1. Exploring loss and grief and supporting the family
Anne Tomkins

2. ‘How people die remains in the memory of people who live’
Cecily Saunders:
‘How people die remains in the memory of people who live’

3. 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.”

4. Pioneering Theorists:
Freud
Bowlby
Worden
Kubler-Ross
Murray-Parkes
Stroebe
Tonkins
Silverman
Walter
Stedman

5. Lois Tonkin Growing around grief

6. Stroebe: dual process model
Everyday life experience
Loss experience
Restoriation orientated
Positive meaning
Revised goals
Positive event reconstruction

7. Averil Stedeford’s Diagram of Grief Work

8. Averil Stedeford’s Diagram of Grief Work

9. Averil Stedeford’s Diagram of Grief Work

10. Averil Stedeford’s Diagram of Grief Work

11. Averil Stedeford’s Diagram of Grief Work

12. Averil Stedeford’s Diagram of Grief Work

13. 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

14. 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

15. 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

16. 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?

17. 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

18. 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?

19. 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

20. 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