Grief Bereavement in SNF

Grief and Bereavement in a Skilled Nursing Facility:: 

Grief and Bereavement in a Skilled Nursing Facility: Professional and Personal Considerations

Introduction and Overview: 

Introduction and Overview Grief is an inevitable experience of working in a Skilled Nursing Facility (SNF) Professional considerations entail working with the grief of patients and their families Personal considerations entail acknowledging and working through one’s own grief reactions Honoring the boundaries between your professional role and personal feelings of loss

What is Grief?: 

What is Grief? The normal constellations of reactions and experiences humans have to a loss Comprised of emotional, physical, mental, psychological, and spiritual components Common threads, but also individualized Varies in intensity, duration, character Similar traits to depression, but not clinical depression

Emotional Aspects of Grief: 

Emotional Aspects of Grief Most common facet of grief Sadness: from simple regret to intense sadness Anger: more common than imagined Guilt: the “would’ves, should’ves, could’ves” Relief: often unexpected Normal: only a setting on the dryer

Physical Aspects of Grief: 

Physical Aspects of Grief Tightness of chest/diaphragm Muscle constriction and tension Loss or increase in appetite Disturbance of sleep patterns Fatigue, unusually tired

Psychological/Cognitive Aspects of Grief: 

Psychological/Cognitive Aspects of Grief Disorientation/confusion Forgetfulness Like living in a fog Hallucinations: visual, auditory, presence of loved one Normal: only a setting on the dryer

Spiritual Aspects of Grief: 

Spiritual Aspects of Grief Anger at God or the world Despair, hopelessness, not wanting to live Thoughts of suicide Feeling betrayed by cultural norms or expectations Crisis of faith or renewal of faith Normal: just a setting on the dryer

Grief vs. Depression: 

Grief vs. Depression Grief: a reaction to a known experience (death of a loved one) or patient Depression: reason for reaction/status unknown Many similarities; Diagnostic and Statistical Manual IV Complicated or prolonged grief Grief as a trigger for prior mental disorders

Grief in Children: 

Grief in Children Stage of development impacts perception of death and hence grieving Younger children view the world in more literal terms Full conceptual grasp of death not attained until adolescence Death re-experienced through developmental stages as child matures

Circumstances that Impact Grieving : 

Circumstances that Impact Grieving Nature of death: traumatic or result of chronic illness; unexpected or expected Age of deceased: premature or elderly Age of survivor Relationship with loved one; duration and intensity Multiple roles of deceased-spouse, best friend, confidant

Circumstances that Impact Grieving: 

Circumstances that Impact Grieving Disease dynamics: cancer, dementia, COPD Patient verbal or non-verbal Length of stay in SNF Other recent deaths of loved ones Perceived treatment by medical profession Amount of support by others

Chronic Illness/Expected Deaths: 

Chronic Illness/Expected Deaths Chance to anticipate death and say “good-bye” Prolonged illness can cause stress/exhaustion Variety of care giving issues Chance to review life and relive experiences Majority of deaths in America Patient having lived a full rich life (or not)

Traumatic/Sudden Deaths: 

Traumatic/Sudden Deaths Emotional bonds are suddenly broken, thus initial grief reaction may be more intense and last longer than an anticipated death Often survivor could not say “good-bye” Dwelling on circumstances and how they could have been avoided; a “preventable” death Ongoing legal or other social issues

Death Due to Life-Style: 

Death Due to Life-Style Tobacco products related deaths Alcohol or other drug abuse Feelings of guilt, sense death could have been avoided Anger of survivors toward patient’s choices

Premature Deaths: 

Premature Deaths A death that is untimely, that occurred before is should have according to cultural norms An “out-of-order” death Parents losing children most common situation Entails loss of expected future of the relationship and all that entails Parents may feel they have failed as protectors

“Disenfranchised” Grief: 

“Disenfranchised” Grief Term applied to deaths when cultural norms won’t allow or support grief Prenatal or perinatal: was “only” a baby with whom you didn’t have a relationship Can always have more children Death of pets Trivializes and marginalizes genuine grief

