Hospice 101 Phases Of Grief Nov 3 2006


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  • Questions to students: Has anyone ever heard of Hospice; What is it?; What comes to mind when you hear the word Hospice? Brief hx of PCCHNS and service area Goals: to give broad overview
  • Is NOT: euthanasia; a religion; a place (necessarily) Involves the concept of a team Began in Middle Ages; Cicely Saunders-St Christopher’s House; US movement late 70s
  • In old medical model; physician is at the center, dictating to the patient. Family is on the side. Hierarchical, isolating. In this model, it is a series of cocentric circles: with the patient in the center of it all, then the family; then the dr; then the team. Collaborative; relational.
  • Care includes family and patient (use a story): Counselors to work with children, special bed, massage may be helpful, social workers for family members……TELL A STORY about a “typical” case.
  • Biggest Question: Giving up Biggest problem: Late referrals Elaborate on points (ending of chemo etc.) Want last monts/years to be spent with family. Doesn’t have to be six months but some people in program for years. (Normal Course of illness)
  • Can include musicians, massage therapists, physical therapist; Volunteer is a requirement of medicare; 5% of staff Not required to use all these services; but most do use them
  • Discuss DNR; Ask Class if they know what a DNR form is?
  • Has anyone ever had to have a difficult conversation with a family member? Sometimes it’s easier to talk with friends but what family?
  • Assume nothing!!! “ He doesn’t know…she doesn’t know” Cues always taken from the patient
  • This speaks directly to issue of “giving up”! What is it the person is hoping for? Terminal illness does NOT mean there is “nothing more we can do”
  • Palliative Care as new field of medicine; There is often much that can be done; but is not curative. Again, have to take it out of trad. Medical model; expand notion of what can be “done.”
  • Class 1: Nicole leads activity of worksheet Class 2: Brian to lead M&M experience
  • Edward Pashke “Nervosa” Attempt to suppress traumatic feelings due to their intensity Resurface on anniversaries or special occasions Has anyone experienced this and comfortable to share? You get the phone call?
  • Often teens retreat to activities that formally were pleasurable in order to avoid the intensity of their loss. Although this is a normal reaction, at it may be helpful for a professional counselor to clarify if this is a self-protecting measure vs. ongoing denial of the loss.
  • For Example: stomach pains, changes in eating, nervousness, sleep disturbances. This may also be an attempt to relate to the person who was ill. Story: Working with teenager with headaches, resolved in couple of week after processing. Have any of you ever been so stressed you felt sick?
  • Earlier stage regressions represents retreating to a time before the loss as a sense of safety.
  • Note: It’s important that children/teens are not made to be “the man/woman of the house” because a feeling of responsibility for the family can develop.
  • Maintenance of routines (going to school, sporting events, etc.) can help to alleviate some symptoms of disorganization. “Who is going to take care of me Now?” Panic can make it difficult to handle even basic tasks.
  • Key is to help the griever find safe ways to express these intense emotions (journaling, hitting a pillow, etc.)
  • Other feelings: unloved or suffering low self-esteem
  • Salvador Dali Who?: May be intensified when surviving caregiver is struggling with grief Fatalistic: May die in the same manner as the deceased Brian’s South Suburbs case example to illustrate
  • Salvador Dali Changes: appetite, disruptive sleep patterns, prolonged withdraw, nervousness, low self esteem, lack of interest in self or others Most intense when recognize loved one is not returning. Risky behaviors may be become associated with coping at this stage (promiscuity, drug use, etc.)
  • Teens: May focus on a fight they had, poor attitude with deceased, not enough time spent, etc.
