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GRIEF AND LOSS

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GRIEF AND LOSS A Healing Culture for All Staff – PowerPoint PPT presentation

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Title: GRIEF AND LOSS


1
GRIEF AND LOSS
A Healing Culture
for All Staff
2
Goals
  • Raise awareness and understanding of loss and
    grief and the healing that can be achieved in a
    supportive environment.
  • How can we support the healing process

3
Background
  • More individuals with I/DD are experiencing the
    deaths of parents, siblings and peers.
  • Staff serving individuals with I/DD may have long
    term relationships with individuals who age and
    die.

4
Background
  • Grieving not well recognized
  • In the past often thought incapable of grieving
  • Recent bereavement associated more psychiatric
    problems and problem behaviors
  • Grief of staff who lose clients is not well
    recognized or discussed
  • (Dowd, Dowling, Hollins, 2005).

5
Contemporary View of Grief
  • With the proper supports, individuals with
    disabilities can live fulfilling and relatively
    independent lives.
  • They can handle painful experiences and master
    abstract concepts of death and loss.
  • Experiencing and remembering are comforting and
    life-enhancing

6
Loss, Mourning, Grief Bereavement
  • Loss is when you are deprived of someone or
    something of value
  • Mourning is the outward, social expression of
    loss
  • Grief is the emotional response to lossor
    potential loss
  • Bereavement includes grief and mourning
  • Adapted ELNEC, 2005

7
Myths About Grief
  • Myth 1 We only grieve deaths. Reality We grieve
    all losses.
  • Myth 2 Only family members grieve. Reality All
    who are attached grieve.
  • Myth 3 Grief is an emotional reaction. Reality
    Grief is manifested in many ways. 
  • Myth 4 Individuals should leave grieving at
    home. Reality We cannot control where we grieve.
  • Myth 5 We slowly and predictably recover from
    grief. Reality Grief is an uneven process, a
    roller coaster with no timeline.
  • Myth 6 Grieving means letting go of the person
    who died. Reality We never fully detach from
    those who have died.
  • Myth 7 Grief finally ends. Reality Over time
    most people learn to live with loss.
  • Myth 8 Grievers are best left alone. Reality
    Grievers need opportunities to share their
    memories and grief, and to receive support.
  • Hospice Foundation of America

8
Reality of Grief
  • Grief is a natural and normal response to a loss
  • The loss may have already occurred or may be
    anticipated
  • Responses are emotional, cognitive, physical,
    social and spiritual
  • Intense feelings and emotions are normal

9
Grief reactions related to
  • Chronologic age
  • Developmental stage
  • Cognitive level
  • Socialization
  • Culture
  • Past experiences
  • Relationships between individual, family members,
    caregivers, health professionals
  • ELNEC, 2005

10
Coping with Grief Means
  • Understanding and making sense of a loss
  • Identifying expressing feelings and emotions
  • Remembering the persons life
  • Continuing on
  • Adapted Hill, M. Drawn together.
    www.DrawnTogether.com

11
Grief can be
  • Normal
  • Complicated
  • Disenfranchised
  • ELNEC, 2005

12
Normal grief
  • Whats normal but
  • Can include
  • disbelief
  • anger
  • guilt
  • sadness
  • preoccupation with the death
  • Sleep loss or excessive sleep
  • Weight loss or gain

13
Stages of Grief
  • Notification and shock
  • Experience the loss
  • Reintegration
  • Stages of adaptation (Harper)
  • Intellectualization
  • Emotional survival
  • Depression
  • Emotional arrival
  • Deep compassion
  • ELNEC, 2005

14
Grief Responses
  • Emotional
  • Cognitive
  • Physical
  • Social (Behavioral)
  • Spiritual

15
Emotional Responses
  • Panic
  • Anxiety
  • Depression
  • Frustration
  • Anger
  • Blaming of others
  • Hopelessness

16
Cognitive Responses
  • Difficulty concentrating
  • Forgetfulness
  • Loss of skills
  • Disorganization
  • Memory Problems
  • Focused on loss/feeling life is not real

17
Physical Reactions
  • Appetite Changes (up or down)
  • Changes in Sleep Patterns
  • Illness/Pain symptoms
  • upset stomach, headaches, aches, numbness
  • Inactivity/Hyperactivity
  • Repetitive Motions
  • Frightening Dreams

18
Social Responses
  • Separating from others
  • Anxiety and fear what is going to happen next
  • Aggression
  • Change in performance at work, school
  • Over protective

19
Spiritual Responses
  • Questioning and challenging faith
  • Feeling the presence of the deceased
  • Visiting with the deceased
  • Fragility of life is realized

20
Grief
  • Experience loss at various times in their lives
  • Separation from or death of a loved one
  • Moving away from families one home to another
  • Separation from or death of a roommate or staff
    member
  • Isolation from family, friends, community
  • Limited independence dependent on others
  • Most experience multiple losses in their lives
  • Many experience unresolved grief (multiple losses
    spanning years)
  • Increased risk of long lasting or complicated
    grief

21
Disenfranchised Grief
  • Grief is not socially recognized
  • The loss is not recognized
  • Griever not recognized as someone who can or
    should grieve
  • Circumstances of the death may lead to stigma
  • Sheltered from upsetting events
  • No education on the life cycle
  • Not informed or involved during illness, death,
    life changes
  • Excluded from rituals
  • Individuals with I/DD and caregivers (health
    care, home aides, homemakers, etc.) recognized as
    experiencing disenfranchised grief
  • Harvey (2004)

