous and without clear direction, that must be taken. • The experience of grieving cannot be ordered or categorised, hurried or controlled, pushed aside or ignored indefinitely. It is inevitable as breathing, as change, as love. It may be postponed, but it will not be denied."Molly Fumia

6. Definitions • Grief: The normal process of reacting to a loss – usually refers to the loss of a loved one through death • Bereavement: The period after a loss during which grief is experienced and mourning occurs – the time spent in a period of bereavement depends on how attached the person was to the person who died, and how much time was spent anticipating the loss • Mourning: The process by which people adapt to a loss as, for example, the death of someone near and dear – the outward expression of that loss – influenced by cultural customs, rituals, and society's rules for coping with loss

7. What are your feelings about death and dying? What are some of your feelings about death? What are some of the things you find difficult about the work you do caring for people who are dying? What are some of the positive things that can be gained?

8. The elephant in the room • There’s an elephant in the room. • It is large and squatting, so it is hard to get around it. • Yet we squeeze by with, ‘How are you’ and ‘I’m fine’. • And a thousand other forms of trivial chatter. • We talk about the weather. • We talk about work. • We talk about everything – except the elephant in the room. • There’s an elephant in the room. • We all know it is there. • We are thinking about the elephant as we talk together. • It is constantly on our minds. • For you see, it is a very big elephant. • It has hurt us all. • But we do not talk about the elephant in the room. • Oh please, say her name. • Oh please, say ‘Barbara’ again. • Oh please, lets talk about the elephant in the room. • For if we talk about her death, • Perhaps we can talk about her life? • Can I say ‘Barbara’ to you and not have you look away? • For if I cannot, then you are leaving me • Alone …. • In a room … • With an elephant. • Terry Kettering

9. Grief • It is a normal and natural response to loss of any kind • Although normal it is often most neglected and misunderstood experience • Grief is the conflicting feelings caused by the end of or change of a familiar pattern of behaviour • Grief is like a fingerprint – unique to each person and their loss • There is no right or wrong way to grieve • ‘Grief is the price we pay for love’

10. Loss and grief are part of life • What losses are experienced in life that may lead to grief? • What are the losses the people we care for may be experiencing? • How might their loss be expressed? • What coping strategies may they have?

11. Loss brings • Role changes • Anxiety • Financial implications • Feelings of isolation and abandonment • Family members all grieve differently • Guilt • Intense feelings

12. What are some common responses to loss? • Normal manifestations of loss are evident in; • our feelings • our physical being • our thoughts • our behaviour • “Suffering … no matter how multiplied, is always individual” • A M Lindbergh

13. Let us bury the stages of grief – for good There are no fixed stages for the grieving process, no linear path through the stages. Each of us is unique and grieves in our own way. “Grief is not a passive process, nor a series of stages that happen to the bereaved: in recognising this we can help those who are bereaved to become empowered in their mourning.” Parkes 1986

14. The journey of grief • “Grief is like a long valley, where any bend may reveal a totally new landscape”C S Lewis

15. Stuck for words What can we say to someone who is grieving?

16. Empathy • What is it? • It is about; • Staying with the person’s feelings • Accepting how they are feeling • Acknowledging their feelings • Hearing what matters most • Giving them permission to feel the way they want • Helping

17. Factors which affect the way we experience grief • Age • Gender • Culture • Spiritual/religious beliefs • Our personality • Centrality of relationship • Past experiences of loss • Support • Degree of change as result of loss • Unspoken grief • War veterans • Defacto relationship • Pets • Abortion • Adoption • Illicit lover • Gay/lesbian relationship • Ambivalence • Type of death • Sudden or long illness • Stigmatised

18. How do you honour death in your workplace? What are the rituals used around death in your workplace? What are your local bereavement resources and how do you access them? How do you care for yourselves and your colleagues when a person dies that you have cared for? Completion of the journey

19. Grief is a normal process There is no set way for a person to experience grief Grief is the price we pay for love Conclusion