Providing Ex Exce cellent and and Com ompassio ionate Car are to Our ur Clie lients, The heir Fam amili lies, Our ur Coworkers s an and Our urselves Du During the COVID – 19 19 Pan andemic. Eugene Dufour Hospice Palliative Care Consultant – Bereavement Specialist – Trauma Therapist Phone: 519-476-2116 Email: edufour@tcc.on.ca
Sess Sessio ion One ne: : Coping Wit ith Multi ultiple an and Com omplex Los Loss. s. – Working with complicated grief. – COVID – 19 and complicated grief – Coping with multiple losses. – Coping with traumatic grief. – Companioning Model of Grief. “ The human soul doesn’t want to be advised or fixed or saved. It simply wants to be witnessed….exactly as it is.” Parker Palmer
Focus of of the e Web ebinar Focus One : Provide the Health Care Worker an opportunity to debrief and defuse from the suffering that you have been experiencing. The webinars will help you identify “Pre -Post Traumatic Symptoms and helpful ways of coping with these reactions to long term suffering. Focus Two: Provide the Health Care Worker with added skills on how to support our clients, family members and our coworkers during this time of multiple and complicated losses. 3
"The reality is that you will grieve forever. You will not 'get over' the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to." Elisabeth Kubler-Ross
I In In cri crisis care re we live live wit ith th the para radox of of knowing th that I I am at t th the same ti time part of f a gre reat wound and part rt of of a gre reat hea ealing 5
COVID - 19 19 and nd Compli licated Gr Grie ief 1. 1. Isola solated from om lov oved one nes be before de death th. 2. 2. Not Not be being ph physic ically lly pr present dur durin ing the he last 48 48 ho hours. 3. 3. Inab nabili ility y to to pa partic icip ipate in n de death th be bed d ritu tuals ls. 4. 4. Wi Witn tnessin ing pe personal l su sufferin ing from om a di distan ance – he helple lessness. 5. 5. Restr train ins of f the he time = = loss of control l and nd ho hopelessness. 6. 6. Indiv ndivid idual, l, fam amil ily, cultu ultural, l, soc social ial and nd fait aith bo bound ritu tual als are ha hampered. 7. 7. Wi Witn tnessin ing ma mass su sufferin ing adds dds to to the he trau aumatic tic na natu ture. 8. 8. Grieving without “my people”.
Depression - Grief
Distinguishing Between Complicated Bereavement and Post-Traumatic Stress Disorder Some of the most common symptoms of each disorder include: Complicated Bereavement: • Persistent focus on the loss • Intense, daily longing • Feeling that life is meaningless • Replaying aspects of death in mind • Intense attachment or rejection of reminders • Bitterness and anger at the world Post-Traumatic Stress Disorder: • Intense flashbacks • Recurring nightmares • Sensory experiences that trigger trauma • Unwelcome thoughts • Paranoia and fear • Anxiety • Jumpiness
STUG A Sud udden Tem emporary ry Upsu psurge e of of Gr Grie ief f (STUG) ) is inten ense and nd un unexp xpec ected. Wha What t can you ou do do after r a STUG? Here are e a few sug ugges esti tions: s: 1. Identifying the experience for what it is and calling it by name can help you stay in charge, even when feeling out of control. 2. Remember that a STUG is a temporary, transitional experience. No one ever dies from a STUG, though many feel like the experience is deadly. The painful feelings will pass. 3. The most effective strategy in the presence of a STUG is to ride it out. Find a safe place, as private as possible, breathe deeply and lean into it. 4. Allow the pain until it passes. During a STUG, a person’s body goes on hyper - alert, releasing endorphins because of the fight-flight response manifest in the perception of danger.
STU TUG A Sudd udden Temp empor orary ary Upsu psurge e of Gr Grief (STU STUG) is inten ense se and nd une unexpected ed. What What can n you you do do after er a STU TUG? G? Her ere e are e a few ew sugges estion ons: s: 5. After the STUG passes, a body needs several hours to absorb the hormones and brain chemicals and return to baseline. 6. Sleep on it. The day following a STUG, cognitive capacities return to normal, allowing more thoughtful consideration of the meaning of what triggered the memory. 7. Take it as a matter of truth that the STUG signaled a reconsideration of a loving experience in the history of the relationship.
The psychological process of coping with a significant loss is called "grief work." Just as the body heals if certain conditions are met, so will the mind heal. A bodily wound will heal if: (1) the foreign material is cleaned out, (2) the edges of the wound are brought back together, and (3) the body is given the proper nutrients. The wound of psychosocial loss will also heal if: (1) unnecessary contaminants such as unreasonable guilt and resentment can be worked through; (2) the individual is prevented from feeling isolated and helped to feel connected to others and; (3) the person can be helped to tap into the psychological "nutrients" that come from helping others.
Th The e Six Six Ne Needs of of Mou ourning ng Durin During ou our r journ journey thr throu ough gri rief and and mo mour urni ning, we e al all enc encoun unter six nee needs we e mus must t mee meet if f we e ar are to o hea heal: 1. 1. Ac Ackn knowledge the the rea eality of of the the dea death. 2. 2. Emb Embrace the the pai pain of of the the loss. oss. 3. 3. Rem emember r the the per person n who who di died ed. 4. 4. De Develo lop a a ne new w self elf-id identit ity. 5. 5. Sea Search for or mea meaning. 6. 6. Rece eceive sup upport rt fr from om othe others. - Dr Dr. Al Alan Wol olfelt lt
- Dr. Alan Wolfelt
- Dr. Alan Wolfelt
Char arting ng: - Consider writing your note with your client. - Write your note as if your client and their insurance company will read it. - Describe, sleep, eating, energy level, concentration, emotions in each note. - If anti depressants make your client feel detached and can’t feel emotions or cry – explain that in note. - Document all the Assessment Scales that you use. - Use the term “Complicated Grief” - Educate in your note: Research states that the death of a loved one takes 2 to 3 years to adjust – 3 to 5 years for the death of a child.
Pres esence ▪ Courage of Presence – I can be with your pain without wanting to hide it, fade it or fix it. ▪ Compassion of Listening – bearing witness, validation. ▪ Humility of Helplessness – Your helplessness frees you to be present. ▪ Confidence of Trust – resiliency ▪ Belief in Hope ▪ Peace of Adequacy ▪ Freedom of Inadequacy ▪ Comfort of Companionship
We in the care partnering communities frequently encounter people with life threatening illness at a point when they are no longer who they have been and are not yet reborn into who they will be. We meet them in a place between “no longer” and “not yet” Joan Borysenko 31
NEW COVID-19 RESOURCES COVID-19 SPECIFIC CONVERSATION GUIDES: • Proactive Goals of Care (GOC) conversations • GOC conversations for a person with mild/mod COVID-19 • GOC conversation for a person with severe COVID-19 • Phone conversations with families of a dying person OTHER COVID RESOURCES: • Palliative symptom management suggested order set for LTC • Advance Care Planning guides for patients and SDM • Sample letter from LTC facilities to families and residents ALWAYS AVAILABLE: • Advance Care Planning, Goals of Care and Consent resources for healthcare providers (conversation guides, e-learning modules) • Person-Centred Decision-Making Toolkit https://www.hpco.ca/
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