Exploring loss and grief and supporting the family Anne Tomkins
‘How people die remains in the memory of people who live’ Cecily Saunders: ‘How people die remains in the memory of people who live’
John Bowlby: “The loss of a loved person is one of the most intensely painful experiences any human being can suffer. Not only is it painful to experience, but it is also painful to witness, if only because we are so impotent to help.”
Pioneering Theorists: Freud Bowlby Worden Kubler-Ross Murray-Parkes Stroebe Tonkins Silverman Walter Stedman
Lois Tonkin Growing around grief
Stroebe: dual process model Everyday life experience Loss experience Restoriation orientated Positive meaning Revised goals Positive event reconstruction
Averil Stedeford’s Diagram of Grief Work
Averil Stedeford’s Diagram of Grief Work
Averil Stedeford’s Diagram of Grief Work
Averil Stedeford’s Diagram of Grief Work
Averil Stedeford’s Diagram of Grief Work
Averil Stedeford’s Diagram of Grief Work
The Grief Wheel Loss Shock Life Function Reorganization Protest Much more fluid than moving from stage to stage Also please reinforce GRIEF IS NATURAL AND SO IS HOW WE GRIEVE. Not everybody needs support Disorganization
Grief Cycle Theories? Kublor Ross – 5 Stages C M Parkes – 4 Stages Denial – Anger – Bargaining – Depression – Acceptance C M Parkes – 4 Stages Numbness – Yearning – Disorganisation & Despair – Re-organised Behaviour
Predicting how well a family will cope. Positive: Cohesive family Supportive family Flexible approach Open communication within family Open communication with staff and volunteers Good record with stress Negative: Over involved family Unconnected family Rigid approach Closed communication within family Closed communication with staff and volunteers Poor record with stress Concurrent stresses
Many families facing adversity will be resourceful and not do it by the book! Break into 2 groups Choose 1 family that you can remember and anonomyse What were there coping strategies How did they make you feel and behave?
The role of the professional To provide education & information To increase knowledge & understanding To promote open communication within the family unit To respond to the individual needs of the patient & family To carry out a risk assessment & plan appropriate support now & in the future
Open ended questions: What’s the worst thing at the moment? What worries you most about the illness? What do you want most from your partner/family? What is helping you most at the moment? What else do you need to know about your illness / treatment? Do you have questions about where things are likely to go from here?
Memory Box and Life Story Work Is offered to all patients and their families A special place to keep mementoes Life story work can create a lasting tribute to the person who has died A memory box can be left for children to remember their loved ones Can be completed individually or with help from Family Support Workers May be started in a pre-bereavement setting and followed through with family - post bereavement
References: Faull, Carter & Woof.(1998) Handbook of Palliative Care. Oxford. Blackwell Science. Hall & Kirshling (1990) A Conceptual Framework for Caring for Families of Hospice Patients. In: Family-based Palliative Care. (ed.J.Kirschling) New York. Haworth Houghton P. (2001) On Death, Dying and not Dying. Kingsley Publishers. Sheldon.F. (1997) Psychosocial Palliative Care. Cheltenham. Stanley Thornes Publishers. World Health Organisation 1990