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Grief in the NICU Identifying, Understanding and Helping Grieving Parents Kirsti A. Dyer MD, MS Physician · Professor Grief and Loss Expert HHC Perinatal Centers Meeting Jacobi Medical Center  March 31, 2009
Managing the Spectrum of Maternal Mental Health Issues from Conception through the Neonatal Experience HHC Conference Jacobi Medical Center Tuesday, March 31, 2009 Part of the © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Learning Objectives ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Presentation Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Background – Case Presentation ,[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Case Presentation - Quote ,[object Object],[object Object],[object Object],My own worst nightmare happened... I delivered a 26 week 1 day, 790 gm baby girl. Suddenly I felt the anguish I had only seen in others and I began to understand the depth of pain and the length of struggle parents live through. It was difficult to comprehend the overwhelming nature of this crisis...until I lived it.
Case Presentation - 1 ,[object Object],[object Object],[object Object]
Case Presentation - 2 ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Case Presentation - 3 ,[object Object],But what was the discharge state and condition her parents and two-year-old sister? © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Case Presentation – The Family ,[object Object],[object Object],[object Object]
Your Presenter – Dr. Kirsti A. Dyer ,[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Findings from Our NICU Experience ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Background – The NICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Image: My Girl.  http://www.sxc.hu/photo/194015 . Used with Permission. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
The Dream ,[object Object],[object Object],[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
The Reality ,[object Object],[object Object],[object Object],[object Object],Image: Bili Shades  http://www.flickr.com/photos/mattandjanet/635259621 . Creative Commons. 2.0 Campbell M. 2008. Birth Plans and Crashing Markets. InsideCatholic.com
NICU Admissions ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Giving Up Lost Dreams - Quote ,[object Object],[object Object],[object Object],Adjustment for the high-risk parent means making unacceptable losses acceptable...  Giving up lost dreams and accepting what we do have is simply necessary...  If we're going to resume living our lives  as a family with any joy.
NICU Hospitalizations are Stressful ,[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
A NICU Baby – Impact on the Family ,[object Object],[object Object],[object Object],[object Object]
The NICU View to the Providers ,[object Object],Image: NICU Machines.  http://www.flickr.com/photos/mattandjanet/623116535 . Creative Commons. 2.0 © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
The NICU View to the Parents ,[object Object],Image Source: Alien Incubator. http://www.flickr.com/photos/jurvetson/536728722. Creative Commons. 2.0 © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Parents are Frightened & Dreading ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dyer K. 2005. Identifying, Understanding and Working with Grieving Parents in the NICU, Part 1. Neonatal Network. 24 (3): 35 – 46. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Goals for This Presentation ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Understanding Loss and Grief ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Terms and Definitions - 1 ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Terms and Definitions - 2 ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
What is a Grief Response? ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
The Body’s Response to Grief ,[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Stages of Grief and Grieving - 1 ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Stages of Grief and Grieving - 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Tasks of Grief ,[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Key Facts About Grief ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Companioning the Grieving ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Companioning with Perinatal Loss ,[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
The Forgotten Grievers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Loss and Grief in the NICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Types of NICU Losses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Parent Response – Dr. Dyer ,[object Object],The inability to do anything, to contribute to my daughter’s care medically as a physician or emotionally as a mother to hold her hand and pacify her was indescribably frustrating.  How was I supposed to "turn off" my years of training as a physician-- being in the hospital, caring for patients and providing them comfort during a tormenting time? It was impossible.
Parent Response – Dianne Maroney ,[object Object],Imagine coming to visit him everyday, not as a nurse, but as a mom. During your time with him you wanted nothing more than to help him through the difficult periods, hold and dress him, change his diaper; but you were powerless.  Every single thing that happened to him mattered!  It mattered not only for the moment but for the future: his eyesight, his lung disease, his ability to walk…
Parent Response – Dianne Maroney ,[object Object],Image: All Hooked Up 1.  http://www.sxc.hu/photo/807052 . Royalty Free Use. This lack of control is very intimidating to parents and is often interpreted as failure. Dianne Maroney, R.N.
