Loss Physical (loss of something tangible) Psychosocial: (loss of something symbolic or intangible) Two general categories of loss exist. Examples of physical loss: stolen car, house burns down, amputation. Examples of psychosocial loss: divorce, retirement, development of chronic illness.

Change: always constitutes loss Developmental change Normal change and growth Competency-based loss Any change necessarily involves loss. At the very least loss of the status quo. Developmental: occurs as we age (eyesight, muscular strength, skin turgor). Normal change and growth: having a baby, moving from dependency on parents). Competency: child leaving home, graduation, attainment of a desired goal).

Secondary loss A loss that coincides with or develops as a consequence of the initial loss. (examples: loss of income when spouse dies, loss of concept of self as healthy when serious illness occurs) Each of these secondary losses must be mourned as well as the initial loss.

Grief & Mourning Grief: the process of experiencing the psychological, behavioral, social, and physical reactions to the perception of loss. Mourning: the work of adapting and changing as a result of the loss

Grief Experienced in four major ways: psychologically, behaviorally, socially, physically A continuing development A natural reaction Expected with all types of loss Dependent upon the individual’s perception of the loss

Mourning Reacting to separation from the deceased Modification of roles, skills, identity Learning to live in a healthy way without the deceased

Myths & Misconceptions Grief declines steadily over time The mourner must put the loss out of mind Intensity and length of mourning are a testimony to love Grief involves only the loss of the person Mourning is complete in a year Time is a healer

Danger: don’t rigidly apply grief theory Commonalities exist Idiosyncratic variations occur It’s not a static state, but rather a process of many changes over time

Kubler-Ross’ Stages Denial Anger Bargaining Depression Acceptance

Why think about death? To give meaning to human existence To encourage productivity & enjoyment of life To prepare for ultimate acceptance of death

Ways to prepare: Be close to someone who is facing death with inner peace Plan financially Develop solid support Incorporate religious beliefs into life

How can we help??? Denial: support without reinforcing Stay physically present Offer regressive care (food, drink, safety)

How can we help??? Anger Provide anticipatory guidance Don’t take it personally Meet needs that precipitate anger

How can we help??? Bargaining Provide information for decision-making Offer resources and referrals

How can we help??? Despair Supportive listening Touch Avoid cliches Assess risk of harm to self

How can we help??? Acceptance Assist in planning Utilize cultural practices Allow expression of feelings Accept changes in feelings Support groups for patient & families

Hospice Care A philosophy of caring for the dying Curing vs. Caring Criteria for moving to hospice care

Helpful hints: Don’t ask whether I’m ‘over it’. I’ll never be ‘over it’. Don’t tell me he’s in a better place. He isn’t here. Don’t say “At least he isn’t suffering”. I wonder why he had to suffer at all. Don’t tell me you know how I feel unless you have had the same experience. Don’t tell me ‘God doesn’t make mistakes’; you mean God did this on purpose??? Don’t tell me ‘God doesn’t give more than we can handle’. I don’t feel like I am “handling” it.

Please just say: That you are sorry. That you miss him too, if you do. That you will listen.

As we learn to help: “Birds make great sky circles of their freedom. But how do they learn it? They learn by falling, and by falling they’re given wings.