Gender Differences?: 

Gender Differences? Conventional wisdom assumes males and females have different grieving styles Not supported by research Females-supposedly more emotional and reach out to others Males-supposedly turn inward, don’t express emotions, keep busy to avoid feelings Treat grief on an individualized basis

The Orphaned Adult: 

The Orphaned Adult Term used by adults, often in mid 40’s, who have finally lost both parents due to death Many Americans may not experience the death of someone close until they are adults Removes the parental overlay of life Survivors now aware they are the generation out front; no protective generation “above” them

Societal Expectations: 

Societal Expectations People and society will want you to get over it and move on People will avoid you because of awkwardness People don’t know what to say Family members will want the “old you” back American culture, in general, does not support loss and death Three-day bereavement leave

The Grieving “Process”: 

The Grieving “Process” Experiencing grief is not going through clearly defined stages to reach a state of closure. One may experience any number of grief’s characteristics at any time and in any combination. Over time, the facets of grief are felt less often and with less intensity There is no such thing as a nice tidy “closure”

The Grieving “Process”: 

The Grieving “Process” People often report more intense feelings six months or so after a death Legal and medical matters that took time are accomplished Social support may have decreased Daily reality of loss sinking in Emotions are no longer numbed by the death

DABDA and other Theories: 

DABDA and other Theories Many theories about the stages, steps, or process of grieving Little empirical research to support them Elizabeth Kubler -Ross On Death and Dying landmark publication DABDA: Denial, Anger, Bargaining, Depression, Acceptance Popularized in media (incorrectly) as stages of grieving

Will I Ever “Get Over” It?: 

Will I Ever “Get Over” It? No. But you can get through it The loss of a loved on is a life-changing event Our humanity yearns for life to return to the way it was, even though our intellect knows this is impossible. Healing from grief is in part adjusting to a new permanent reality, as painful as that may be

Triggers: 

Triggers Triggers are those aspect of life that cause us to experience our loss with a renewed intensity despite the passage of time Anniversaries: one year after death, weddings Holidays Places and people Music and other shared experiences

Helping Someone Who is Grieving: 

Helping Someone Who is Grieving The gift of your caring non-anxious presence Simply be there and listen A closed mouth gathers no foot Avoid clichés and platitudes “I know how you feel” “He/she is in a better place” “It must have been God’s will” “I’m so sorry”

Helping Someone Who is Grieving: 

Helping Someone Who is Grieving Be aware, especially among family members, that each person will grieve in their own way Honor and respect the differences Each person related to the deceased in a different way Avoid “competitive grieving”: my grief is worse than yours

Creating a Peaceful Place: 

Creating a Peaceful Place Make sure the patient’s room is calm, dignified, and quiet Limit the number of visitors in the room at any one time Include the patient in all conversations; don’t talk as if they weren’t there Close the door, if necessary, to limit noise from the hallway

Creating a Peaceful Place: 

Creating a Peaceful Place Don’t ask the patient questions; make statements that don’t require thinking about a response Talk about the patient’s life and your experiences with them; honor and affirm what the patient has done Be natural; humor and laughter can be just as healthy as sadness and tears

Self Care: 

Self Care Grief is too exhausting and difficult to do 24/7 Lean into your grief as deeply and as often as you can, then lean back for a rest Don’t intentionally isolate yourself Get a massage Do whatever you can to re-create Learn about grief and how it works through your life

Self-Care: 

Self-Care Learn what your own “triggers” are Find or create rituals that replenish you Plan to do something that heals on those anniversaries and special days Make use of services like those at hospice Be aware that personal grief may “spill over” into your care for patients and their families

Hospice Individual Grief Services: 

Hospice Individual Grief Services For family members, up to 12 months of free bereavement counseling if deceased on hospice Family includes all those people who were close to the deceased, to include helping professionals For non-hospice family members, two free individual counseling sessions

Hospice Support Groups: 

Hospice Support Groups Four groups, all open to the public on a drop-in basis General support group Women’s support group Men’s support group Suicide support group Numerous support groups in the public schools