Lecture 6 - bereavement

• Grief after death is not a pathology

• Acute grief – somatization – breathing, nauzea, rumination, guilty feelings, irritability, loss of social support, meaning loss, anger against death loved one or staff of hospital/hospice

• It is a process/not state of mind

• Model/theory can help in education, understanding the process x it can also does not help sometimes

• denial (avoidance, confusion, shock,fear)

• anger (frustration, anxiety, irritation)

• depression (overwhelmed, helplessness, hostility, flight)

• bargaining (strugging to find meaning, reaching out to others, telling ones story)

• acceptance (exploring options, new plan in place, moving

  on)

• DADBA

• Today - a more dynamic view - Stroebe, Schut

- dual process of grief

• Loss orientation • Restoration-orientation

• This model does not say that grief will be cured/resolved, the grief of loss can return throughout life

- Pain - Accepting the loss

- Get used to the life without the death loved one

- Change the relationship to the death loved one (the relationship still exists)

- It deals with loss, the need to go through it

- Emotions, behavior and thinking

- Accepting that the world has changed

- Rest from grieving

- new plans

- New relationships, new identities

- It is difficult to navigate the world without the deceased

- Primarily practical and material tasks, transfer of resources and roles which the deceased held

• listen to client: is he/she more inclined to loss or restoration orientation —> personal, but also the difference in the time since the loss

• offering the other polarity, but not disparaging the chosen coping strategy

• oscillation is normal and healthy (Schwingungen)

• finding a time to grieve and a time to rest - ability to consciously manage it

• grieving is work and process, it needs a lot of energy

• loss orientation does not mean only emotionally oriented coping strategies and v.v.

  
  

• get stuckd - after about 6 months

• 10-20% of survivors

• ICD 11

  • intense feeling of separation pain

  • desire to be with the deceased, excessive preoppucation with the deceased, unwillingness to accept the fact of death, problems planning the future, symptoms of separation anxiety, homesickness, dealing with the circumstandes

  • + 6 of the other symtoms: shoch, bitterness, self blame, difficulty accepting the loss, difficulty recalling good memories, difficulty believing the death, desire to connect with the deceased

• identity disrupton

• emotional numbness as a result of the death

• intense emotional pain related to the death

• marked sense of disbelief

• avoidance of reminders

• difficulty engaging in ongoing life

• intense loneliness as a result of the death

• feeling life is meaningless because of the death

• Less education

•Depression, anxiety

• Poor physical health

• Maladaptie dependency

• Attachment - insecure

• n = 641 in RCT

• 70% of participants who received PGT were much improved

• 2 x as effective as gold standard treatment for depression

• Emotional reaction which occurs in family caregivers before the death of their loved ones

• Two components

- anticipatory grief which is oriented on the future and anticipated loses and second is illness-related grief which is oriented on the present and losses related to the progression of the illness

• The prevalence of anticipatory grief in family caregivers of persons with a life-limiting illness is 24.78 % (95% CI 19.04 % to 30.99 % (Kustanti et al., 2022)

• It is negatively associated with prolonged grief (risk factor)

• It needs support and normalization

• the client's family, the closest

• clients of the home - roommates, etc.

• staff of the home - was anyone with the deceased at the time of his death, did anyone talk to him about the death, was anyone close to him?

• Allow to say goodbye

• To be with them in a difficult situation - to take care of current affairs, to offer help

• Condolences, memorial letters

• Meeting of survivors

• Counseling, therapy

• Memory corner, parte

• Memorial meeting (as part of activities)

• Individual interviews with roommate, supportive psychological care

• Allowing attendance at a funeral

Do not forget!

• Debriefing

• Rituals

• Evaluation of care, highlighting the positive

• For demanding care – group, individual supervision

◻ Less verbal

◻ Anger

◻ Needs time to relax from grief

◻ More somatic experience

◻ Small children can be angry, behave badly

▪ Prolonged grief

◻ Self-harm

◻ Pasivity

◻ Avoidance social acitivities

Listen Be honest. You never lie to a child.

Answer the questions they ask. Even the hard ones.

Remember and talk about the person who died. Make the child's world safe for grieving.

Expect and allow a variety of emotions to be expressed.

Forget the "stages of grief“ (!)

Respect differences in grieving.

Get out the pencils, crayons, brushes and chalks Run! Jump! Play it!

Be an example of good grief.

Encourage children to eat and drink properly.

Give yourself a break.

Plan a family program together. Take care of yourself and your grief