Welcome to Understanding Loss & Bereavement There is a range of evidence (Stephen et al 2006) that the way those who have been bereaved experience the events around the time of death will influence the trajectory of their grief journey. Where health services get it right, showing empathy and providing good quality care, bereaved people are supported to accept the death, and to move into the grieving process as a natural progression. Conversely if the health services get it wrong, then bereaved people may experience additional distress, and that distress will interfere with their successful transition through the grieving process, with implications for them, those around them and for the social economy of the nation. Some Pointers to Pre- Bereavement Work Bereavement care should begin as soon as death is expected Clear information about dying and what the relatives might expect Discussions about post mortem DNACPR Place of dying Proving spiritual and religious care before and after the death Providing a suitable environment if in hospital Managing the death with sensitivity and with clear unambiguous language Proving a place of privacy for the family Proving the death certificate and other necessary paperwork with adequate explanation and sensitivity. Treating the deceased and last offices with sensitivity and where applicable involving family members. Having children Adoption Different Kinds of Loss - 1 Children growing up Children leaving home Children getting married Marriage Divorce Separation Becoming parents Becoming grandparents
Different Kinds of Loss 2 Different Kinds of Loss 3 Death of a pet Loss of innocence Loss of virginity Loss of face Loss of security Loss of faith Rape Still birth Abortion Miscarriage Cot death Having a child with a disability Loss of income Unemployment Retirement Moving home Change of school Change of job Theft, burglary Ageing Loss of bodily function Incontinence Loss of limb Loss of hearing/eyesight Loss of hair/looks
GRIEF WHEEL Critical Event GRIEF WHEEL Shock Life function REORGANISATION DISORGANISATION SHOCK PROTEST Numbness Denial & Disbelief Emotions Unaffected, hysterical, euphoric Thinking Unaffected, slowed, chaotic, efficient Activity Unaffected, slowed, superdrive Suicidal thoughts GRIEF WHEEL Protest GRIEF WHEEL Disorganisation Confusion Decreased resistance to illness Sadness Anger Guilt Dreams & Nightmares Yearning Searching Restlessness Anquish Loneliness Loss of Faith Loss of meaning Hopelessness Concentration and memory difficulties Low self esteem Fear Relief Preoccupation Physical Distress Depression Apathy & Aimlessness Loss of Confidence Anxiety Sadness Suicidal thoughts Loss of interest
GRIEF WHEEL Reorganisation Developing balanced memory Pleasure in remembering Control over remembering Return to previous levels of functioning Changed values Dual Process Model of Coping with Loss Loss -oriented Grief work Intrusion of grief Breaking bonds and ties Denial/avoidance of restoration changes Everyday Life Changes Restorationoriented Attending to life changes Doing new things Distraction from grief Denial/avoidance of grief to life changes New roles, Identities, relationships New meaning in life Growing around Grief (adapted from Tonkin s Model, 1996) Continuing Bonds (Klass, Silverman and Nickman 1996) Bereaved remain psychologically and emotionally connected to the deceased Connection develops and changes over time Relationships continue These connections provide solace, comfort, support and ease the transition from the past to the future
Meaning Making Cultural Issues Looks at loss not as a series of stages people go through but as an active process in which they make meaning (sense) of their changing lives Professional carers need to be aware of differing beliefs and customs and how they might affect the care and support required While many individuals hold no strong religious beliefs, there are a range of individuals who share similar or different beliefs within our community Ten ways to help - 1 Ten ways to help 2 By being there By listening & accepting in a nonjudgmental way By demonstrating empathy By encouraging them to talk By tolerating silences By being familiar with your own feelings By being able to reassure the person By not taking the person s feelings personally By recognising that your feelings may be a reflection of theirs By accepting that you cannot make them feel better grief takes it s own time
Useful Web Addresses Let me reassure you that it is OK to feel uneasy or afraid. it is OK to feel eerie or unduly tense, to hide and cry, to want to swear or scream, or lash out at easy targets. It is OK to feel relieved or even happy when someone dies. It is OK to feel whatever is real. Feelings have no morality. They are neither good nor bad always ethically neutral. Kavanaugh,, (1974) http://www.muchloved.com http://www.bereavementadvice.org/ http://www.rowanshospice.co.uk/ Resources Education & Training Education downloads. Resources Bereavement Resources Bereavement downloads. http://www.rd4u.org.uk/ http://www.direct.gov.uk/