1. Cherry BERNARDO-LAZARO, MD 12 February 2010 ASMPH YL6
GRIEF and BEREAVEMENT
Cherry BERNARDO-LAZARO, MD
12 February 2010
ASMPH YL6

2. DEATH

3. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

4. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

5. DEATH
Notifying family members about the death of a loved one is a difficult and stressful task.

6. NOTIFYING the FAMILY about a DEATH
Encourage the family to be present at the time of death if at all possible
When the family is expecting the death of one of its members, ask how they would prefer to be notified if they are not present

7. NOTIFYING the FAMILY about a DEATH
3. Notify the family immediately at the time of death
- With an expected death, call on the family as previously agreed
- With an unexpected death, ask the family as a whole to come to the hospital and discuss the events leading up to the death

8. NOTIFYING the FAMILY about a DEATH
4. Think about what you want to say before making the call: Many people remember the exact words spoken by whoever told them of the death
5. While being sympathetic and sensitive, avoid euphemisms: Use the words “death, dying and dead.”
6. Say, “You have my sympathy” rather than “I am sorry” which could be construed as an apology

9. NOTIFYING the FAMILY about a DEATH
7. Give the family the opportunity to view the body and say their goodbyes.
a. Arrange for the viewing to occur in a private room
b. Make sure the body has been cleaned and prepared
c. Offer to have a member of the healthcare team stay with the family
d. Allow them to remain with the deceased as long as they wished

10. NOTIFYING the FAMILY about a DEATH
8. Meet the family
a. Before or after the viewing to show concern and facilitate a healthy grieving process
b. Provide information about the cause of death: Solicit and answer any questions
c. Answer any questions about autopsy and organ donation
d. Use active listening skills: Expect expressions of intense emotions

11. NOTIFYING the FAMILY about a DEATH
8. Meet the family
e. Make yourself available as a support for the family: Offer to have follow-up meetings, either to discuss autopsy results or questions about the deceased that will likely arise in the future
f. Remind the family to call their funeral director
g. Encourage the family to include children, especially those older than 5 years, in the funeral and other family gatherings

12. NOTIFYING the FAMILY about a DEATH
9. With an unanticipated or traumatic death, consider making a home visit soon thereafter: With an anticipated death, send a sympathy card and/or attend the calling hours or funeral
10. With an anticipated death, telephone the family 1-2 weeks after the death to inquire about them, answer any questions, and encourage any necessary follow-up

13. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

14. DEFINITION OF TERMS
What is the difference between GRIEF and BEREAVEMENT?
GRIEF: internal feeling one experiences in reaction to a loss; refers to the loss of loved one through death
BEREAVEMENT: state of having experienced loss

15. DEFINITION OF TERMS MOURNING Outward expression of that loss
Usually involves culturally determined rituals that help the bereaved individuals make sense of the end of their loved one’s life & give structure to what can feel like a very confusing time
Examples?
Grief: INTERNAL: Mourning: EXTERNAL

16. GRIEF
Normal grieving is characterized by intellectual and emotional awareness of the loss and feelings of guilt, stress, pain, anger and hostility
Grief is typically a cyclical process in which all these feelings may be present at any time and, but certain feelings may dominate at different points in the cycle

17. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

18. STAGES OF GRIEF Shock or disbelief Denial Anger Bargaining Guilt
Depression
Acceptance/hope

19. STAGES OF GRIEF Difficulty believing what has happened
DENIAL
Wishing to make a deal with fate to gain more time with the one who was lost
BARGAINING

20. STAGES OF GRIEF Questioning the fairness of the loss
ANGER
Getting in touch with how very sad they are about losing their loved one
DEPRESSION

21. STAGES OF GRIEF
Feelings of regret about difficult aspects of the relationship with the deceased
GUILT
Numbness associated with initially receiving the news of the death of a loved one
SHOCK
Feeling of resolution to their grief and more ability to go on with their own life
ACCEPTANCE

22. PHASES OF GRIEF
ACUTE PHASE
SECOND PHASE
RESOLUTION PHASE

23. PHASES OF GRIEF ACUTE PHASE
Begins with the notification of death and is characterized by emotional shock
Typically lasts up to 2 weeks
Depression and somatic symptoms are common and persist into the SECOND PHASE

24. PHASES OF GRIEF SECOND PHASE
Characterized by rumination over memories of the deceased
During this phase, people may withdraw and become introverted as they may examine what recent death means for their own life
Typically takes from 3 to 6 months

25. PHASES OF GRIEF RESOLUTION PHASE
Somatic symptoms and preoccupation with the deceased lessen
Bereaved family members begin to plan for the future and participate again in activities that were an important part of their lives prior to the death
Punctuated by the anniversary of the loved one’s death

26. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

27. FACTORS influencing GRIEF
Survivor’s own physical and emotional health before the loss
The relationship between the bereaved and their family member or other loved one
Nature of the death

28. TYPES OF GRIEF
Anticipatory mourning
Sudden Loss
Complicated Grief

29. TYPES OF GRIEF ANTICIPATORY MOURNING
includes feelings of loss, concern for the dying person, balancing conflicting demands and preparing for death
natural process that enables the family more time to slowly prepare for the reality of the loss
People are often able to complete unfinished “business” with the dying person (for example, saying “good-bye,” “I love you,” or “I forgive you”).