  • Picasso
  • Hospice 101 Phases Of Grief Nov 3 2006

    1. 1. HOSPICE 101 Midwest Palliative & Hospice CareCenter 2050 Claire Ct., Glenview, IL 60025 847-467-7423
    2. 2. Presenters <ul><li>Midwest Palliative & Hospice CareCenter </li></ul><ul><li>Families with Children Counselors </li></ul>
    3. 3. What is Hospice? <ul><li>A special way of caring for people with life limiting illness. </li></ul>
    4. 4. GOALS OF HOSPICE <ul><li>Comfort and quality of life as defined by the patient. </li></ul><ul><li>Support for the family as the primary unit of care. </li></ul>
    5. 5. WHERE ARE PATIENTS CARED FOR ? <ul><li>At home </li></ul><ul><li>Independent or Assisted Living facility </li></ul><ul><li>Long Term Care or Skilled Care Facility </li></ul><ul><li>Hospital </li></ul><ul><li>Hospice Inpatient Unit </li></ul>
    6. 6. ELIGIBILITY <ul><li>Patients who desire to end curative phase of treatment </li></ul><ul><li>Patients who want to be kept as physically, emotionally and spiritually comfortable as possible. </li></ul><ul><li>Patients whose doctors certify that they have a prognosis of 6 months or less </li></ul>
    7. 7. THE HOSPICE TEAM <ul><li>Patient </li></ul><ul><li>Patient’s family </li></ul><ul><li>Primary physician </li></ul><ul><li>Hospice physician </li></ul><ul><li>Nurses </li></ul><ul><li>Chaplains </li></ul><ul><li>Social workers </li></ul><ul><li>Nursing Assistants </li></ul><ul><li>Volunteer </li></ul><ul><li>Others as needed by plan of care </li></ul>
    8. 8. COMMON QUESTIONS <ul><li>Can I change my mind? </li></ul><ul><li>Nutrition, hydration, CPR </li></ul><ul><li>“Giving Up” </li></ul><ul><li>For cancer patients only </li></ul>
    10. 10. <ul><li>ASK YOUR LOVED ONE WHAT S/HE THINKS IS HAPPENING. </li></ul>
    11. 11. <ul><li>WHAT ARE YOUR LOVED ONE’S GOALS? </li></ul><ul><li>WHAT IT IS S/HE REALLY WANTS? </li></ul>
    13. 13. BEREAVEMENT <ul><li>Telephone Contact </li></ul><ul><li>Memorial Services </li></ul><ul><li>Support Groups </li></ul><ul><li>Individual Counseling </li></ul><ul><li>Referral </li></ul>
    14. 14. RESOURCES <ul><li>National Palliative Care & Hospice Organization </li></ul><ul><li>800.658.8898 </li></ul><ul><li>www.nhpco.org </li></ul><ul><li>www.Medicare.com </li></ul>
    15. 15. Personal Loss Activity
    16. 16. Phases of Grief
    17. 17. Helping Children Cope with Grief <ul><li>Author: Alan Wolfelt, Ph.D </li></ul><ul><li>13 Dimensions </li></ul>
    18. 18. Shock/Denial/Disbelief/Numbness <ul><li>Most intense 6-8 weeks after death </li></ul><ul><li>Can resurface over time </li></ul>
    19. 19. Lack of Feelings <ul><li>Appear unaffected by death </li></ul><ul><li>Continue with age appropriate activities to avoid intense emotions </li></ul>
    20. 20. Physiological Changes <ul><li>Grief may be expressed through physical symptoms </li></ul><ul><li>Symptoms are usually temporary and normal </li></ul>
    21. 21. Regression <ul><li>Occurs when previously mastered tasks are no longer completed </li></ul><ul><li>Can represent need for protection and security </li></ul><ul><li>If ongoing, may need therapeutic intervention </li></ul>
    22. 22. “ Big Man”/”Big Woman” Syndrome <ul><li>Opposite of regression </li></ul><ul><li>Take on adult roles </li></ul><ul><li>Can be an attempt to replace the deceased </li></ul>
    23. 23. Disorganization and Panic <ul><li>Feeling of being overwhelmed and anxious </li></ul><ul><li>Manifestations </li></ul><ul><ul><li>Restlessness </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Inability to concentrate </li></ul></ul><ul><li>Routines are important </li></ul>
    24. 24. Explosive Emotions <ul><li>Feelings </li></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Hatred </li></ul></ul><ul><ul><li>Terror </li></ul></ul><ul><li>Directed at anyone or anything </li></ul><ul><li>Enjoyable events lose their appeal </li></ul><ul><li>Important to validate feelings of pain, frustration and hurt </li></ul>
    25. 25. Acting-Out Behavior <ul><li>Result of Explosive Emotions </li></ul><ul><li>May be associated with feelings of abandonment </li></ul>
    26. 26. Fear <ul><li>“ Who will take care of me?” </li></ul><ul><li>Fear of own death </li></ul><ul><li>Fatalistic View </li></ul><ul><li>Consistency is important </li></ul>
    27. 27. Relief <ul><li>Natural expression after witnessing prolonged illness </li></ul><ul><li>Difficult to admit </li></ul><ul><li>Associated with guilt </li></ul>
    28. 28. Loss/Emptiness/Sadness <ul><li>Most difficult emotions </li></ul><ul><li>May demonstrate physiological changes </li></ul>
    29. 29. Guilt and Self-Blame <ul><li>May assume responsibility of death </li></ul><ul><li>“If only I had done something differently” </li></ul>
    30. 30. Reconciliation <ul><li>Grief no longer overwhelms daily functioning </li></ul><ul><li>Begin to feel hope and anticipation for the future </li></ul>
    31. 31. Questions