Compassion Fatigue and the Clinician. Bereavement- a state of sorrow (robbed) Grief- Emotional...
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- Compassion Fatigue and the Clinician
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- Bereavement- a state of sorrow (robbed) Grief- Emotional response to loss Mourning- Process of Adaptation Basic Terms of Loss, Grief and Mourning
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- Normal Complicated Anticipatory Disenfranchised Four types of grief to consider
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- Emotionalcognitivephysicalbehavioral Normal grief is expressed in predictable ways.
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- Anticipated grief begins before loss When a terminal diagnosis is given Family support Back and forth between support & daily activities Family difficulties Impaired family coping skills Life threatening illness may trigger anticipatory grief.
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- 40 yo father & 39 yo mother, 6 yo daughter one year ago pt diagnosed with rare bone cancer 6 month prognosis Three other children 4, 10 & 13 yo Husband lost job due to downsizing, mother provides only income & benefits for family Frequent hospitalizations Recently, chose hospice care for 6 yo Husband primary caregiver at home Anticipatory grief case
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- What are some possible signs of anticipatory grief? Possible losses facing the family Possible problems? Questions
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- State of being Severe Yearning for diseased Stuck In constant protest Complicated grief may look like
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- Suddenness of death Untimely death-child, adolescent Suicides Ambiguity-questioning occurrence A sense of causing death-driver of a car involved in wreck Complicating Factors relating to the death itself
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- Unresolved losses earlier in life Predisposed to depression Need for the approval of others Unable to form relationships with others Unable to form new lifestyle apart from lost person Complicating factors relating to survivors psychological state
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- Extreme identification with dead Ambivalent feelings toward dead Intensely close relationship with deceased Continued reliance on life patterns with deceased Complicating factors relating to relationship with lost person
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- Inability of survivor to accept intense feelings Lack of ability by family to legitimize feelings Lack of access to usual rituals that would help to manage grief Excessive drug use Extreme isolation Complicating factors relating to inability to express feelings
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- 35 yo white female, RN mother of two children 8 & 10 yo. Now, an inpatient at a drug and alcohol and drug rehab unit Pts mother died in 3/9/11 and father died 3/2/12 Pt consciously represses emotions She feels helpless in terms of expressing emotions Complicated grief case
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- Pt admits that her father had heart trouble & his death came suddenly Expressed that she felt that she caused his death She was aware of illness but never forced him to seek medical care She had time to prepare for mothers death, but due to chemical dependency avoided emotions. Complicated Case continued
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- A loss that can not be openly acknowledged, socially sanctioned, or publicly shared. Ex-spouses Ex-partners Fiancs Lovers, mistresses, Mothers of miscarried babies What is disenfranchised grief?
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- Tasks of Mourning Tasks of Mourning (Worden, 2009& Wolfelt 2006) Acknowledging the reality of the loss Processing the pain of the grief To remember the person who died To develop a new self-identity To find meaning in the midst of embarking on a new life
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- Death anxiety- pre-occupation or awareness of personal loss. Defenses and behaviors: Evading emotionally sensitive conversations Speaking only when spoken to about uncomfortable topics Distancing, avoidance and withdraw Cumulative loss and the clinician.
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- The unexamined life is not worth living! Socrates Personal comfort with death is affected by, personality, culture, social and spiritual belief systems. Explore, experience and express feelings regarding death Discuss beliefs systems about death/afterlife with friends, peers, pastoral care workers Self awareness is Key.
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- Succession of losses Pts and residents living with life-threatening disease What is cumulative loss?
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- Professional training Personal history Life Changes Support systems Some factors influencing adaptation
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- Express emotions appropriately Attend to pts and families with inter-personal and compassionate care Verbalize feelings to begin to process loss and grief Professional Training helps to
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- Our personal experiences with death effect how we deal with dying pts/residents Personal life changes Triggers (people or situations) We bring a Personal Death History & Life Changes.
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- Things to do: Prior to encounter To prepare for interaction During interaction If you are experiencing negative emotions during encounter Listen rather than speak Validate by naming pts emotion Name your emotions as long as not diverting attention from pt. If not sure question If you are feeling overwhelmed, its ok to excuse yourself Afterwards talk through the experience Strategies to manage negative emotional triggers.
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- Patti, the pediatric care professional, has a twenty year history of providing care in the acute care setting. Recently, Pattis mother died and she sent her son to college. Normally, Patti has an active social life however, due caring for her mother during her long illness and sending a child to college, she has neglected her relationships. In addition, Patti enjoyed singing folk music with a local group but dropped out when her personal responsibilities began to encroach on her life. Professionally, Pattis palliative care team has experienced an increased volume of elderly patients actively dying. Cumulative Loss: A case study
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- Case managers are advocating for discharge and families are extremely emotional with unexpected end of life conversations. The team has also received consults for several difficult cases referred to palliative care for end of life discussions. After a family meeting with the parents of a 10 yo to discuss removing the patient from life support, Patti found herself crying with a colleague when discussing the case. Normally, Patti can hold things together but recently she notices that she is worrying more and more about patients when at home. She is unable to sleep and has taken to the liquor cabinet to calm her nerves. Case Study Continued
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- Discussion Questions: What are some potential issues the team may face? What should a team members do to help other members of the team?? Questions
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- Debrief emotional events Reach out to colleagues Seek out or strengthen relationship with mentor Write about your work for larger audience Psychosocial rounds with colleagues to explore issues Positive adaptive responses.
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- Name a difficult case when feeling the emotion. Are you able to talk about a difficult case? Is there a place to go to talk? How can your team provide support?
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- Pre-planned gatherings Debriefing sessions Memorial services for pts/residents who have died Formal Support systems
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- Co-workers Pastoral care or spiritual support Supervisors Physicians Informal support systems to process loss
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- Clinicians have a right to seek support systems to cope with death anxiety, loss and grief Ask for help Journal writing Exercise Relaxation Friends Hobbies and play Self Care for palliative care clinician
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- Persistent feelings of exhaustion, anger, worthlessness, hopelessness or anxiety interfering with work, eating disorders, acting out and changes in interpersonal relationships Self-prescribing sedative medication Substance abuse Persistent disturbances: nightmares, difficulty staying asleep Loss of professional boundaries. Indicators of triggers that might need professional help.
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- Questions? Ed Lewis, M.Div., MPM Bereavement & Spiritual Support Coordinator Palliative and Support Care Institute- UPMC Passavant 412-297-6865 firstname.lastname@example.org