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Exploring Personal Values and Feelings about Death and Loss in End-of-Life Care

This module focuses on helping personal support workers in long-term care settings explore their personal values, beliefs, and feelings about death and loss. It also covers the stages of grief and tasks of mourning, and provides vocabulary and manifestations of grief.

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Exploring Personal Values and Feelings about Death and Loss in End-of-Life Care

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  1. “Communication at End-of-Life” for Personal Support Workers in Long-Term CareModule 2

  2. What do I think/feel about death, dying, and loss? • Identify feelings and beliefs related to hospice palliative/end of life care • Explore personal values about death and dying • Explore personal experiences of grief and loss • Review Elisabeth Kübler Ross’s stages of Grief • Review William Worden’s Tasks of Grieving

  3. Personal Values about Death What are my personal values about Death? • Role? • Meaning? • Beliefs about life after death? • What I fear the most? • Preferences for when and where I die? Complete the handout on your own. After you finish, find one other person in the group and share some of your answers. Give your undivided attention as you share and listen.

  4. Answerthe Following Questions… • What was difficult to discuss; and why? • What was easier to discuss; and why? • How does it feel to discuss these topics with others? • What surprised you as you listened to someone else talk about death? • What did you learn about yourself in doing this exercise?

  5. Create a list of objects, values, and/or people that you cherish in your life and that give you meaning and purpose for living. Activity: Cherished Objects, Values, People

  6. Grief & Loss Vocabulary GRIEVING: A normal, natural, and individual (internal) response to a loss MOURNING: The process by which we publicly work through a loss. It is a form of healing and people need opportunities to experience this process. BEREAVEMENT: The event of loss

  7. Stages of Grief DR. ELISABETH KÜBLER-ROSS

  8. Stages of Dying/Grief • Denial • Anger • Bargaining • Depression • Acceptance

  9. THE FOUR TASKS OF MOURNING DR. WILLIAM WORDEN (TEAR) TASK 1: TOACCEPT THE REALITY OF THE LOSS TASK 2: EXPERIENCE THE PAIN OF THE LOSS AND EXPRESS IT WITHOUT JUDGEMENT TASK 3: ADJUSTTO THE NEW REALITY WITHOUT THE LOST PERSON OR OBJECT TASK 4: RE-ESTABLISH AND RE-INVEST IN EMOTIONAL TIES

  10. Manifestations of Grief PHYSICAL EMOTIONAL BEHAVIOURAL SPIRITUAL COGNITIVE

  11. PHYSICAL MANIFESTATIONS OF GRIEF • Tightness in the throat • Shortness of breath • Disturbed sleep patterns • Loss of energy • Change in appetite • Dry mouth • Hollowness in the stomach • Tightness in the chest

  12. BEHAVIOURAL MANIFESTATIONS OF GRIEF • Crying/sighing • Withdrawal of independence • Loss of interest • Restlessness • Hostile outbursts • Treasuring objects that belong to the deceased • Visiting places that remind the survivor of the deceased

  13. EMOTIONAL MANIFESTATIONS OF GRIEF • Sadness and pain • Anger hostility • Personal guilt or shame (e.g. remorse, regret) • Anxiety • Loneliness and Helplessness • Mood swings • Shock • Yearning • Relief • Numbness

  14. SPIRITUAL MANIFESTATIONS OF GRIEF • Doubts about God/Higher Power/Creator • Lack of belief or faith in a higher power • Unable to pray, despair • Guilt • Dreams: seeing the deceased • Hopelessness • Decreased value of life • Shame • Regret • Resentments

  15. COGNITIVE MANIFESTATIONS OF GRIEF • Disbelief • Confusion • Foggy mind • Poor memory • Forgetfulness, absent minded • Inability to concentrate • Poor judgment • Poor reasoning • Perception distortion • Ability to learn is compromised

  16. LOVE AND GRIEF “Only people who avoid love can avoid grief. The point is to learn from it and remain vulnerable to love” -John Brant

  17. LOVE AND GRATITUDE Love and Gratitude The agony is so great… And yet I will stand it. Had I not loved so very much I would not hurt so much. But goodness knows I would not want to diminish that previous love By on fraction of an ounce. I will hurt!! And I will be grateful to the hurt For it bears witness to The depth of our meanings, And for that I will be eternally grateful. -Author Unknown

  18. NEEDS OF THOSE IN MOURNING NEEDS OF THOSE IN MOURNING • SHARE FEELINGS - Allow people to ventilate their emotions and fears • AFFIRM THEIR PERSONHOOD –Provide support and let them verbalize memories • FEELSUPPORTED AND ACCEPTED – They may have fear of abandonment

  19. NEEDS OF THOSE IN MOURNING • Expressions of DEPENDENCY are to be expected • To FIND MEANING IN THE DEATH EXPERIENCE – Do not minimize this. People expend massive amounts of psychic energy in the process 6. Need for REALITY-TESTING - To be reminded to stay in the present

  20. Death ends a life, but not a relationship

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