Bereavement

Initially Shock and disbelief
Stage 1 Denial and isolation
Stage 2
- Anger where does it come from?
- dealing with grievances
- sharing feelings
- guilt
Stage 3 Bargaining
Stage 4
- Depression
- Growing awareness
Stage 5 Acceptance
- talking
- crying
- loneliness
- hope
- anniversaries
- permission to stop grieving

The family

communication with family

coping with reality > conflict
preparatory grief
health beliefs and expectations
children
guilt

The doctor

personal experience
collusion of anonymity >
- purposeful
- accidental
to tell or not to tell

talking about dying

Sharing feelings

Techniques
- reflection
- mirrorimaging
- paraphrasing
Confidentiality
Respect
Understanding
Sympathy
Empathy

Keys to good listening

Warmth and caring
Empathy
Nonjudgemental acceptance
Respect
Genuineness
Limit your own talking
Clarifying
Summarising
Use open-ended questions
Don't interrupt
Turn off your own fears, worries and problems
Listen for FEELINGS
Don't assume or jump to conclusions
Listen for what is NOT said
Concentrate and focus your attention

How to help someone who is suffering from loss

DO...
- be available to listen let your genuine concern and caring show
- say you are sorry about what happened and about their pain
- allow them to express the unhappiness they are willing to share
- encourage them to be patient and not expect too much of themselves
- allow them to talk about their loss as much as they want to
- talk about the special endearing qualities of their loss
- reassure them that they did everything they could
DON'T...
- let your own sense of helplessness prevent you from reaching out
- avoid them because you are uncomfortable
- say you know how they feel
- say "you ought to be feeling better by now"
- tell them what they should feel or do
- change the subject when they mention their loss
- avoid mentioning their loss from fear of reminding them
- try to find something positive
- point out at least they have their other...
- say they can always have another...
- suggest they should be grateful for...
- make comments which suggests the loss was their fault

Death and the family

Statistics for Britain (1984 OPCS) In Britain there are

3,200,000 widows
750,000 widowers
180,000 children under 16 who have lost a parent through death

1 woman in 7 is a widow
1 man in 28 is a widower
1 woman in 2 over 65 is a widow
1 man in 6 over 65 is a widower

Every day

500 wives become widows
120 husbands become widowers

Introducing loss

Hand out paper with "LOSS" in the centre
Ask group to write out random types of loss they can think of eg:
- starting school
- new brother/sister
- moving home
- change of school
- grandparent dies
- parents separate
- changing teacher
- changing friends
- losing job
- failing exams
- choosing academic options
- leaving school/university
- broken leg
In small groups define loss
Compare definitions and how they were arrived at

Feelings associated with loss

What is a feeling?
Imagine you have lost something SPECIFIC that is important to you.
- Close your eyes.
- Ask them where they keep it and imagine going to look for it.
- Tell them it is gone, and let them be aware of the loss.
- Open your eyes how do you feel about the loss?
- Imagine it is half an hour later, and you have still not found it
- How do you feel now?
- Have you told anyone?
- Why not?

bewildered...dazed...denial...alienated
self pity...lonely...vulnerable...anxious
insecure...relief...disorientated...panic
distress...unloved...burdened...hurt
impotent...guilty...tearful...freedom
misunderstood...disbelief...grief...unwanted
redundant...helpless...shocked...powerless
sad...release...apprehensive...pain
hopeless...tired...worthless...revengeful
numb...fear...unhappy...gratitude

How others feel

Loss can affect us all in different ways: Purpose of exercise is to think how other would feel in a certain situation.

What is your immediate personal reaction to the character you have been given
The reaction other people could have to this person
Discuss and share experiences of this group of characters
Debrief

The labels

Unemployed young person
Redundant person of 45
A rape victim
A single parent with teenage children
A disabled telephonist
Boy with Downs syndrome
Widowed person of 35
Gay person with AIDS
Senior citizen
Homeless person
Unmarried mother
Black policeman

How can we help?

98% of people wanted to know they were dying
60% of doctors did not want to tell them
80% of people knew anyway

List:

The advantages for the dying person to know they are dying
The disadvantages for the dying person to know they are dying
The advantages for the families to know the person is dying
The disadvantages for the families to know the person is dying

Loss and health

Social readjustment scale Holmes and Rahe 1968

Hand out group copy of scale
Rank events from 1-100(100 is most important)
In pairs, compare top 5
Compare with Rahe scale - why do the differences occur?

Listening

Remember a time when you felt you were listened to what was good about it?
Remember a time when you felt you weren't listened to what were the reasons for this?
What is listening anyway? (wanting to hear)

Social readjustment scale

Social readjustment scale - questions
Social readjustment scale - answers

What to do when someone dies

Report to Coroner if:

14 days after attending patient
No doctor in attendance
Accident, operation or anaesthetic contributed to death
Violent death
Doubtful stillbirth

Sure of cause of death, certificate issued, but inform Coroner anyway (and indicate box A) if:

Death from industrial disease
Death from poisoning or drugs (including alcohol)
Suicide
Abortion (except natural miscarriage)
Death where care is being criticised
Death in custody or in prison
Death of a child in a foster home
Death of a service pensioner
Death associated with medical treatment
Death where neglect has played a large part

IF IN DOUBT RING CORONER