• 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
    • mirror-imaging
    • 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

  1. Hand out paper with “LOSS” in the centre
  2. 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
  3. In small groups define loss
  4. Compare definitions and how they were arrived at

Feelings associated with loss

  1. What is a feeling?
  2. 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…alienatedself pity…lonely…vulnerable…anxiousinsecure…relief…disorientated…panicdistress…unloved…burdened…hurtimpotent…guilty…tearful…freedommisunderstood…disbelief…grief…unwantedredundant…helpless…shocked…powerlesssad…release…apprehensive…painhopeless…tired…worthless…revengefulnumb…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.

    Take a label and read it out

  1. What is your immediate personal reaction to the character you have been given
  2. The reaction other people could have to this person
  3. Discuss and share experiences of this group of characters
  4. 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
  1. The advantages for the dying person to know they are dying
  2. The disadvantages for the dying person to know they are dying
  3. The advantages for the families to know the person is dying
  4. The disadvantages for the families to know the person is dying

Loss and health

Social readjustment scale Holmes and Rahe 1968
  1. Hand out group copy of scale
  2. Rank events from 1-100(100 is most important)
  3. In pairs, compare top 5
  4. Compare with Rahe scale – why do the differences occur?


  1. Remember a time when you felt you were listened to what was good about it?
  2. Remember a time when you felt you weren’t listened to what were the reasons for this?
  3. 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 the patient
  • No doctor in attendance
  • Accident, operation or anaesthetic contributed to the death
  • Violent death
  • Doubtful stillbirth
Sure of the cause of death, a certificate issued, but inform coroners 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



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