1. Facilitator: Step 6 1

2. Review / Recap Step 5 workshop review Review of ‘To Do’ List Reflection discussions 2

3. Objectives Step 6 objectives: Identify necessary actions for care after death Offer practical support and information to families, significant others, colleagues and other individuals Recognise aspects of grief and bereavement Respect individual faiths and beliefs to address individual wishes Explore support mechanisms to protect self 3

4. Step 6 Care after death “ Good end of life care does not stop at the point of death. When someone dies all care workers need to follow good practice in the care of the body and in supporting those close to them.” The Route to Success in end of life care – achieving quality in domiciliary care 4

5. Care after death Group work: Consider issues surrounding care after death for: The individual Families and significant others Domiciliary Care Worker 5

6. Care after death considerations Religious, cultural, spiritual wishes Possessions Information Support (relatives / non-family members) Practical issues 6

7. Actions following a death Offer comfort, sensitivity, and privacy to those present If no-one present, contact: office/on-call, and next of kin Inform GP or out of hours service 7

8. Actions following a dea th Expected deaths: The doctor will attend to verify and certify the death (unless individual has not been reviewed in last 14 days) The doctor will provide a medical certificate of the cause of death plus information on how to register the death Funeral director may be contacted once the death has been verified After a death certificate has been issued, the death must be registered within 5 days 8

9. Actions following a death Unexpected death : (or if individual not seen by a doctor in last 14 days) Contact the GP / Out of Hours GP Unexpected deaths must be referred to the Police and the Coroner Coroner will allow certification and cause of death to be recorded, or decide on post mortem or inquest Coroner will decide when to release the body Registration of death cannot take place until investigations are complete 9

10. Grief Grief: D efined as a deep, intense sorrow or distress in response to loss " Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve." (Earl Grollman) 10

11. 5 stages of coping (Kubler-Ross) ANGER BARGAINING DEPRESSION ACCEPTANCE 11 DENIAL

12. Normal Grief Disbelief, shock, numbness Anger, guilt Sadness, tearfulness Preoccupation with the deceased Disturbed sleep, altered appetite Average 6 months but can take up to 12 months and be prompted at anniversaries 12

13. Abnormal grief Chronic grief: unable to find closure Delayed grief: extended process Exaggerated grief: intense reactions Sudden grief: Unexpected 13

14. Abnormal Grief (2) Suicidal thoughts Withdrawal from society Inability to function Hallucinations 14

15. Bereavement support GP Local bereavement groups CRUSE Family/friends 15

16. Carer support Paying respects (attending funeral) Ongoing contact with relatives Support from organisation Taking care of ones’ self – recognising loss 16

17. Objectives Step 6 objectives: Identify necessary actions for care after death Offer practical support and information to families, significant others, colleagues and other individuals Recognise aspects of grief and bereavement Respect individual faiths and beliefs to address individual wishes Explore support mechanisms to protect self 17

18. Onwards... ‘To Do’ List Reflective practice Evaluation of session Evaluation of programme 18