3/21/2019

Bereavement Take a moment to complete the Loss Exercise handout. Grief: Important People that Most prized Favorite Most valued : personal you love the possessions activities body parts Process State abilities most

Playing Caring for Home Brain Spouse with kids others Mourning: Spending Learning Art time with Eyes Mom Expression new things friends

Sense of control Identity and role Work Independence Relationships Financial security Energy Sexuality Physical appearance Physical function “Normal life” Ability to remain at home Fertility Unfulfilled goals/dreams Ability to plan for the future

1 3/21/2019

EMOTIONAL PHYSICAL COGNITIVE BEHAVIORAL SPIRITUAL

• Shock • Exhaustion • Disbelief • Changes in • Increased • Sadness • Low energy • Confusion sleep/eating spirituality • Anger • Tightness in • Distraction • Isolation • Spiritual • Guilt chest • Forgetfulness • Restlessness distress • Anxiety • Feeling of • Perceived • Tearfulness • Conflict between • Fear of being hollowness presence of • Focus on experience alone • Headaches deceased objects or and belief • Helplessness • Stomach and • Inability to places of importance • Emptiness intestinal concentrate problems to deceased • Numbness • Yearning • Relief

2 3/21/2019

Intuitive • Feelings are intensely experienced • Focus is on emotional expression: talking about feelings, sharing memories, crying

Instrumental • Thinking and action are focus • General reluctance to talk about feelings • Mastery of oneself and environment through problem-solving

“Even when I’m really sad, I always have to be ready to move on to the next patient.”

“I’m grieving, but I can’t talk with my family about my patients who have died.”

“One day someone’s here, and the next, they’re gone, and I’m supposed to act like everything’s fine.”

3 3/21/2019

Ages 2-4 • Self-oriented and present-oriented. • Often most upset about changes in care. • Brief, intense emotional responses; behavioral regression. • NEED short, honest answers; repetition of facts; outlets for play; reassurance that needs will be met.

Ages 5-7 • Gaining language and sense of autonomy. • May believe that thoughts can cause bad things to happen. • May ask same questions repeatedly, or act as though nothing has happened. • NEED physical outlets and opportunities to safely express emotion through symbolic play, stories, drawing, etc.

Ages 7-11 • Concrete, logical thinking. Greater socialization, confidence. • Beginning to see death as final, perhaps as punishment. • Concerned with how others respond. May experience school problems, withdrawal from friends, acting out. • NEED to given choices and options when possible, balance of “alone time” and opportunities to talk. Ages 12-18 • Problem-solving, abstract thinking. Integration of personality. • More “adult” approach to death. Ability to think abstractly. • Extreme sadness. Denial. Regression. More often willing to talk to people outside of family, peers. Risk taking. • NEED autonomy and respect, but to have support available.

4 3/21/2019

Northouse & McCorkle, 2010

Pay close attention to what is being said.

Listen and allow Take care of the person their yourself. feelings.

Trust your gut Avoid judgment. reactions.

Don’t try to cheer the person up. (From Therese Rando, Ph.D.)

5 3/21/2019

Thank you!

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