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Grief

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on 17 November 2014

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Transcript of Grief

The 5 Stages of Loss and Grief
In PARENTS
As NURSES
Loss & Grief

Sadness
Sleep issues
Loss of appetite
Body aches w/o obvious physical causes
Regression
Irritability
Issues with concentration
Denial or preoccupation
Guilt
Challenges

Death is a taboo topic in our society
A child’s grief is often overlooked
Child’s grieving process differs from an adult’s, may be difficult to identify
Grief can be misunderstood or mistaken for children misbehaving or being inappropriate

Manifestations of Grief in Children
Child’s developmental age changes
how they view death:

2-4 years
: Egocentrism. Death is viewed as not permanent
4-7 years
: Death is still viewed as reversible. Child may have feelings of responsibility and guilt
7-11 years
: understanding permanence but wish death was reversible. May view death as punishment
11-18 years
: abstract thinking is developed, view death in an adult-like way

Case Study II
Richard*, 39 Years Old. Lost his mother to cancer at age 16.

Felt that there was no one to talk to once the funeral was over
His father, while dealing with his own grief was shut off from his children and became a heavy drinker
All the adults in Richard's life acted as though nothing had happened, this included relatives and teachers
It wasn't until attending York University that he was set up with a grief councilor and was able to move through the stages of grief for the first time
Question:
What other challenges
may caretakers have
when dealing with a
grieving child?
Tasks of Grief
Experience pain associated with the death
Accept permanence of death
Remember the deceased
Convert relationship to memory
Incorporate aspects of deceased into self
Form new relationships
Reestablish developmental projectory

Unaddressed grief can cause
behavioral, physical, cognitive and emotional difficulties that will continue into adulthood

Therapeutic Interventions
Normative information
Personal story telling
Question answering
Art therapy
Reminiscence
Journal writing
Letter writing
Play
Bibliotherapy
Music therapy

Question:

What Can Nurses Do?
What Can Nurses Do?
Educate the child’s caretakers
Access to resources
Refer to grief counseling
Patterns of Grief
(1) Denial and Isolation
First Reaction
Defense Mechanism
(2) Anger
Directed at inanimate objects, friends, family
(3) Bargaining
What IFs
Line of Defense
(4) Depression
Sadness
Feelings of regret
(5) Acceptance
Different from depression
Withdrawal and sadness
Grieving process depends on:
Age
Gender
Personality
Relationship to Deceased
Support from Others
Grieving process differs with age

Adults
Period of numbness that lasts hours to days
Second phase is anxiety
Appetite is lost
Weight is lost
Short term memory is diminished
Older adults may suffer major losses within short period of time such as financial security, his or her best friend, social contacts
Diff between diff losses: child, spouse, friend, family
In CHILDREN
Fathers manifested mental disturbances, suicidal thoughts, attempts or actual suicide
Fathers experienced increased risk of mortality from unnatural causes in the first few years post-loss
Reported more heavy alcohol ingestion within the first 2.5 years post-loss
Some mothers felt fathers coped better with loss as they returned to work earlier leaving some mothers to feel abandoned
Mothers reported more anxiety and depression than fathers
Mothers reported more PTSD symptoms than fathers
Mothers faced an increased risk for both natural and unnatural deaths and a slightly increased cancer risks
Patterns of Grief

Expressed a positive outlook on life and described having learned from their experience
Able to control where and when they grieved such that their daily activities were not impaired


Completely consumed and overwhelmed by their painful loss and the memories of their deceased child to the point that functioning on a daily basis seemed to be compromised
Uncontrollable, severe grief reactions and inability to foresee a future without severe pain
Feelings of emptiness and lack of fulfillment
Unable to positively reframe their experiences of loss
Continued to struggle with accepting their child’s death
Minimal Grief
Difficulties expressing emotional pain associated with the loss of the child, seemed to either avoid, inhibit expressing grief or minimize it, restricted range of affect
Appeared to try to carry on with their daily routine as if nothing had changed
Scheduled their days with multiple activities
Expressed their concerns about others’ feelings of grief and how others were coping emotionally with the loss
Integrated Grief
Consuming Grief
Case Study I
Carlos*, age 34. Lost his friend in an accident at age 10.
Realized for the first times that adults did not have all the answers or know how to react
Felt as if there was not anyone around to talk to, and that teachers treated him as though nothing had happened
Felt the grief of this loss for a decade
Felt like this loss contributed to his "outsider status" and not fitting in throughout school