Acute Distress Response of Parents ,[object Object],[object Object],[object Object],[object Object],Hynan MT. 2001. Assisting the trembling hands that hold the tiny hands: Helping high-risk parents improve neonatal outcomes. Paper presented at the annual meeting of the National Perinatal Association, San Antonio, Texas.  http:// www.uwm.edu/People//hynan/SanA.htm . © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
NICU Parents – Stages of Adaptation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Meriter Hospital NICU Staff. Sick Newborn Health.   Emotional Support > Stages of Adaptation.  http:// www.meriter.com/living/sicknewborn/emotion/adaptation.htm
[object Object],[object Object],[object Object],[object Object],[object Object],The NICU Roller Coaster Ride Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Different Grief, Different Responses ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Intuitive or Instrumental Griever Image: Nothing is Hopeless.  http://www.flickr.com/photos/christinasnyder/1046786100 . Creative Commons 2.0 Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Intuitive (Emotional) Grievers ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Instrumental (Physical) Grievers ,[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Coping with Loss and Grief ,[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Parents learn a lot from their children about coping with life. Murial Spark Learning About Coping - Quote © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
TAKE CARE – Basics of Coping ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Helpful Strategies for NICU Parents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Coping Suggestions for Grievers Martin T. Doka K. 1999.  Men Don’t Cry, Women Do: Transcending Gender Stereotypes in Grief.  Routledge. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Grief Impacts Everyone ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Cultural Considerations of Grief - 1 ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Cultural Considerations of Grief - 2 ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Strategies to Aid NICU Parents ,[object Object],[object Object],[object Object],[object Object],[object Object],Image: Holding Hands.  http://www.sxc.hu/photo/207150 . Royalty Free Use. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Helpful Strategies from NICU Parents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Phrases to Use with NICU Parents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Despair vs. Anger Image Sources:  http://www.sxc.hu/photo/579286  and  http://www.sxc.hu/photo/114127  Royalty Free Use. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Managing Intense Emotions - 1 ,[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Managing Intense Emotions - 2 ,[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
When to Advise Seeking More Help ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Follow up - Aftercare ,[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Aftercare ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Who Does Aftercare? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Final Thoughts ,[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
For NICU Parents: Have Faith ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
A Definition of Faith ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Image: Hiking in the Fog.  http://www.sxc.hu/photo/35635 . Royalty Free Use. © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Finding or Making Meaning in Loss ,[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
[object Object],[object Object],Help Us Cope - Quote Image Source: Modified from Shattered Glass.  http://www.sxc.hu/photo/76749 . Royalty Free Use. Hynan M. Helping Parents Cope with a High-Risk Birth. Terror, Grief, Impotence, and Anger. Presentation.
For NICU Providers: Be Helpful ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Hope is Important - Quote ,[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Resources ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works
Thank You ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009.  Creative Commons 3.0  Attribution-Noncommercial-No Derivative Works

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Helping Grieving NICU Parents

  • 1. Grief in the NICU Identifying, Understanding and Helping Grieving Parents Kirsti A. Dyer MD, MS Physician · Professor Grief and Loss Expert HHC Perinatal Centers Meeting Jacobi Medical Center March 31, 2009
  • 2. Managing the Spectrum of Maternal Mental Health Issues from Conception through the Neonatal Experience HHC Conference Jacobi Medical Center Tuesday, March 31, 2009 Part of the © Kirsti A. Dyer MD, MS, FT. 2009. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works
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  • 45. Intuitive or Instrumental Griever Image: Nothing is Hopeless. http://www.flickr.com/photos/christinasnyder/1046786100 . Creative Commons 2.0 Image Source: Microsoft Clipart © Kirsti A. Dyer MD, MS, FT. 2009. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works
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  • 49. Parents learn a lot from their children about coping with life. Murial Spark Learning About Coping - Quote © Kirsti A. Dyer MD, MS, FT. 2009. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works
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  • 59. Despair vs. Anger Image Sources: http://www.sxc.hu/photo/579286 and http://www.sxc.hu/photo/114127 Royalty Free Use. © Kirsti A. Dyer MD, MS, FT. 2009. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works
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