30. TYPES OF GRIEF SUDDEN LOSS
experienced after a sudden, unexpected death
Sudden, unexpected loss may exceed the coping abilities of a person, which often results in feelings of being overwhelmed and/or unable to function
Even though one may be able to acknowledge that loss has occurred, the full impact of loss may take much longer to fully comprehend than in the case of an expected loss

31. TYPES OF GRIEF COMPLICATED GRIEF
times when grief does not progress as expected; the intensity and duration of grief is prolonged and dramatically interferes with a person’s ability to function
Symptoms of depression and anxiety may be prevalent and prolonged. Thoughts, feelings, behaviors and reactions may seem to persist over long periods of time with little change or improvement

32. PRIMARY CARE COUNSELING
With a traumatic death, schedule an office visit soon after the funeral.
With anticipated death, schedule an office visit within 1 month after the loss for interested family members to review the death and autopsy results.

33. PRIMARY CARE COUNSELING
Encourage family members to talk about the circumstances surrounding the death, recall memories, and openly discuss feelings of sadness, anger, and guilt. Give them permission to grieve.

34. PRIMARY CARE COUNSELING
Inquire about any significant changes in financial status. Settling an estate, the loss of income, and the lack of experience managing money can intensify grieving process.
Normalize signs of grieving (eg. Crying spells, lack of energy and preoccupation with the deceased).
Tell the family that normal or uncomplicated grief typically takes 1 year for active phase to resolve.

35. PRIMARY CARE COUNSELING
Avoid the use of psychotropic medications such as sedatives or hypnotics, except in unusual circumstances or when a family member is unable to sleep.
A sedated person at the funeral may not be able to participate or even remember this important time. Starting antidepressant, antianxiety or antipsychotic medications are typically NOT indicated during bereavement.

36. PRIMARY CARE COUNSELING
Monitor closely the medical status of the recently bereaved as research indicates that the bereaved are at higher risk of serious illness and death.
Encourage family members to come in for health evaluation at 6 months to assess any increased risk for illness or delayed difficulties with grieving.

37. PRIMARY CARE COUNSELING
Refer interested family members to community-based self-help support groups.
Monitor family members for signs of unresolved grief reaction. Refer is necessary.

38. SIGNS & SYMPTOMS of COMPLICATED/UNRESOLVED GRIEF
Prolonged, severe clinical depression
Prolonged social isolation, withdrawal, or alienation
Emotional numbing
An inability to cry
Talking as if the dead person were still alive
Persistent compulsive overactivity without a sense of loss

39. SIGNS & SYMPTOMS of COMPLICATED/UNRESOLVED GRIEF
Persistence of a variety of physical complaints
Profound identification with the decease and prolonged acquisition of symptoms belonging to the illness of that person
Extreme , persistent anger (may be directed at the clinician)

40. SIGNS & SYMPTOMS of COMPLICATED/UNRESOLVED GRIEF
Alcohol or drug abuse, persistent requests for sedative or narcotic medications
Marital or family problems
Work or school problems

41. COMPLICATED GRIEF
Prolonged and extreme reactions to grief are themselves dangerous and necessitate referral to a specialist.
Referral may be made for evaluation, bereavement counseling, psychiatric treatment or family therapy, as is appropriate.

42. SEATWORK
Have you experienced death of a loved one? If yes, who and how is he/she related to you?
How were you notified of the death?
What did you feel then?
How long did you grieve?
How did you cope with the loss?

43. How can people cope with Grief?
DUAL PROCESS MODEL
Endorses the bereavement process as a dynamic struggle between the pain of death of a loved one (loss-oriented) and recovery (restoration-oriented)
Recommends that bereaved individuals alternate between directly working on their loss (confrontation) and taking a break from that process when appropriate (avoidance).

44. OBJECTIVES Define grief and bereavement
Compare the phases/stages of grieving
Discuss the nature of grief
Discuss how to notify family members about the death of a loved one

45. CONTENT Definition of Terms Phases/Stages of grief
Factors influencing grief
Types of grief
Signs & symptoms of unresolved grief reaction
Notifying family members of a death

46. Please pass your seatwork.
Thank you.
Please pass your seatwork.