Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief...

33
Part A: Section A.2 1 Part A: Understanding Grief and Loss in Children and Their Families Understanding Grief and Loss in Children

Transcript of Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief...

Page 1: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Section A.2

1Part A: Understanding Grief and Loss in Children and Their Families

Understanding Grief and Loss in Children

Page 2: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Objectives

1.1 Describe the overarching process of grief and loss,

including:

a. ranges of grief reactions: denial, anger, bargaining, depression,

acceptance

b. difference between “normal” and “complicated” grief

1.2. Explain how the child’s concept of death develops

from toddlerhood through adolescence

Part A: Understanding Grief and Loss in Children and Their Families 2

Page 3: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Objectives (continued)

1.3. Demonstrate knowledge of the stages of acquisition of

information that occur in children with life threatening

illnesses, including:

a. What children understand and know as their disease

progresses.

b. How to assist children’s understanding in discussions of

medical information.

Part A: Understanding Grief and Loss in Children and Their Families 3

Page 4: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Term Definitions

o Grief: a normal process in response to loss

o Bereavement: the state of having suffered a loss

o Mourning: the public expression of grief

o Complicated grief: persistent separation distress lasting

more than 6 months and interfering with daily functioning

Part A: Understanding Grief and Loss in Children and Their Families 4

Page 5: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Components of Grief

o Denial: “This isn’t happening.”

o Anger: “It’s not fair!”

o Bargaining: “If I just behave better, things will be

different.”

o Depression: “Everything sucks, what’s the point?”

o Acceptance: “I miss Shaggy, but things will be okay.”

Part A: Understanding Grief and Loss in Children and Their Families 5

Page 6: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 6

Activity: Loss Exercise

Each participant takes 5 pieces of paper and writes down

something of personal value on each piece. (Can be a

person, pet, object, skill, opportunity, etc.) Then each

participant finds a partner. They then each take three pieces

of paper away from their partner.

Page 7: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Expressions of Childhood Grief

o Sadness

o Guilt

o Fear

o Numbness

o Withdrawal

o Disbelief

Part A: Understanding Grief and Loss in Children and Their Families 7

o Explosive emotions

o Regression

o Acting out behavior

o "Big Man” or "Big

Woman" Syndrome

o Physical symptom

Page 8: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Grief in Children

o How a child experiences grief will depend on their

developmental stage and personality

o Context of the relationship is also a key element

o Other important elements are

o Nature of the death

o Prior experiences with death or loss

o Availability of family/social support

o Behavior, attitudes and responsiveness of parents and other

support individuals in their environment

Part A: Understanding Grief and Loss in Children and Their Families 8

Page 9: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Pediatric Bereavement

o Children have several “tasks” to accomplish during

bereavement:

o Accepting the loss

o Experiencing the pain and other emotions associated with loss

o Adjusting to a new situation/environment

o Finding ways to memorialize/remember the individual

who is gone

Part A: Understanding Grief and Loss in Children and Their Families 9

Page 10: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Complicated Grief

o Invasive and debilitating grief symptoms lasting more

than 6-12 months

o Can include:

o Yearning for deceased

o Difficulty accepting death

o Inability to trust

o Excessive anger

o Intense loneliness

o Frequent pre-occupying thoughts about deceased

Part A: Understanding Grief and Loss in Children and Their Families 10

Page 11: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Complicated Grief Risk Factors

o Deep attachment to deceased person

o Child, spouse, parent, sibling

o Unexpected death

o Traumatic death

o Prior experience with traumatic loss

Part A: Understanding Grief and Loss in Children and Their Families 11

Page 12: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 12

Reflection

PBS “It’s my life” on “Dealing with Death” (6:39)

http://www.youtube.com/watch?v=WHUewQtLgNs&feature=r

elated

Page 13: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 13

Reflection

o What grief responses do the children identify in the video?

o What additional losses to the children identify?

o What coping mechanisms do the children identify?

Page 14: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Changing Face of Death

Part A: Understanding Grief and Loss in Children and Their Families 14

Before 1900s

• Intergenerational family units

• Limited effective medical interventions

• Common to experience births and deaths in the home

20th

Century

• Hospitals and medical technology advance

• Resuscitation (CPR) developed in 1960

2000s

• Emphasis on youth and health

• Death as a medical failure

• Death occurring in medical facilities > home

Page 15: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Adult Understanding of Death

o Irreversibility

o Death is permanent.

o Nonfunctionality

o All life-defining functions cease at the time of death.

o Universality

o All living things die, including self.

o Causality

o There are physical reasons someone dies.

Part A: Understanding Grief and Loss in Children and Their Families 15

Page 16: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Understanding of Death

Part A: Understanding Grief and Loss in Children and Their Families 16

Age Developmental Stage (Piaget)

Perception or Concern

Anticipated Response

< 2 years Sensorimotor Sense separation and the emotions of others

WithdrawalIrritability

2 – 6 years Preoperational Dead = “Not Alive”Death as Temporary

Wonder about what the dead “do”Magical thinking (I am the cause)

6 – 10 years Concrete operational

Morbid interest in deathOthers die I die

Exaggerated behavioral reactions to the idea of death and dead things

Adolescence Formal operational

Adult conceptsExistential implications

“But not me”Death as an adversary

Page 17: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 17

Reflection

PBS “Sesame Street” Big Bird learns about death

(Mr. Hooper dies) (4:33)

http://www.youtube.com/watch?v=9NjFbz6vGU8&feature=rel

ated

Page 18: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 18

Reflection

o Where is Big Bird in his developmental understanding

of death?

o How do the adults help support his understanding?

o How could you use this with parents or patients?