Case Study III
Melody*, age 39. Had a baby born still at age 20.
The baby died in utero, and hoping her body would go into labour naturally the doctors treating Melody had her carry the baby for a week before induction.
The nurses were incredibly supportive during her delivery, taking the baby's footprints, doing his measurements, and treating him like a "real baby" even though he would not be going home
Once home people did not know how to treat or speak to her, often just ignoring the fact that she had been pregnant at all
Remembers the baby on his birthday every year and involves her other children in this process
Nurses Experience Grief Too
With loss of patients, both expected and unexpected
The loss of a bond that was developed with the child
The inability to achieve one's professional goals of curing or saving a child
The loss of one's assumptions about death, since childhood death is perceived as reversing the order of nature
The emergence of a previous traumatic loss
The imagined loss of a loved one
reminder to appreciate what you have
Burnout and Job Dissatisfaction
Burnout is defined as the frustration, loss of interest, decreased productivity, and fatigue caused by overwork and prolonged stress
Darla (2009) reported that given the moral and ethical distress, personal pain, and lack of support experienced by pediatric palliative care nurses, employee turnover rates were very high
“In one large children's hospital, average length of employment for nurses was 2 to 3 years in the neonatal intensive care unit (NICU), 3 to 7 years in the pediatric intensive care unit (PICU), and 2 to 5 years in the oncology ward”
References
Question:

Have you developed any tools to deal with loss? If interested in peds how do you feel you'll deal with the loss of a child?
*name has been changed
*name has been changed
*name has been changed
“Patterns of parental bereavement following the loss of a child and related factors”:
-Collaboration between researchers from Sick Kids, Princess Margaret, and U of T

-20 parents (13 mothers and 7 fathers) from the Critical Care and Hematology/Oncology units of a large pediatric hospital

-3 bereavement patterns: 13 (65%) presented Integrated Grief (uncomplicated), 5 mothers (25%) were Consumed by Grief (complicated), and one father and mother from separate families(10%) expressed Minimal Grief


Papadatou (1997) proposed model for loss and grief which involves coping mechanisms for HCP experiencing the loss of a patient
Interview Question: Papadatou states that HCP alternate between periods of dealing with grief and avoiding it, as a means of not becoming completely consumed by the situation while also not becoming overly detached. Do you agree with this stance or would you say that this delays the grieving process unnecessarily?
Response: "I can honestly say that that was never my experience. I don’t think that pediatric nurses by nature are detached people. So I don’t think that that theory applied to my lived experiences".

Dealing with Grief Experienced by Parents

Interview Question: How would you try and comfort parents after they experienced the death of a child?
Response: “I think you just do everything you can to support them, to give them their privacy. Right after the death, certainly the nurses would leave the room and allow the parents their time if that’s what they wanted. I found for the most part parents didn’t want to be left by themselves so there were nurses there [in the room]. If they wanted to assist in washing the body we’d allow them to do it. Sometimes parents would want to see their child again in the morgue, and there was a viewing space where they could do that”.
Darla (2009) reported that nurses found that there were not adequate resources for nurses in comforting grieving parents

Coping Mechanisms for Loss & Grief

Babies and toddlers
• Don’t have an understanding of death
• Can experience loss and separation
• Can understand people’s anxiety around them

Preschoolers
• Think death is reversible

Primary School Children
• Starting to first learn about death so a little confused
• Explaining death to this age group is very important

Older Children
• At this age they know that death is irreversible
• They might feel strong emotional reactions such as guilt and anger

Teenagers
• May engage in behaviours such as sexual contact, drinking and drugs
• Want to be around friends more than family to seek support

Older Adults
• More likely to lose more than one friend or family member within a short period of time
• Long term physical or mental illness can make the grieving process more difficult

A Nursing Perspective on Loss and Grief
Question:

What other challenges may caretakers have when dealing with a grieving child?
In Children, Parents, and Nurses
Full transcript