22
Complicated grief
  • Long period of time
  • Significantly interferes with life activities
  • Intense symptoms (ex suicidal thoughts or acts).
  • Factors include
  • Suddenness or circumstances of the death
  • Gender of mourner
  • Relationship to the deceased
  • Previous psychiatric history or substance abuse
  • (http//www.cancer.gov/cancertopics/pdq/supportive
    care/bereavement)

23
Grief and I/DD
  • Complicated and disenfranchised grief may be
    present because
  • Grief not recognized
  • Poor sense of time loss experienced over and
    over
  • Few relationships
  • Ability to intellectualize the grief
  • Ability to express emotions

24
Personal Exploration
  • 1. Describe the very first loss you experienced.
  • 2. Were you able to share your concerns about
    your loss?
  • 3. What is your greatest fear concerning loss?
  • 4. How do you respond to others who are
    experiencing loss?
  • 5. What is a good helping relationship?
  • 6. What is your greatest asset that you bring
    into a helping relationship?

Husar Bereavement Care
25
Staff Roles
NorthPointe has three levels of grief support
  • 1. All Staff
  • Completed Grief Loss A Healing Culture
  • 2. Grief Support Facilitators
  • Completed Grief Loss Moving through the
    Grieving Process
  • Completed Enhancing Community Based Options for
    End of Life Care
  • 3. Grief Therapist
  • Licensed Psychologist, LCSW, LPHA

26
All Staff Role
  • Offer support
  • Listen
  • Direct and honest
  • Notice changes verbal and non-verbal
  • Know when to ask for help

27
Grief Support Facilitator Role
  • Shares information regarding loss or death
  • Assists in making arrangements
  • Brings the team together
  • Supports the grieving process
  • Notices changes verbal and non-verbal
  • Engages community supports
  • Knows when to ask for help

28
Grief Therapist Role
  • Provide therapeutic counseling
  • Stress reduction
  • Coping
  • Acceptance
  • Revinvestment of energy
  • Works with the team
  • Provides suggestions for the team
  • Supports caregivers

29
Supportive Actions
  • Be honest, include, involve
  • Listen, Be There
  • Respect photos and other mementos
  • Minimize change
  • Avoid assessment
  • Support the observance of anniversaries
  • LISTEN, LISTEN, LISTEN
  • OBSERVE, OBSERVE, OBSERVE

Managing Grief Better People with Intellectual
Disabilities, Sheilla Hollins
30
Communication
  • Be direct and honest
  • Communicate in a private place
  • Repeat the message
  • Dont be afraid to set limits on time and place
  • Be supportive

31
What to Say
Avoid
Words to use
  • died
  • death
  • passed on
  • long sleep
  • pushing up daisies
  • kicked the bucket
  • went to sleep and died
  • went to the hospital and died

32
Listening Skills
  • Listening to someone who is crying is difficult,
    but important
  • Calm down someone who is hysterical
  • Dont change the subject or distract the griever
  • Dont give advice or quiz for details

Husar Bereavement Care
33
Listening Skills
  • Listen for content AND the feelings underneath
    the content
  • Pay attention to non-verbal communication
  • Relax, be yourself
  • Tolerate silence

Husar Bereavement Care
34
Listening Responses
  • Nod, smile, intermittent eye contact
  • Pause
  • Casual Remark -I see Uh huh
  • Echo- repeating back the last few words

Husar Bereavement Care
35
Listening Responses
  • Clarify- asking for more information
  • Paraphrase- summarizing what you heard
  • Interpret the speakers ideas within context

Husar Bereavement Care
36
Support Structures Complex Needs/Limited
Communication System
  • Environment based strategies
  • Security
  • Stability
  • Comfort
  • Routine
  • Continuity
  • Relaxation Support
  • Sensory Activities

Coping with Grief and Loss, Scope 2007
37
Organizational Support
  • DSP Training
  • Grief and Loss A Healing Culture
  • Individuals We Support
  • The Life Cycle Workshops
  • Remembrance Workshops (for individuals and staff)
  • Dr. Sue Radtke
  • A Day of Remembrance for residents and staff
    celebrating lives
  • At Killian Center (following loss)
  • At homes (following loss)

38
Supportive Actions
  • Be honest, include, involve
  • Listen, Be There
  • Respect photos and other mementos
  • Minimize change
  • Avoid assessment
  • Support the observance of anniversaries
  • LISTEN, LISTEN, LISTEN
  • OBSERVE, OBSERVE, OBSERVE

Managing Grief Better People with Intellectual
Disabilities, Sheilla Hollins
39
Supportive Activities
  • Memory Box
  • Few items of deceased are kept
  • Memory Book
  • Photos, Pictures of favorite things
  • Painting or collage
  • Tape of favorite songs
  • Poem or Song
  • Helps remember the person, but also provides
    comfort
  • Calendar
  • Upcoming events they can look forward to
  • Explore a new leisure activity

40
When to seek professional help
  • Excessive periods of crying
  • Frequent behavioral outbursts
  • Extreme change in behavior
  • Withdrawal or isolation for long periods
  • Lack of interest in activities previously enjoyed
  • Frequent nightmares/sleep disturbances
  • Frequent headaches/physical complaints
  • Fluctuation in weight
  • Apathy, numbness and general lack of interest in
    life
  • Negative thinking or lack of interest about the
    future

41
Grieving Process Resources Resource Room Library
  • Lessons In Death and Dying
  • Helping People with Developmental Disabilities
    Mourn
  • Enhancing Community Based Options for End of Life
    Care

42
QUESTIONS IDEAS
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