Grief and Bereavement Palliative Care Education for Front-Line

Grief and Bereavement Palliative Care Education for Front-Line Workers in First Nations Communities cerah.lakeheadu.ca

Grief is a total human experience impacts the following aspects of life: social physical cognitive emotional spiritual part of a normal healing process

Definition Grief is the complex set of responses to those losses which create the emotional and spiritual transitions of our lives Grief is most commonly thought of as a natural emotional reaction to loss

Four dimensions of grief 1. 2. 3. 4. Feelings Physical sensations Cognitions Behaviours Worden 1991 Two other dimensions 5. Spiritual or philosophical 6. Interpersonal Gilbert 2001

Grief Sometimes there is so much pain associated with grief people believe that grief is something that needs to be “fixed” or “overcome.” People often think that there is a “right” and “wrong” way to grieve.

Grief as a series of tasks Four tasks: 1. Accept the reality of the loss 2. Work through the pain of grief 3. Adjust to the environment in which the person who has passed is now missing 4. Emotionally relocate the person who has passed and move on with life Lindeman, 1944, Worden, 1991

Grief as an active process of coping directed at remaking reality “Time in itself does not heal. It’s what you do with the time that makes it meaningful.”

Grief Grief may be viewed as a spiritual journey Grief is a uniquely personal experience

“ to lose someone you love is not like losing your car keys. It’s like the laws of gravity have been repealed. We need to reclaim the law of gravity to survive ” - Peter Marris

In palliative care we speak primarily of two forms of grief Anticipatory Grief - grieving not only for what one has lost but for what one is about to lose Bereavement Grief - a healthy adaptive process in response to a death and its accompanying losses

Two perspectives of anticipatory grief The perspective of the individual who is passing. The perspective of others who care about the individual who is passing.

Anticipatory grief mourns for: Past – the past that was shared and can never be regained Present – the losses that occur and are experienced as a diminution, or end, of capabilities; the ongoing experience of erosion Future – the losses of the anticipated death and such related losses as loneliness and events that will not be shared

A 3rd type of grief Disenfranchised grief – the grief that people experience from a loss that is not, or cannot be, openly acknowledged, publicly mourned, or socially supported Doka, 1989

Some suggestions for living with grief (1 of 3) Proceed gently; don’t rush too much; the body needs energy to repair Keep decision-making to a minimum; if possible, don’t assume new responsibilities right away. Accept help and support when offered Ask for help Search for support from others; consider meeting new people

Some suggestions for living with grief (2 of 3) Be patient; healing takes time Lean into the pain; it cannot be ignored, it must run its course Crying does help Try to find (or schedule) comforting activities during the holiday times Look for help from a spiritual advisor or counsellor.

Some suggestions for living with grief (3 of 3) Get enough rest Try to eat balanced meals; good nutrition is important in the healing process Keep a journal Read Moderate exercise helps “work off” frustration and promotes sleep Don’t feel guilty when enjoying good times with family and friends

Attitudes toward grief support Your behaviour and attitude are more important than your words Be aware of your own feelings and how you deal with loss and passing.

Ways to offer support (1 of 3 ) Be comfortable with expressions of emotion; remember emotions are NOT rational, they just are Be patient; your willingness to spend the time to listen is what counts most Support their pain; don’t overprotect or hurry people Encourage active participation in the care of the person who is very sick.

Ways to offer support (2 of 3) Accept and do not judge family members who cannot bring themselves to be present Help people find their own answers to problems Listen without judging, and allow family members to voice concerns or tell stories

Ways to offer support (3 of 3) Remember you are not responsible for making it better Be clear on what you can offer; follow through on commitments Be aware that culture, religion and family background will affect people’s grief process Learn to recognize grieving difficulties

Grief only becomes a tolerable and creative experience when love enables it to be shared with someone who really understands Simon Stephens