Page 19: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 19

Reflection

GENERATIONS; The Final Farewell, in a Child’s Eyes, in

New York Times October 29, 2006

Page 20: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 20

Reflection

o What are your personal experiences with talking about

death?

o What are your personal experiences being told about a

death?

o What are your fears around talking about death with

children?

Page 21: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 21

Activity

Role play explaining the death of a grandparent to a child

aged 3, 8, and 14 years old.

Page 22: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 22

Understanding of Death –

Impact of Experience

Page 23: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 1

o Child’s Information

o “It” is a serious illness

o Not all children will know the name of the disease

o Experience Required for Passage to This Stage

o Parents informed of the diagnosis

o Child’s Self-Concept at This Stage

o I was previously well but now I am seriously ill

Part A: Understanding Grief and Loss in Children and Their Families 23

Page 24: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 2

o Child’s Information

o The names of the drugs used in treatment, how they are given and

their side effects

o Experience Required for Passage to This Stage

o Parents informed the child is in remission

o Child is speaking to other children at clinic

o Child’s Self-Concept at This Stage

o I am seriously ill but I will get better

Part A: Understanding Grief and Loss in Children and Their Families 24

Page 25: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 3

o Child’s Information

o Purposes of procedures and treatments; relationship between

procedures and specific symptoms

o Experience Required for Passage to This Stage

o First relapse

o Child’s Self-Concept at This Stage

o I am always ill and I might not get better

Part A: Understanding Grief and Loss in Children and Their Families 25

Page 26: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 4

o Child’s Information

o Larger perspective of the disease as an endless series of

remissions and relapses

o Experience Required for Passage to This Stage

o Several remissions and relapses

o Child’s Self-Concept at This Stage

o I am always ill and will never get better

Part A: Understanding Grief and Loss in Children and Their Families 26

Page 27: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 5

o Child’s Information

o The disease is a series of remissions and relapses ending in death

o Experience Required for Passage to This Stage

o Child learns of the death of an ill peer

o Child’s Self-Concept at This Stage

o I am dying

Part A: Understanding Grief and Loss in Children and Their Families 27

Page 28: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 28

Reflection

o “My So-Called Lungs" from Hearing Voices: Radio Diaries

(21:13) http://www.radiodiaries.org/my-so-called-lungs

o "Living with Muscular Dystrophy" by Bryan Arnold (5:36)

https://www.youtube.com/watch?v=ZrPnmgs4rHM

o "My philosophy for a happy life" by Sam Burns (12:45)

https://www.youtube.com/watch?v=36m1o-tM05g

Watch one of the videos of a child describing their life with a

life-limiting disease

Page 29: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Part A: Understanding Grief and Loss in Children and Their Families 29

Reflection

Write a reflective essay or discuss with your group how

you perceive quality of life for a patient you have cared

for with a chronic or terminal illness.

Page 30: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Strategies to Assist the Child’s

Understanding of His/Her Illness

o Discover what the child understands about the illness

before beginning the conversation.

o Look beyond age and verbal presentations for an

indication of the child’s conception of illness and death.

o Answer what the child wants to know.

o Children want to know different things at different stages in their

illness.

Bluebond-Langer M. A Child’s View of Death. Current Pediatrics. 1994; 4: 253-57.

Part A: Understanding Grief and Loss in Children and Their Families 30

Page 31: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Strategies to Help the Child

Understand His/Her Illness

o Use terminology the child understands.

o Draw pictures

o Use diagrams

o Check the child’s understanding by asking the child to explain what you have said with statements like “Now if you were the doctor how would you explain this?”

o Once is not enough

o Don’t assume the child understands after one conversation.

o Be honest

o Do not tell a child anything you do not believe.

Bluebond-Langer M. A Child’s View of Death. Current Pediatrics. 1994; 4: 253-57.

Part A: Understanding Grief and Loss in Children and Their Families 31

Page 32: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Strategies to Assist the Child’s

Understanding of His/Her Illness

o Don’t necessarily try to correct a child’s distorted ideas

and magical feeling about his/her illness.

o These thoughts may serve a purpose in coping.

o It is unwise to break down such defenses unless you are sure

more desirable concepts will take their place.

o Try to understand the family’s emotional coping style.

o Family interaction and coping strategies have a large effect on a

child’s adjustment to illness.

Brewster, AB. “Chronically Ill Hospitalized Children’s Concepts of Their Illness.” Pediatrics.

1982; 69: 355-62.

Part A: Understanding Grief and Loss in Children and Their Families 32

Page 33: Understanding Grief and Loss in Children Grief and Loss in Children...Part A: Understanding Grief and Loss in Children and Their Families 14 Before 1900s • Intergenerational family

Talking to Ill Children About

Goals of Care

o What are you looking forward to most of all?

o Is there anything that is worrying you or making you feel

afraid?

o Is there anything about how you are feeling that is

making you feel worried or afraid?

Hurwitz CA, Duncan J, Wolfe J. Caring for the Child with Cancer at the Close of Life. JAMA.

2004; 292:2141-2149

Part A: Understanding Grief and Loss in Children and Their Families 33